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[allie007]

Morning all,

Have been on HRT for over a year now and still don't feel great, really low mood, anxiety and broken poor sleep . Every GP has refused to do any monitoring blood tests telling me it is pointless so I've decided to arrange having some done privately.
Been on the Nuffield website and there are a few to choose from. Woud anyone know if I just need my oestradiol level checked?
Thank you

[CLKD]

Your GPs are correct and my Gynae treats on symptoms because levels rise and fall all the time.

What else has your GP suggested?  Maybe more HRT or anti-anxiety medication to give your brain/body a break?

[allie007]

He hasnt said much, i saw a new GP last week and he said he didnt have a clue and when he has 10 minutes he will read through my notes and get back to me. That was last Wednesday and I've heard nothing since. He mentioned something called Tibolone.
Previous GPs have said about using amiltryptiline but theyve never given me a prescription.
At the moment Im using a 100mg Estradot patch and have recently added a pump of Estrogel. Mood is good now Ive added the gel but none of the GPs wanted me to go as high as the 100 patch, never mind the gel too. Sleep still all over the place.

[Saffy]

When my meno specialist wants to check how much I'm absorbing and why I still feel ropey she requests bloods for Oestradiol, Testosterone, SHBG (Sex Hormone Binding Globulin) and FAI (Free Androgen Index). Together these give a pretty good picture of what's going on and how to resolve it.

[Saffy]

Ooh, forgot to add that the lab needs to know you're on HRT (well, the NHS one does)  .

[allie007]

How come some say to do tests and others say no point?
Saffy, do you know what 'normal' levels should be?

Thank you both for replying x

[CLKD]

Because hormone blood tests are not well understood?  How many GPs get a 'normal' reading for thyroid but the patient still suffers symptoms because they require more medication 

[Saffy]

How come some say to do tests and others say no point?
Saffy, do you know what 'normal' levels should be?

Thank you both for replying x

The tests to show if you're menopausal such as Lutenising Hormone and Follicle Stimulating Hormone are the disputed ones I think, as they are only indicative at a particular moment in time. Similarly hormone levels prior to and during peri-menopause are up and down over the course of the month. Once you are on HRT, assuming it's not alleviating your symptoms, then checking Oestradiol, Testosterone, SHBG would be the only way to see if you are not absorbing and why or whether you personally require a higher dose etc. Hope that makes sense!

'Normal' levels vary between labs but this is a rough indication taken from an NHS hospital site:

Oestradiol:
Follicular: 72 – 529 pmol/L
Ovulatory: 235 – 1309 pmol/L
Luteal: 205 – 786pmol/L
Post-menopause: Less than 118 pmol/L

Testosterone:
0.7 – 2.8 nmol/L

SHBG
18 – 114 nmo/L

My local lab has 200 mmo/L as the upper level of SHBG so you can see how they can vary. For oestradiol I work on the basis that I want my levels above around 250 pmol/L as that is (roughly) the level needed to prevent osteoporosis.

[allie007]

Thanks Saffy

My symptoms are low and irritable mood, bad sleep and anxiety. Would i need all those tests as Nuffield do just oestradiol?

[MicheleMaBelle]

Allie- there is a company called medichecks who do a variety of tests. Check out their website.
They send you a kit and depending on what you've ordered, it's either a pin**** sample or a full sample ( your practice nurse should be able to do this but check beforehand)
You post it away and they e mail you when the results are available. You get them online along with a Drs report. I did quite a comprehensive one recently and was really impressed.x

[Saffy]

It would be more helpful to have the full range as oestradiol alone may not give you the full picture for why you still feel ropey. I mean, if your oestradiol levels seems good you may personally need more for you to feel better and/or be needing to add testosterone. If your oestradiol levels are low your lack of absorption could be due to high SHBG or just the method of delivery.

Have you looked for other providers that will do a selection of tests? I'm sure a couple of people on here have used some online services where you take a kit to a local test centre. Not sure which ones though - maybe start a thread to ask?

Edit: Ah I see Michele has replied while I was typing  .

[allie007]

Thanks MicheleMaBelle and Saffy. i was looking at them.  Spoke to my GP this afternoon  and hes adamant he wont do any despite me being on HRT for over a year and it not working well.

[allie007]

Another question lol. GP is referring me (again) to the Gyni clinic who did nothing. At the time they wanted me to come off HRT to do a blood test to see what my levels were to be able to say how much HRT i needed. They wouldn't test while I'm using HRT.
If I do pay for tests privately are they likely to ignore the results if they do show something being as they think they are pointless/unreliable?