Menopause Matters Forum
Menopause Discussion => Postmenopause => Topic started by: Firebearer on May 30, 2025, 04:37:58 PM
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I'm a bit puzzled by the oestrogel dosing issue. I'm currently on four pumps a day. Two in morning, two in evening. I feel fine on it. However, I feel like I'm getting chastised by some of the medical profession for taking too high a dose, particularly for a post-menopausal woman, and get dire warnings about breast and ovarian cancer risk. I get regular blood tests via Newson Health: six months ago my oestradiol levels were 500, my more recent test shows them to be 1000. Newson not concerned about this. But I'm wondering why my levels are fluctuating so much now that I'm post menopause and whether, indeed, I am taking too much. Other than blood tests, how would one know if you were getting too much? Any physical/mental symptoms? And why do my levels still flutuate? Planning to start reducing the dose to go down to three. Hopefully that will pacify the medical profession. And hopefully, I will still have symptom control, as I'm also told that post menopause we need less oestrogen....
Also, any tips on reducing dose to avoid 'withdrawal symptoms'?
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Hi firebearer,
Which medical profession? f you are feeling fine I wouldn't worry. I believe 4 pumps is the maximum licenced dose.
What is Newson's response to your questions? If I was paying privately I would expect informed answers from them as they are the menopause specialists and would allow you to confidently respond to the other medical profession.
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Hi if you’re feeling ok then there’s no need to reduce. 4 pumps is within licence. I’m on 4 pumps and have been for 7 years.
Not sure why you have having frequent blood tests….
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Hi Dotty, thanks so much for your responses. I had frequent blood tests to check testosterone - I'd swapped androfeme for testogel so needed a baseline and a follow up after sox months (absorbing the testogel much better than the androfeme and its much cheaper BTW).
I find it weird that they seem so concerned about 4 pumps as I also beleived that this was within licece, so what is the problem. Its not an ultra high, high dose.
Medical profession: Locum GP (female) and private gynecologost (went to see her for something else, but she started advising me on HRT dose).
Newson advised that it was towards the upper level of what they recommend but if I was getting good symptom control then thre is no need to reduce.
It's a case of 'who to believe' but confirmation bias makes me want to go with what Newson advised.
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Hi again firebearer,
I think there are at least 2 Dottys here! Spooky two of us both replied
If you feel fine and 4 pumps are managing your symptoms with no side effects, I would say "Happy days!" and stick with it. And if you feel the need to explain to anyone tell them the above and that the dose is within guidelines.
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Ah yes, two Dotty's. My bad. and syncronicity! Thanks for your response.
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How long have you been post meno? The ovaries continue to do 'something' for some time after bleeds stop and before they die completely. I'm in agreement with the above, if it ain't broke don't fix it. Personally I think everyone in the nhs has been told to reduce the hrt bill. I'm also a bit suspicious that the lower requirement post meno might be more to do with them prescribing less than with symptoms, I seem to need more not less. But perhaps I'm too cynical ;D
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Hi, not too sure how long post meno, probably about 5 or 6 years. Think it makes sense that there will still be some hormonal 'activity' after the last bleed as the whole menopause is a process rather than a sudden turning off of the taps. Thanks for that :-)
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I'm a bit puzzled by the oestrogel dosing issue. I'm currently on four pumps a day. Two in morning, two in evening. I feel fine on it. However, I feel like I'm getting chastised by some of the medical profession for taking too high a dose, particularly for a post-menopausal woman, and get dire warnings about breast and ovarian cancer risk. I get regular blood tests via Newson Health: six months ago my oestradiol levels were 500, my more recent test shows them to be 1000. Newson not concerned about this. But I'm wondering why my levels are fluctuating so much now that I'm post menopause and whether, indeed, I am taking too much. Other than blood tests, how would one know if you were getting too much? Any physical/mental symptoms? And why do my levels still flutuate? Planning to start reducing the dose to go down to three. Hopefully that will pacify the medical profession. And hopefully, I will still have symptom control, as I'm also told that post menopause we need less oestrogen....
Also, any tips on reducing dose to avoid 'withdrawal symptoms'?
Don't reduce your oestrogen to please others, no matter who they are.
Your symptoms are your guide.
I need far more oestrogen in post meno than i did in peri, in peri 100mcg was enough, not so in post, I am seeing my Dr at the end of this month as I still have symptoms.
I don't know about post menopause oestrogen fluctuations but Dr Newson has loads of videos about all sorts of meno subjects, her new site is also a repository of hormonal information drlouisenewson.co.uk. She's great until you can see a doctor to treat you.
I know Newson prescribe based on symptoms, whereas far too many of the NHS Drs have out-of-date info and they are too busy to keep upto date with it.
The WHI study of 2002 is still very strongly influencing Drs even though it was found to be flawed.
HTH
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if you’re feeling good on four pumps and your clinic isn’t worried, that says a lot already. Everyone’s body reacts differently, and it’s not always a one-size-fits-all thing. Some people do notice things like mood swings, sleep issues, or hot flashes coming back if they lower too fast.
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I had night sweats and anxiety back on 3 and half pumps.
I raised it to 4, now I’m fine. Infact I feel the best I’ve been in a long time.
I’m 10 years post menopause. 🤷🏼♀️
Like the others have said, if you feel good, don’t change it.
On the other hand, if you get sore breasts or feel down with anxiety, then maybe it’s too much. xx
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Thanks lovelies for all your helpful responses.
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I don't think I had symptoms of too much oestrogel - slightly sore left breast (could be the bra), no anxiety until I was told I was on too high a dose. Nevertheless, I decided to conduct an experiment on myself: to see what would happen if I reduced from four to three. Definately feel suboptimal, although slightly less suboptimal these last couple of days. Not sleeping so well, slight headache and brain fog. Plus, think muscles more sore after exercise. I'm gonna give it two weeks (i'm one week in) and if I still feel suboptimal, I'm going back up to 4 ;)
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So that worked well…Felt so rubbish that I stopped the experiment and have gone back up to 4 pumps. It was definitely a case of ‘if it ain’t broke don’t fix it’. Sleep terrible, brain stopped working (got lost between Euston and St Pancras - a route I walk at least once a month). Then I got cramps and had a bit of spotting, so have managed to upset a system that has been happily in equilibrium for the last couple of years. Oh well, we live and we learn. Also found out that fluctuations in oestradiol levels common with gel - might well get high levels shortly after applying it. Obvs when you think about it. Thanks again for all your helpful advice 8)
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Hello Firebearer
Thank you for the update.
It is interesting that you very quickly noticed a difference in your symptoms when you lowered your dose. We are always told to wait for three months before hormonal changes come into effect but clearly this was not the case for you. Hopefully a resumption of four pumps of gel will soon have you back to normal.
I am all in favour of experimentation and I'm currently two months without any oestrogen gel and hoping to make it to three months before I decide what to do next. I'm keeping my fingers crossed for a half decent result but time will tell!
Wishing you well.
K.
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Thank you K. I can confirm that I'm feeling great again on four pumps. So I'll stick with that. Hope your journey goes well. Best wishes.
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This thread might be done with but I thought I would add a bit more.
I was on 150mcg oestrogen and got a blood test shortly after my last post on this thread.
My doctor said 289, better than 112, March's result, (I was only on 75mcg, had been increasing from 25mcg), like before but still not good enough to cover symptoms.
I meet with her tomorrow.
I increased my dose to 175, I don't think she'll mind, she is very up-to-date on HRT & T prescribing and understanding 🙏.
Dr Louise Newson said in a recent video that some women feel a difference in days, well, I am one of those, I noticed in perimenopause when I was titrating oestrogen upwards, I felt a little better the day after, until I reached my sweet spot of 100mcg. With the upward titration in postmenopause, not so. I can look back on my post menopause treatment over the last few months, and definitely see gradual improvements for sure, but not the "straight from good to better" I got in peri.
Why did I reduce my oestrogen from 100mcg to 25mcg? Bleeding. At the time, my GPs and me believed the oestrogen dose needs reducing when we bleed. I now know that is out of date.
Takeaway for future reader of this, never assume your GP knows best with HRT, they're too busy to keep up-to-date with the currently, rapidly evolving menopause information.