Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Blue Kingfisher on April 25, 2022, 04:07:12 PM
-
I’ve been under two different clinics that use two different forms of testing. The one that uses blood tests says my oestrogen level is too low and the one that uses saliva says my oestrogen levels are too high.
My latest blood test shows my oestrogen is 105 (77-2400)
All I know is when I was on a higher level of oestrogen I had one good patch each month but on a lower dose I feel dreadful every day. This issue is complicated in that my thyroid medication has apparently been inadequate. I’m getting my thyroid dose changed but low thyroid symptoms will definitely have been playing in. Just wondered what people think about the different types of testing and also what you think of my oestrogen level? I’ve been on 2.5 pumps oestrogel daily for at least six months now.
Thanks for any responses.
-
Hi Blue Kingfisher
This article from zrt labs explains it.
https://www.zrtlab.com/sample-types/hormone-testing-for-different-supplementation-types/
I’d go by the saliva test as what I can’t get my head around with the blood spot testing is contamination of the fingers if you are applying topical without using some sort of applicator.
If anyone knows of such an applicator please let me know! X
-
Hi Marchlove,
My blood tests have always been done at a doctors surgery with a syringe blood draw, not a finger prick test. I guess looking at that link they suggest a finger prick test is more accurate which I haven’t done. I’d imagine most ladies go by the serum blood draw on this forum but I’m just guessing. I’d also imagine they are using these test results to alter their HRT dose. Doesn’t mean it’s the right thing to do but would be interested to hear what other people think. Ultimately I feel worse on a lower dose but it could solely be my thyroid. I am experiencing low oestrogen symptoms however such as flushing, night sweats, insomnia & anxiety. Ultimately I could try increasing by half a pump to see what happens over a period of time. Difficult to know what to do with such different opinions on testing!
-
Yes I expect most ladies will be going by serum testing which even the GP’s admit isn’t accurate.
I haven’t done blood spot testing because of the contamination issue which they don’t mention in the article, yet they do for troche/sublingual regarding saliva testing!
Yes could be thyroid related of course which estrogen impacts. x
-
I doubt whether a saliva test shows anything at all ..........
Blood tests for hormone levels are reliably unreliable too. My GPs 'go' on symptoms. As hormone levels rise and fall regularly blood would have to be taken at exactly the 'right' time to determine where oestrogen etc. might be.
How do you feel? When did you last have a full blood count, VitD level and thyroid function tests?
-
Hi CLKD,
I last had a full blood count about 3 weeks ago and all was fine apparently. I supplement vit D and my levels have been high rather than low. Full thyroid test done a while ago but getting another one soon once I’ve been on my new thyroid dose for 6 weeks.
I feel hot most of the time, fatigue, night sweats, flushing, low appetite, headaches, very low mood, jittery, brain fog.
I think I will try increasing the oestrogel by half a pump for a while and see if that helps.
-
Also, I’ve had no withdrawal bleed after stopping a high dose of progesterone (200mg for 21 days). I stopped the progesterone 2.5 weeks ago…….does this indicate low oestrogen I wonder? I was on two and a half pumps of oestrogel.
-
Hi Blue Kingfisher
I answered on your other thread about the lack of bleed.
I would ignore any results from saliva testing - which is not standardised and not carried out on NHS, so completely unreliable ( for oestrogen and progesterone etc) and go by the standard blood testing using blood drawn from a vein as carried out by your GP (or private doctor).
Having said that as CLKD says all blood tests are unreliable and variable and can only be a rough guide. Estradiol levels not only vary throughout the day (circadian rhythm) but from day to day, and also if you take hRT - will depend on when your last dose was and in the case of gel also which part of the body.
As CLFD also says best to go by symptoms, and in addition if you have underactive thyroid then this too will be having an effect - important to get this right first and then tweak your oestrogen dose. Any change in dose should be done gradually either increasing or reducing.
What symptoms do you still have that you feel are due to incorrect oestrogen dose? Sorry I can't remember if you are peri or postmeno and how old you are!
Hurdity x
-
Just because saliva testing is not standardised or carried out by the nhs does not mean it’s completely unreliable.
I expect the reason it is not carried out by the nhs us because it is more expensive and because they do not know how to interpret the results.
It begs the question what is the point of having standard blood tests if these are unreliable also, is this then a waste of nhs resources?!
-
Marchlove: as I stated above, hormone levels alter throughout 24/7, so to take a blood test it would need to be carried out at 'exactly' the correct time . If saliva tests were reliable they would be available on the NHS. I wonder which hormones are present in a 'spit test'?
Blue Kingfisher: you seem to be on top of your various tests, hopefully the thyroid function will come back within normal limits: however, this does not mean that the thyroid isn't 'upset'. Many GPs however won't request further testing even when patients complain of continuing symptoms relating to the thyroid.
Let us know how you get on with upping the dose, mayB every 3rd night initially?
-
I’m sorry but just because NHS doesn’t use it doesn’t mean it isn’t valid! Plenty of private doctors and labs use saliva testing for hormones. The NHS is completely hopeless with hormone issues so I wouldn’t use them as the benchmark, they are miles behind on thyroid issues.
I wouldn’t rely too much on testing if levels anyway, it’s something to use alongside symptoms which are a much better indicator.
Do not do blood prick when on HRT though. It’s contaminated by the creams etc on your hands, you need a blood draw or saliva but I have only used saliva for cortisol testing.
I would get your thyroid right first, then address your estrogen needs. I’m hypothyroid too.
-
Thank you everyone, I think we are all agreed that testing is unreliable and best to go by symptoms but for me I will be using blood tests by a doc as my ‘guide’. This is probably the best solution for me personally since I’ve kept a record over the years of my blood test results and how many pumps of oestrogel I was on at the time & I know how I felt at that time.
Thank you for the well wishes with my thyroid and yes, I’m trying to get that sorted as a priority but feeling now more confident that my oestrogen is currently a bit low. I’ll try upping by half a pump (maybe not every day) & see how I go.
Hurdity I’m 53, no idea if I’m not longer peri as I’ve been on HRT for a while now :-\
-
Read this thread with interest! I have found testing of my Estrogen to be absolutely critical in my meno journey as an indicator of where things are. I've always used venous tests from Medi checks and found the results to be very reliable. Never been convinced of the notion of your Estrogen level fluctuating massively during the day - doesn't fit with all the publications of how your hormones fluctuate regularly in a cycle and certainly hasn't been the case for me. I often wonder if that's a myth peddled by the NHS who don't want to do blood tests! You do have to test on roughly the same day in a cycle if you're still having one, in order to get a good comparison, but doing it that way has worked very well and very reliably for me.
Does anyone here know of somewhere you can compare the results from salvia tests to blood tests? I had two sets of salvia tests done back in 2018 pre Peri and I would desperately love to know what the equivalent results are in pmol blood test, but despite searching everywhere I can't seem to find a way to get a rough idea of comparison!
-
Gilla99 - You might find something in the footnotes of this article, but I haven’t read them to see x
-
Thanks Marchlove - I did have a good read (and googled till I'm blue in the face!) but can't seem to find an equivalent given anywhere.
I've had saliva, venous and finger prick blood tests done and never had a problem with reliability on any of them - the salvia rhythm tests (also DUTCH tests) were extremely useful as are the blood tests I have done, which have never fluctuated much outside of the normal pattern of your cycle, with thr exception of once when my estrogen plummeted and I needed to up my dose (the blood test confirmed why I was feeling so terrible). Blood tests have been so helpful for me, I'd be shooting in the dark without them
The only reliability problems I've ever had was from using a finger prick test once I started on HRT - even after wearing gloves for 2 weeks to put on Lenzetto (and you don't even touch the product like you do gel) I got a contaminated reading every time. So gave up with those in the end and stick to venous!
-
Ah, that’s confirmed it for me then regarding the contamination with blood spot, even with gloves on!
Yes the Dutch test is brilliant x
-
Read this thread with interest! I have found testing of my Estrogen to be absolutely critical in my meno journey as an indicator of where things are. I've always used venous tests from Medi checks and found the results to be very reliable. Never been convinced of the notion of your Estrogen level fluctuating massively during the day - doesn't fit with all the publications of how your hormones fluctuate regularly in a cycle and certainly hasn't been the case for me. I often wonder if that's a myth peddled by the NHS who don't want to do blood tests! You do have to test on roughly the same day in a cycle if you're still having one, in order to get a good comparison, but doing it that way has worked very well and very reliably for me.
I completely agree with this and have also found blood testing to be crucial for my HRT odyssey. No doubt in peri there is fluctuation but once our own hormones have pretty much packed it in and we're solely reliant on HRT for hormone intake, then in fact our intake and levels are likely to be pretty stable. I've been told not to take HRT for 24 hrs before testing and of course to test venously to avoid contamination and with those precautions have found blood levels reliable and stable (albeit reliably bad/low in my case!)
I am now seeing Panay on the NHS and he too is absolutely using and encouraging serum levels of hormones as a guide to what's going on hormonally - while also of course listening to what symptoms are.
-
Re discussion abut saliva tests and blood tests. This is a perennial issue (raised by some who use the private system for their healthcare, saliva tests being used notably by some practitioners not recommended by BMS).
Here is the lowdown:
It is well established that saliva testing is an inaccurate way of measuring sex hormone levels and not recommended by the menopause societies eg North American Menopause Society:
“Testing hormone levels is not required to determine whether a woman has the “right amount” of hormones. The optimal hormone levels in postmenopausal women have not been established. How symptoms respond to a particular dose of hormones or nonhormonal menopause medication is the only reliable guide.
Saliva testing is often a part of custom-compounded “bioidentical hormone therapy” with hormones. But saliva testing is not only unnecessary; it has also has also not been proven to be accurate or reliable. Because hormone levels vary day to day as well as throughout the day, even a blood test cannot accurately reflect the body’s hormone levels.
The common hormone test that may be appropriate is for the level of follicle-stimulating hormone (FSH) to help determine if a woman is in menopause, especially for women who do not have a uterus and thus cannot tell by their menstrual pattern that they are menopausal.
NAMS does not recommend saliva testing to determine hormone levels and does not recommend custom-compounded products over well-tested, government-approved products for the majority of women.”
https://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy/what-is-hormone-testing-
British Menopause Society
https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/
Hormone level testing
"Some HCPs who prescribe cBHRT claim to be able to determine the precise requirements of each individual woman through a series of complex serum and saliva tests. This costly practice has never been substantiated through rigorous research, it is not recommended by the menopause societies and it is largely unnecessary."
Two of the Key messages:
"There is insufficient evidence to justify multiple serum and saliva hormone tests often claimed to precisely individualise cBHRT
The management of women with menopause related problems should be underpinned by the principles and guidelines of the British Menopause Society and wherever possible, regulated products should be prescribed"
Hurdity x
-
Gilla99 - good that you are having appropriate treatment and that in your case you are finding blood tests to be helpful and I ohpe you continue to feel well.
However - I do take issue with this comment:
"Never been convinced of the notion of your Estrogen level fluctuating massively during the day - doesn't fit with all the publications of how your hormones fluctuate regularly in a cycle and certainly hasn't been the case for me. I often wonder if that's a myth peddled by the NHS who don't want to do blood tests! "
Circadian rhythms are a well established biological phenomenon and undisputable - different biological systems exhibit them in various ways.
Re estradiol - I haven't done an extensive search but here is the first one I came across (I haven't read the whole article which is probably not relevant to the discussion):
"Estradiol demonstrates a circadian rhythm. The diurnal cycle of estradiol exhibits an early morning peak and two, three or four ultradian harmonics throughout the 24-hour period [25]. During the menstrual phase, the peak in estradiol occurs later in the morning. The normal character of the estradiol rhythm is relatively unaffected by the menstrual cycle, except for the acrophase during the menstrual phase."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853846/
As for the NHS - why on earth? But I expect it was tongue in cheek! The need for blood testing of hormones and when it should be carried out was set out in the NICE Guidelines on menopause and were based on extensive literature review....that in most cases blood testing is not necessasry - at least to diagnose menopause. I can't remember what they say re ongoing testing....
And of course also financial considerations must be taken into account - as well as the science. There are many cases where we would like the NHS to do more eg regular endometrial scanning for women on HRT to enable greater individualisation of HRT, if only funds were available...
All the best :)
Hurdity x
-
Thank you Hurdity, extremely interesting.
I think the key answer for me in starting this thread is symptoms, symptoms, symptoms. I had two tests, one saliva, one serum blood. Saliva says I’m far too high in oestrogen, blood says I’m 105 and need more. I decide to reduce the oestrogen, I feel terrible (insomnia, night sweats, etc). Ive subsequently increased the oestrogen - flushing, night sweats, insomnia improving massively and swiftly. I will only use bloods as a guide going forwards but be ruled by symptoms. May be different for other people but I’m learning the hard way, what works for me!
-
Which ever route 1 takes to determine levels, 1 has to be aware of those Companies who sell products on the back of their 'results'. Cynic, Moi? ;)
Symptoms can be charted successfully by keeping a diary. Fortunately I never suffered badly in peri., though I do wonder if the depression and anxiety problems did increase in those years; I can't remember how my cycles were then to be retrospective - appropriate medication has helped. VA symptoms have been eased by 'ovestin'. Itchy skin treated with hand cream.
It's the Trial and Error that can be so tiring. As well as wanting to be well sooner rather than later. Because many are dealing with young children/teens/aging parents which is difficult enough, without throwing hormonal upheaval into the mix!
-
I totally agree CLKD, it is a bit of a minefield knowing who/what to trust. And also if there's one thing I've learnt through this forum and my peers it's that one person's journey doesn't match another, so what is helpful for someone (eg me with my blood tests) is not necessarily helpful to another.
The trial and error makes everything so long and drawn out and I am guilty more than most of wanting to just "fix it" immediately. I have to remind myself to think about how far I've come in the last year and just keep putting one foot in front of the other!
-
Sorry Hurdity missed your post!
I can only give feedback on my own experience which is that the blood tests I have every month are stable relative to where I'm at in my cycle, regardless of what time of day I have the test (i always test on day 21). I'm talking about to within 100pmol, not within 2 or 3!
Yes tongue in cheek but also born out of my frustration at the treatment I've received from my doctors during my Peri journey. Knowing my estrogen level has been absolutely key and critical to me and i've found it frustrating that GPs refused to test it. FSH only tells you if you're ovulating and for a proportion of women the symptoms of Peri start before your periods go haywire, something which isn't talked about enough or understood by many GPs. Coincidentally knowing my estrogen level prior to Peri and then testing it again when I was highly symptomatic enabled me to really see that it fallen dramatically and understand what was happening. Continuing to monitor it has been equally as valuable for me.
I think the key point I was (not very eloquently) trying to get across is that different strategies work for different women, as everyone is so unique - tests might be crucial to me and not for someone else and vice versa xx