Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: donnacrichton on October 24, 2024, 11:12:05 AM
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Good afternoon I actually posted on the other forum before noticing there was a post menopause chat. I am currently 52 and have been on hrt for about ten years under a specialist. It took a long time to get the right dose for me but have been on 100mcg Estraderm and Mariana coil for about six years. Always had issues with anxiety but other symptoms were under control. Since January I have had fatigue like I have never had before. I have had about ten urine infections as they keep coming back. I have put on two stone and have a belly like I have never had before but could be diet related. I am someone who went to the gym everyday but now I am just exhausted. Anxiety is through the roof. I have acquired heartburn no idea if that is related. Obviously I was put on a high dose as I was very young. How do I know my body needs a bit less estrogen as I have aged 14 years since being menopausal. I have just had full blood work done and all was fine but never thought about it being hormone related until today. Maybe I need less now I’m older? Anyone had experience x
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You probably need more, not less.
This is what happens when the population gets brain-washed by the BMS to think that 100mcg is 'high' dose. It's not, and you don't know how much you are absorbing of it either. (I'm assuming it was tested with your recent bloods? What was the result?)
At 52, your own hormones are now failing and you are becoming increasingly dependent on HRT. As a result you likely need more E, not less.
Gaining weight around the belly is a classic sign of low estrogen, that's why it's called 'menopause belly'. Fatigue, anxiety, UTIs - all this is classic low E. Are you on local estrogen as well? (Vagifem pessaries, Ovestin cream?) That would help prevent the UTIs. Many women need both local E and systemic HRT. You should be able to get local estrogen on the NHS easily, alongside your 100mcg patches.
You may well need to go to a private clinic to get prescribed a dose which is above 100mcg because GPs are reluctant to prescribe above the licensed dose.
Please don't be afraid of higher estrogen levels if you need them. Personally, I'm on 6 pumps of gel and 200mcg patches - and sleeping better than ever, although still not perfectly.
You don't need ever to reduce or stop your HRT. You can remain on it until you die. I fully intend to!
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I agree, I think you need more not less. I'm probably just post meno and have recently noticed a fall in oestrogen too. Have trialled 125mcg for a week now and the symptoms are on their way out. If you have any spare oestrogen I'd suggest you do the same then you can decide if it's worth a private appointment to get it regularly. Personally I'm starting to think the mantra that you need less post meno is a load of hogwash!
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Thanks for the reply. I don’t have falling estrogen levels as I have had my ovaries removed in 2019 due to hormone fluctuations for ten years previously. I also intend to stay on estrogen for life but I am now at a natural age for menopause and not just surgically induced. I absorb the patches well and have done for many years. At one point I was on six pumps of estrogel also and that was so high I felt ill. The uti and joint pain and fatigue iare all new and I have been on the 100mcg for years and been stable so my dose hasn’t changed. I have been researching my symptoms and frequent uti’s and fatigue are documented for high estrogen. I remember being on really high doses years ago in my early forties under a specialist unfortunately I was discharged during covid. I was just wondering if anyone else had similar issues having to reduce the dose as I am now at a natural age and might not need the 100mcg x
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It's possible that for some reason you have stopped being able to absorb the patches. We don't know why but sometimes that can happen and sometimes can mean you need to switch to a different product (ie back to gel).
It really would be worth getting the result on your estradiol test, or getting it tested, before deciding what to do. It is much easier to do that than to go the wrong way with the dose.
Frequent UTIs are not commonly found with high estrogen at all. Nor is fatigue. It is usually the opposite, people feeling wired and pumped. Joint pain was one of my first low estrogen symptoms during peri.
There is nothing about a 'natural' age for menopause and needing to reduce the dose. Everyone's dose is individual.
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I agree none of the symptoms you describe are characteristic of excess estrogen. Your current dose may or may not need increasing - I certainly wouldn't be thinking of reducing it.
However the new onset fatigue, urinary and GI symptoms and increasing abdominal girth really do warrant investigation, in particular an ultrasound and a CA125 if this wasn't done on your recent blood tests.
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Thank you so much for the replies I question my sanity when it comes to hormones! I have been referred for a bladder scan but been told it is a long wait. I didn’t consider that I might need more when 100mcg has been sufficient in years. I have put on two stone which I am now dealing with and I’m aware that might also contribute to the pain and fatigue. I think I will go private and get some bloods done as my gp is useless. X
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Hi! also even when ovaries are removed, there may be enough stem still attached to pump out hormone.
U mention 10 urine infections: has a urine sample been sent to a Lab to be 'grown' and any bug treated with appropriate antibiotics ?
Also, has any1 over the years mentioned vaginal atrophy which can mimic repeated urine infection-type symptoms >:(. Do read the various VA and bladder issues thread, make notes
;-).
It may be worth while you starting VA treatment ASAP. As oestrogen levels drop the body may become dry, inside and out, including the vulva and vagina.
If U are extremely tired and putting on weight: when did U last have a thyroid function and VitD blood test?
Let us know how you get on.
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The urine infections have had blood and white cells in them. Some of the cultures have come back clear. I asked about estrogen pessaries and the doctor said as long as I don’t have dryness or atrophy they would not be required as I would have enough systemically. Thyroid was checked and all ok so back to weight loss group. The weight could explain the joint pain as it is knees and hips no upper joints and also the fatigue. That all fits around the timing for fatigue too. I was just curious if anyone had to drop their estrogen as they got older. The only thing that doesn’t fit with the weight is the urine infections as I have no dryness at all quite the opposite. Thanks for taking the time to reply it is appreciated. X
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Most dip stick tests show what your urine has in it and your GP is WRONG >:( :cuss:
I wasn't dry either. Is there a Nurse Practitioner with more sense in the Surgery? Ring and ask for VA treatment, U don't have to be examined.
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Thank you so much I will contact the practice nurse. Unfortunately the only way I will get it is to say I do have VA it is a battle constantly with them x
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I find the Nurse Practitioners to be a godsend, they seem more up to date on all things related to menopause going on my last review.
I've posted a link in Jules thread that will surely help you, hopefully!
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My 2 cents is that I agree with everything everyone has said.
But if you are reticent for whatever reason then lower it and see if that helps.
Theres more than 1 way to skin a cat, for want of a better phrase, you can approach it from lowering or increasing.
It's really up to you, but please don't be afraid of body-identical estrogen, I'm afraid of a lot of things but estrogen isn't one of them.
Your body knows what to do with it and craves it, it's been coursing through your body since puberty.
You'll soon know whether you're in a better place by lowering but my sense is the same as others,
an increase is the way to go.
TD
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Please do check if your Ca125 has been done. I do not just mean a bladder scan, I mean an abdominal and pelvic ultrasound to exclude a mass.
Do you still have your ovaries in place?
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My ovaries have been removed. I have an embedded coil back in March so every bit of me was canned lol thankfully no masses. I have seen all my internal organs. My gut was to reduce it but I really do think the weight gain has a part to play. It was just the UTIs they kept saying you can’t have another one and yip. They would only give me three days of antibiotics which meant it kept returning. I’m annoyed I asked about peas Aries and was shrugged off. I lived on this site for about six years so have read a lot of stuff. I am takin Dmanos from Holland & Barratt as a preventative but I feel like I’m the edge of an infection all the time. I’m going to put a straight request in by prescription and they better not blow me off this time. Is it vagifem? If so is it every second day you use it. I can’t remember as this is one symptom I haven’t been plagued with until now. My biggest symptom is usually anxiety and constant UTIs is embedded in my brain this year 🤷♀️
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Would the cream be more effective as can make sure the urethra is covered?
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We can only answer from our own experiences and you will have to find out for yourself through trial an error what will eventually work for you.
I use Vagifem pessary and Estriol cream which covers all areas, I have to have both treatments to keep my VA under control.
All these UTI symptoms could be easily resolved by using topical oestrogen, it can be as simple as that.
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This maybe controversial, having read the other posts, but personally I would try gradually reducing the oestrogen a bit to see if your symptoms change/improve.
I only say this as I was of the "more must be better" mindset and got up to 4 pumps for sometime. Some of my symptoms reduced but I gained others including weight gain right around my middle from my armpits down to my hips. I was still exercising daily (cycling/walking/pilates) so couldn't put it down to that and had a healthy diet. My anxiety went through the roof and palpitations unbearable so I reduced down to 2 pumps and felt a whole lot better. I also lost quite a lot of my blubber in the process. I am now on the equivalent of 1 pump (on patches) and generally feel (relatively) ok.
I have come to the conclusion that there is not a one size fits all for HRT and you have to tweak it to find your own sweet spot. I hope you manage to find the right doseage and start to feel better.
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Thank you so much for all the replies. I’ve decided to keep the dose I am on and treat the UTI with cream or pessaries and address the weight and exercise. I also had issues with high estrogen on gel which is why I was asking. If it is high for me I usually can not sleep and the anxiety is unbearable. If I don’t get any relief I will take a different approach. I can’t tell you how helpful it is to have people who just understand 😁
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Donna, there are loads of threads about vaginal atrophy etc on the forum, so do check those out.
The gist is that you should feel free to liberally use as much local estrogen as necessary to feel better. You can use both Vagifem pessaries or similar PLUS Ovestin cream if you want something internal and external. I do think if your issues are UTIs that getting something internal is going to help get the estrogen closer to the bladder.
You should feel free to use local estrogen every day forevermore if necessary and any doctor who insists you should reduce to twice a week is simply wrong. Many women need it daily. It is local and won't go systemic.
And for the weight situation, I can highly recommend (been on my own journey here) eating a very high protein diet (like 1g of protein per lb of desired body weight, per day - for me that is 145-150g of protein a day) PLUS strength training. You can do this at home using dumb bells, you don't need to go to a gym. There is a great app for iPad or laptop called CGX (Caroline Girvan) which has an Ultimate Beginner programme on it and is really excellent. I'm on my 3rd programme with Caroline and with the high protein as well, my body has changed beyond belief.
There is also a great podcast called Metabolism and Menopause by Stephanie Crassweller which has loads of info on the best nutrition (high protein) and strength training for fat loss in menopause.
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I am very concerned about previous posts encouraging use of very high doses of estrogen. Regarding the first question about when to reduce estrogen, it is very reasonable to reduce at this stage Donna. Having been stable with no ovaries for a number of years, there would be no reason to increase the dose as has been suggested, and gradually decreasing is the right option for many women. Whatever dose of HRT is taken, many women still have vaginal and bladder symptoms and benefit from taking vaginal estrogen in addition.
I am aware that this doesn't always happen but once settled on HRT, ideally an annual review should discuss if what you are taking is best for you for:
-symptom control
-side effects
-dose
-type
-route
-duration
-need for vaginal estrogen
Regarding very high doses, this is a serious concern. It would be worthwhile reading the following--
https://vajenda.substack.com/p/a-master-class-in-hormone-levels
Best wishes
Heather
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Surely the best advice would be for Donna to get her estradiol levels tested, so she can actually see how much she is absorbing? And then make a decision accordingly.
If she has been stable for a number of years without ovaries and now has developed new symptoms, she may have stopped absorbing her patches.
High doses are irrelevant if someone is not absorbing them. There are women (I'm one of them) with serum estradiol levels on 3x the licensed dose which are the same as women on 3 pumps of gel or 75mcg patch. What sense does it even make to talk about dosages?
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tnx. Heather.
Donna: if you have supposedly repeated urine infections what has your GP/Nurse Practitioner suggested, have U been referred to an appropriate urinary consultant for a diagnosis? There are situations were infections become embedded which need exploration at Hospital under the care of a urologist.
Use the VA treatment nightly and when I have symptoms I take 2 Nurofen 3 times a day to ease that nip as the urine flow stop. 4 me it acts to relax the spincter = less urgency.
Hormones rise and fall so to me it stands to reason that a woman may not need the same dose of HRT throughout the 'month', hence it's a bit Trial and Error to find a regime that eases symptoms. :-\. I have mentioned elsewhere that I had/have no idea which hormone causes which part of my cycle, 4 a period arrived every 32 days ....... with excruciating pain and flooding >:(. Then it went that I had a bleed every 10 days ......
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Surely the best advice would be for Donna to get her estradiol levels tested, so she can actually see how much she is absorbing? And then make a decision accordingly.
I agree.
Formulations can change over the years, in particular people have been reporting certain brands of patches sticking less well than they used to.
Also someone's weight may have changed or they may have developed another condition, started taking other medication or changed aspects of their lifestyle that affects absorption.
Additionally there is no evidence to support the idea that women should try to taper down their hormones because they have reached a certain age or duration of use.
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Thank you for everyone’s replies. I have been referred for a scan but a mass was ruled out earlier in the year with an embedded coil scan. My urine infection did become embedded and it took four courses of antibiotics to clear it only when I got private tests done 🤷♀️. I have joined the gym for strength training and addressed the diet and on high protein. I am taking a preventative DManos to help the bladder. I will contact my nurse practitioner on Monday for some VA treatment. If all this fails I will consider adjusting the dose very slowly as it took years to get it right which is why I am hesitant. I have no intention of every coming off hrt but as I age I would take the lowest effective dose but hoping I don’t need to adjust something that has worked so well🤞