Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: pepperminty on February 28, 2025, 05:38:33 PM
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Hi Ladies,
Just wondering about everyone's thoughts regarding levels of estrogen and HRT post meno.
Should we be going down to a lower level of estrogen in the late fifties when the peri stage has most likely stopped ?
I wondered what levels of estrogen those of use after the peri stage on average ?
Are we all on medium doses or mostly low doses?
The consensus is that post meno we need less estrogen.
If so when did you decide to lower the dose post menopause and what were the reasons?
Did it make you feel any better?
PMxx
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Hi I’m post meno, 60 years old and I’ve been on 4 pumps of Oestrogel (high dose) for 7 years. I don’t intend lowering the dose . 😊
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Interesting question 🤔
I'm on the same, four pumps of gel, and a pea sized blob of testosterone, so I have wondered if it should go up or down in dosage, I think our own levels drop every year is that right but also do we have spikes in our own as some times of the day can feel very different as in moods etc..
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I'm 6 years post meno and it took 4 pumps of Oestrogel to control my symptoms. I have no intentions of reducing that and hope the GP will continue to prescribe at that level. I don't absorb that well and my blood levels when last tested were only just about that needed for bone health. I feel pretty good on my current regime, so see no need to alter it. As far as I am concerned, HRT is for life!
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If you are doing well, symptom-free and have no signs of excess estrogen like unwanted bleeding or sore boobs, there's zero reason to change anything.
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I’m mid 50’s and increasing mine as still trying to get suitable absorption and enough oestrogen into my system to feel well and functional.
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Hi I’m post meno, 60 years old and I’ve been on 4 pumps of Oestrogel (high dose) for 7 years. I don’t intend lowering the dose . 😊
Hi Dotty,
I agree- Why change whilst it works. Do you know your levels of estrogen, or whether you are a poor absorber or not?
PMxx
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Interesting question 🤔
I'm on the same, four pumps of gel, and a pea sized blob of testosterone, so I have wondered if it should go up or down in dosage, I think our own levels drop every year is that right but also do we have spikes in our own as some times of the day can feel very different as in moods etc..
Hi Epona52,
I keep on reading that older women do not need a high dose - but what constitutes older I wonder? And what constitutes a recommended dose for older women ? Obviously we are all different, but there must be an average ?
PMxx
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If you are doing well, symptom-free and have no signs of excess estrogen like unwanted bleeding or sore boobs, there's zero reason to change anything.
I agree, but there appears to be a lot of information indicating lower doses for older women. The Newson website states :
Will I need a lower dose of HRT if I’m older?
Older women often need smaller doses of oestrogen than younger women, and there are preparations of lower doses specifically for older women. The safest way to take replacement oestrogen is through the skin in a patch, gel or spray. Even a small amount of oestrogen replacement can often alleviate your symptoms effectively and provide you with the bone and heart protection you need.
It also says about remaining on an effective dose for symptoms.
PMxx
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If you are doing well, symptom-free and have no signs of excess estrogen like unwanted bleeding or sore boobs, there's zero reason to change anything.
I agree, but there appears to be a lot of information indicating lower doses for older women. The Newson website states :
Will I need a lower dose of HRT if I’m older?
Older women often need smaller doses of oestrogen than younger women, and there are preparations of lower doses specifically for older women. The safest way to take replacement oestrogen is through the skin in a patch, gel or spray. Even a small amount of oestrogen replacement can often alleviate your symptoms effectively and provide you with the bone and heart protection you need.
It also says about remaining on an effective dose for symptoms.
PMxx
I find it all so confusing. Presumably by small dose they mean the smallest dose that a particular woman can get away with to alleviate her symptoms? Which depending on many factors might not be a small dose even if she’s an ‘older’ woman. I’m currently on testosterone too and I know my levels of that for free testosterone are out of range but the testosterone in my body is at the low end of the normal range. I’m assuming my GP isn’t going to reduce my prescription as I’m not absorbing all that I’m taking. Having a similar issue with oestrogen too which is currently low.
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I'm inclined to think it's from the same book of fairy stories as the 'everyone is meno by 54' fable. Every time I've tried to reduce my symptoms return.
It's possible it's true if you start hrt post meno.
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I will be staying on the dose that enables me to thrive and which has evidence for preventing osteoporosis.
There is absolutely zero evidence supporting the commonly held belief that older women need less estrogen - whilst older women frequently receive less estrogen, this has nothing to do with their need.
It is usually a unilateral decision by the prescriber based on conclusions drawn from the flawed WHI study.
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I wonder how you can tell that you are post menopause when you have had a hysterectomy at 34, 'ovaries were left in'
I'm currently on four pumps of gel and a little testosterone but have in the last month experienced tender breasts and dry around nipples also bladder issues, just wish you could have light at the end of the tunnel :(
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I just wish you could have light at the end of the tunnel :(
Menopause isn't a tunnel, it's a hole.
In your case you could get a FSH blood test done. If this is sufficiently elevated you can be considered postmenopausal.
However symptoms can occur long before FSH rises, and should be used to guide treatment.
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Thanks bombsh3ll,
Oh and I like that, definitely a hole that's deep with nasty little surprises in it all waiting to mess your life up :o,
I will ask about blood tests, always been told in the past that blood tests are unreliable and not good at showing what stage you are in menopause, it's more about symptoms being under control,
X
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That is generally true but for someone with no uterus, or not bleeding due to an IUS or ablation, a raised FSH can be definitive, however it may not necessarily influence clinical decisions so if you are within the expected clinical age range the NHS might not fund it.
For others eg with an IUS or ablation it can be helpful to know when contraception is no longer required although that isn't you.
It should be done if someone is young to avoid undiagnosed POI/early menopause.
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bombshell I think you've hit the nail on the head really. It is so hard to pick your way through this and to determine whether there really is any scientific hard-backed evidence that older women 'need' less estrogen, or whether it isn't more the case that providers would prefer to give them less estrogen because they are (always) so terrified of it.
And then there is also a big difference between what a woman 'needs' for symptom control and what a women 'needs' for ongoing prevention of osteoporosis, heart disease, blah etc.... Just because someone feels their symptoms can be controlled with less, doesn't mean they are necessarily gaining all the benefits. What does it mean to 'need' something - and who gets to determine how much of a hormone someone 'needs'.... This is just prescription power-play, as usual.
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This is really interesting! I am 3/4 years post menopausal and can’t quite believe how bad the symptoms still are so off I trotted to see the menopause nurse practitioner at our surgery the other day! I took myself off hrt a year ago as I felt it wasn’t really needed and side effects were annoying, but after about 6 months oh boy, not great! Anyway she said there was no way I was going to feel better without hormones and was shocked I was put on such a low dose ( 1 pump Oestrogel + utro continuously) she said the starting point should def be 2 pumps! That was her starting point even post meno! Soo different to the last person I saw who wanted to be very slow and careful! So my experience has been that attitudes to post menopause hrt seems to have changed in a year and half! And this thread has been very timely! I would also say that obviously if you are ticking along nicely that’s great, I was struggling so hence the reason for hrt again!!
I do feel us post menopausal women sometimes get left in the ether, with no one quite sure what to do about us and often under prescribing as we “should” be on an even keel by now, sorry probably a little over dramatic ;). Anyway let’s hope this time round is more successful! And yes what indeed constitutes an older woman? I’m 56 is that an older woman? No idea!
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Noooo lesred, your not old at 56,
I think it all depends on our mental and physical health, :)
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I wish someone would clone that nurse ;)
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;D
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If you are doing well, symptom-free and have no signs of excess estrogen like unwanted bleeding or sore boobs, there's zero reason to change anything.
So is it a reasonable practice to use as much as you need to produce sore boobs, and then back off a bit until they don’t hurt anymore? Then THAT amount is the right dose for you?
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I would not recommend deliberately aiming for symptoms of excess, then dialling back a bit.
The target level for each individual depends on her own physiology and treatment objectives.
Some HRT users (and prescribers) are seeking only palliation of vasomotor symptoms. This can be achieved with very low starting doses titrated to symptom relief.
Others like me choose to aim for physiological replacement, approximating the average estradiol levels across a natural menstrual cycle with the exception of the ovulatory peak, and higher than the early follicular phase as most women don't feel their best during menstruation.
I will personally be maintaining a plasma level of 400-500pmol/L which I know from having had bloods done premenopausally that I thrive at, and this also guarantees bone protection in as far as anything in life can be guaranteed, however I will also get a DEXA every 5 years.
Should new evidence emerge regarding optimal levels for other health outcomes I will be very interested to read this however doses used in clinical practice today are well below the therapeutic doses of the 1990s, hence outcomes for chronic disease prevention in the post WHI era have been disappointing.
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I think it depends on the individual and what your actual problems are.
Like bomb says, hot flushes and night sweats are relatively easy to get rid of on a lowish oestrogen dose but if you want to prevent osteoporosis or you have anxiety and depression, you probably need more. Then you need to consider the fact that oestrogen levels continue to fall well into your post menopause years.
I was able to keep daytime sweats at bay with one pump of Oestrogel but then my silent migraines made a comeback so I had to increase to 2 pumps of Oestrogel because my particular type of migraine auras are caused by low oestrogen.
Sometimes we get women on here who find their HRT suddenly stops working well into their 50s and 60s and they need to increase their oestrogen dose while others are able to keep going on a lower dose but obviously we don't know if they are getting a high enough dose to prevent osteoporosis or cardiovascular disease.
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Hello,
I've just had a blood test and have got an oestrogen level of 123 pmol. Dr says this is too low. I'm on a 50 patch and a half pump of oestrogel. I feel pretty good but have sore breasts. Apprehensive about increasing but have oestapaenia (which I can't spell).
Think I'm otherwise actually fairly menopause symptom free.
Any thoughts? Should I increase oestrogen?
I'm post meno by the way.
Can't find any suggestions about optimum post meno oestrogen level
Thank you!
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It comes down to your individual needs and treatment goals.
That is a relatively low estrogen level and it would have been much higher than this when you were menstruating - did you have sore breasts frequently then?
Sometimes it can be the progestogen not the estrogen causing this.
Tibolone is another good option for bone protection.
Evening primrose oil and a vitamin B complex can also really help with hormonal breast tenderness - I got this advice from an eminent (male) gynaecology professor many years ago, and I thought it was BS that anything over the counter could help but it was cheap and I tried it anyway - it worked so well I no longer had any warning when my period was coming!
Also, some women do manage to maintain (or at least lose more slowly) bone on 50mcg patches so your other option is getting serial DEXA scans on this dose.
The addition of testosterone if you can access it is also bone protective, as well as helping to prevent frailty and sarcopenia.
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lizzy, yes for sure you should increase estrogen if you have osteopenia and an estrogen level that low.
It is very normal to have sore boobs for a few months any time you increase estrogen, but usually it settles down 3-6 months after an increase. Besides, sore boobs are not dangerous or a sign of anything to worry about, so as long as they are not so sore they are impossible to live with, don't worry!
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Thanks for your advice Bombshell and joziel, I have upped the patch to 75 and maybe will go higher.
I have also started taking evening primrose oil which has already made a big difference to my breast pain after only a few days. I had presumed the breast pain meant I had too much oestrogen but obviously it didn't!
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I am 69. I am on a high dose of HRT and have tried to reduce my dose several times. Each time the symptoms return I do not absorb well. I hope to stay on HRT as I believe that the benefits are worth it