Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: cocopop100 on October 04, 2025, 02:58:18 PM
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Hi all,
I’ve been taking estrogel for five months now. I started on one pump and have worked my way up to three pumps currently (only five days in). I heard on a Liz Earle podcast that some meno specialists recommend targeting an optimal oestradiol level and I’m considering using this to guide how much I continue increasing my dosage by. When I last tested at two pumps my oestradiol levels were 79.9 pmol/l.
The levels that were mentioned are -
180 - 360 pmol/l - dr felice girsch
Louise Newson says 250 pmol
My question is really whether this is the right approach as I’m basically working this out on my own based on podcasts!? Thanks so much
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Blood levels are of limited value when using gel as it peaks rapidly in the plasma and then drops off equally rapidly.
Minimum levels considered adequate for maintaining bone health in the majority of women are 250-300pmol/L. A study by Sarrell et al in the 1990s outlined approximately 184pmol/L (50pg/mL) as being the threshold to avoid urogenital atrophy - therefore the presence of GSM can be considered a harbinger of osteoporosis. Note these levels are minimal not optimal, and thresholds for other outcomes are not well defined.
Personally I will be aiming to maintain above 400pmol/L which has been shown to be bone positive in the majority as opposed to merely slowing the rate of loss relative to placebo. This also approximates the average level across a natural menstrual cycle outwith ovulation, and is also above the early follicular phase i.e. during menstruation, when most women don't feel their best.
It is possible that indirect markers can be used to assess the adequacy of dosing whilst on gel, such as FSH or SHBG, however these have not been validated for clinical use and do not form part of standard practice (however nor does checking any blood tests at all).
Additionally you could follow symptoms (obviously highly subjective and not universal, plus the fact that just a whiff of estrogen can dramatically reduce vasomotor symptoms but not alter the health trajectory of undertreated women), lipid profile, serial DEXA scans and serial coronary artery calcium scoring, however these have practical limitations and you don't necessarily want to wait 5 years between DEXAs for example to find out you are losing bone hand over fist.