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[Hurdity]

I posted on another thread about my oestrogen blood test done recently which come out much lower than I thought. I know that blood tests are inaccurate and that symptoms are the way forward but even so I really thought my "snapshot" levels would be higher than this:

I am on 62.5 mcg patch (increased about 18 months ago because I didn't want to get testosterone dominant as I use T gel too), changed every 3 days and was having 200 mg utrogestan taken vaginally every 6-8 weeks. -  I did have some random spotting at the wrong time, so having a scan in a couple of weeks to check all is OK (through GP).  She was concerned my oestrogen levels might be too high (which might explain the spotting) and thought I should be thinking about reducing on account of my age ( and the spotting) so ordered blood tests for oestrogen, T, and SHBG ( well I asked for this).

My estradiol level was incredibly low for someone on medium HRT  - 85 pmol/l - and hoping it's a one-off anomaly otherwise it's not protecting me against osteoporosis very well. After the scan I'll see what the situation is and discuss with the doc where to go from here re dosage....the blood tests were done 3.5 days after patch change so was due to put a new one on - but still shouldn't have been as low as it was. The reason I had it done then was I didn't want it to appear very high ( if it does go high at all after patch change) so GP would say my level is too high!

The puzzling thing is I don't get hot flushes and the last time it was measured - maybe 6 years ago or so maybe more - it was something like 212 - but I was welll post-meno then. Every time I try to reduce the dose - well I haven't done this recently) I get hot flushes, so I am puzzled why my body hasn't registered this vast decrease in oestrogen, unless I am one whose levels on the patch drops off very quickly?

One could say maybe I'm through hot flushes at age 66 but last year I tried the gel for a while (1 mg Sandrena) but my hot flushes returned after a while showing that the oestrogen levels was lower.... I can't fathom it out - except that if my levels are low it muight explain my extreme morning tiredness and stiffness etc and generally lower energy levels when my T levels are fine....

I've been feeling so rough on the prog part this cycle ( 100 mg vag - only up to about Day 7 so far) that once again I am wondering about jacking it all in - but fearful of what will happen to my body and how I will feel if I do....

Thanks for your comments on the other thread Tracey E and Tc!

Hurdity x

[CLKD]

As oestrogen levels drop so muscles may become lax = aches and pains.  Can you reduce the progesterone at all? 

If it ain't broke why fix it.  If the scan comes back 'within normal limits' - why wouldn't it? - then stick with what you know? 

[Perinowpost]

Do you think it's possible the reading could be wrong? Or like you say affected by the fact that you were due for a patch change.  As you say symptoms are the main indicator and as you're not having adverse symptoms I.e,, hot flushes it is puzzling.

I would be tempted to have your levels checked again after your scan, and make sure it's on the first day of a patch change. Wishing you well and let us know how you get on x

[Wrensong]

Hurdity - is it possible your flushing on the Sandrena was in response to peaks & troughs from daily application when your body has been used to steadier levels from continual patch release?  I recently trialled gel & found my daytime flushing was improved on it but the night sweats were unchanged, as if the effect of the morning gel spike was declining by then.  I know there is fluctuation over the life of a patch & constant(ish) levels are said to build after a while on gel, but just trying to make sense of your recent discovery of low oestradiol on patches in the light of the earlier flushing on gel. 

Another possibility that occurs to me is that perhaps your flushing was in response to better absorption on the gel if your levels on patch have perhaps been lower than you thought for some time.  I remember my flushing & sweats increased for a while when I first went onto HRT postmenopause after oestradiol had tested below bottom ref range - so that was in response to levels building rather than simply very low levels.  After all this time on HRT you will have a better idea than me what's going on in your own body, of course!

[pepperminty]

Hi Hurdity,

sorry you are having issues. Sometimes a reading at least gives us reasurance, or an indication of whether there is an issue.  Firstly I would have a test at a different time with the patch and see if the reading is different. Medi checks do  a good one, if you can't go through the GP.  Also the I remember that ladies have had absorbtion problems with GEL if they use body washes and moisturiser, which has lessened absorbtion? And also the way it was rubbed in? So maybe you did not absorb it?Or as Wrensong said it could be more absorbtion, but without measuring at the time you don't kow.

Maybe you are one of those people who needs a lower dose than average to keep things at bay?
It is very confusing when you are doing all the right things and you still get issues. Sometimes medication and illness can effect absorbtion too, so it might be a blip, so also test your levels in a months time to see maybe to be sure?
I too am getting extreme tiredness and are very stiff, mine seems to be worse on the estrogen phase- maybe because my sleep is better on the progesterone  phase? Our bodies all react so differently.

I know you prefer transdermal, but can you top up with oral estrogen if needed? Have you tried Provera, sometimes our responses can change to a drug over time.  Can you increase your patch? I am just throwing things out here  .

It must be so frustrating for you, and worrying, when you are doing all the right things !   

I hope that your scan goes ok , please keep us informed.

Wishing that it is a blip for you.x

PMX

[Turkish delight]

Hia Hurdity!

Sorry to hear that you have been feeling ruff on utro phase, so many of us can relate here.

Re bones density can you get a DEXA scan done with your GP? I think that you would feel more assured if you knew that your bones were in good order, and then you have all the info to move toward a decision.

Then as you say you have a couple of options, it's either quit and walk away or up your estrogen and test in 3 months to see if that helped. Hopefully, you will feel the benefits with the tiredness ect. It is puzzling that you may need to up your dose, it's the opposite of what one would expect given your situation.

Keep us posted

TD

[Kathleen]

Hello Hurdity.

Sorry to read that you are having this trouble. I'm in no position to advise you but I'm interested to learn how you get on.

Obviously I don't want you to have problems but it feels good to be offering you support for a change.

Wishing you well and keep us updated.

K.

[Anjia]

Hurdity when you say you dident want to get testosterone dominant how would you no you were ?

[Rhiner]

Hi Hurdity,

Just wanted to let you know that I too have surprising low level of E. I am on 75ug patch and my estrodiol level was 115 pmol/l when measured at patch change. I feel pretty good in myself though (do not take any T). This was measured around 18 months ago and I would like it doing again but GP says its a waste of time! It just shows how absorption differs between individuals.

Rhiner

[CLKD]

If U feel well then stick with it! 

[MicheleMaBelle]

Hi Hurdity- sorry you're having a bit of a rough time just now.
 
I don't know what's going on with you. Is it maybe you're becoming immune to the dosage and you need to up it to get the same effect? When I saw professor Lumsden recently she wanted to up my patch to 75 mcg and she said that after a while I'd probably need to go up to 100 mcg patch.
Something I'm not comfortable with, it doesn't feel right at present.

Maybe you could think about coming off it for a while to see how you get on? I'm thinking of doing the same when I get my holiday out of the way.

Let us know how you get on
X

[Salad]

It is so difficult keeping everything in balance 

I agree with others suggesting a retest as it could be a one off.
It could be if it is that low and you're not flushing and having symptoms, maybe your body is adjusting to being post menopausal.
I'm not a progesterone user but guess there are issues if you're using too much progesterone too.

No real answers for you Hurdity apart from checking all your other levels are good too eg Vitamin D, B12, Magnesium.

Hang in there, nothing too hasty 

[Hurdity]

Hi there - thanks for all your thoughtful comments - sorry I haven't thanked you before as I haven't been on the forum as been v busy. Will try to answer them one by one where appropriate as I find it difficult scrolling backwards and forwards!

CLKD - progesterone has to be taken to protect the endometrium. Because of not liking the prog and side effects (never have!) I am already trialling a reduction in dose from 200 mg to 100 mg ( vaginally) and because of this a shorter cycle ( to approx 5 + weeks). The point is I still feel rough part of the time despite being lower dosage so if scan is OK I'm thinking I might as well have a longer cycle (ie longer without the prog) and take the higher dose. Weirdly though now, I feel less rough than a couple of days ago when I posted that - had a phase of about 3 days of it - but still feel v tired as I always do on the prog and especially in the mornings!

Will answer other posts separately!

Hurdity x

[Hurdity]

Do you think it's possible the reading could be wrong? Or like you say affected by the fact that you were due for a patch change.  As you say symptoms are the main indicator and as you're not having adverse symptoms I.e,, hot flushes it is puzzling.

I would be tempted to have your levels checked again after your scan, and make sure it's on the first day of a patch change. Wishing you well and let us know how you get on x

Thanks Perinowpost. The only other time I had them checked at doc's request a few years ago - (again because she - different doc - thought my levels might be too high because I was on vaginally oestrogen as well - at the time it was estriol so shows how much she knew about HRT since the blood test measures estradiol not estriol!!) - the blood test was done half-way through the patch change time so I was changing on a Mon eve and the test was done on Weds morning. I would be surprised for my levels to drop off so quickly though as it takes 12 hours or more anyway for them to drop after you remove a patch. Yes I would like another tests, but I'm not sure she will allow another one but will try to persuade her following the scan, if I mention osteoporosis....!

Hurdity x

[Hurdity]

Hurdity - is it possible your flushing on the Sandrena was in response to peaks & troughs from daily application when your body has been used to steadier levels from continual patch release?  I recently trialled gel & found my daytime flushing was improved on it but the night sweats were unchanged, as if the effect of the morning gel spike was declining by then.  I know there is fluctuation over the life of a patch & constant(ish) levels are said to build after a while on gel, but just trying to make sense of your recent discovery of low oestradiol on patches in the light of the earlier flushing on gel. 

Another possibility that occurs to me is that perhaps your flushing was in response to better absorption on the gel if your levels on patch have perhaps been lower than you thought for some time.  I remember my flushing & sweats increased for a while when I first went onto HRT postmenopause after oestradiol had tested below bottom ref range - so that was in response to levels building rather than simply very low levels.  After all this time on HRT you will have a better idea than me what's going on in your own body, of course!

Thanks for your ideas Wrensong. That's just it though - this result means I don't know what was going on in my own body!!! I mean I thought I did - I've been on 50 mcg (or a bit more) patches for most of the past 12.5 years and all the time on this dose I have never had flushes or sweats. When I reduced to 25 mcg I got flushes and sweats back and the same with 37.5 mcg so I just assumed that with the gel it was due to the same reason as it was theoretically less than medium dose ( 1 mg) and medium oestrogel is 1.5 mcg (absorption differences aside). As I had been successfully using patches for all those years I didn't bother to stay with it or try to find out because I just wanted to remain flush free and there was no particular reason to try the gel - I just wanted to try something different! I think if I have a re-test then this will makes things clearer and as I feel well ( apart from exceptional morning tiredness) I should just carry on - except if levels are lower than I thought as I mentioned in a previous post, I am not getting the same protection against osteoporosis.

Hurdity x