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[Hurdity]

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

Thanks for all your suggestions pepperminty!

Yes maybe as you say, I feel well at a lower dose. but because the last test few years ago was more than double (the estradiol level), and lowering the dose causes sweats etc to return - this is puzzling! I have been using these patches for so many years and don't use creams etc on my butt cheeks so everything has been consistent in that regard for many years!

Thanks for ideas re different products - I am a nil-by-mouth gal when it comes to HRT so would never do oral anything (except dydrogesterone if it came onto the market) - especially not oestrogen at my age ( remember I am mid 60's so tablet hRT not a good idea). Also it increases SHBG which will bind my meagre testosterone further!

Yes - if the next tests still show lower than optimal oestrogen levels half-way through patch change I will stop snipping off the corner of my 75 mcg patch and increase as you suggest! Just my doc saying I should be reducing at my age - but I am nowhere near decent levels -(if these are anywhere near accurate) as we are always saying here - it's not about the objective dose as written on the packet, it's about how you feel, and at least basic preventative estradiol levels!

Hurdity x

[Hurdity]

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

Hi Turkish Delight - you know I hadn't even thought of asking for a DEXA scan because as far as I was concerned my oestrogen levels were sufficient to prevent bone loss. I've just looked at the criteria and I don't fit them (as not low BMI!) but I can ask....thanks for suggestion. It'll be quite funny if I have a retest of estradiol and all is fine, and will have been angsting over nothing 

Hurdity x

[Hurdity]

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

Testosterone levels need to be kept within normal range for women and taken with the SHBG levels to give Female Androgen Index within normal range. Most authorities (gynae experts) suggest T replacement only when oestrogen replacement is optimal  (although this is variable amongst women). In my case they might not be so I might be a bit more T dominant than I would like to be. Small increases I doubt would have any effect - but too much T replacement over oestrogen can give androgenic side effects - eg increased hairiness, voice changes etc but I think T has to be quite high to notice these. Interestingly I have noticed my waist size being larger and my shape more male-like (straight up and down) - ie the typical apple shape of post-menopausal women. I don't know if that is due to lowering oestrogen levels or not! I think oestrogen would have to be pretty high to become a lovely pear again! Those days are gone foerever!!!

Hurdity x

[Hurdity]

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

Thanks Rhiner - very interesting to know. When you say at patch change - do you mean just after the change (12 hours?) or when it was due? It makes me less worried about increasing fully up to 75 mcg ( depending on another blood test....)

Hurdity x

[Saffy]

Sorry Hurdity, just catching up! Can't add much to the other comments but wondered what your SHBG was, particularly in comparison to previous tests?

I think the issue about osteoporosis could be worrying for a lot of women. I wonder how many are on the standard 'prevention' dose and relatively symptom-free but are unaware that their blood levels may not be high enough?

[Hurdity]

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

Thanks MicheleMaBelle

At this point I shouldn't be becoming immune to the dosage I would have thought - but rather oestrogen might just be declining or have declined over the years since last testing. I have been pretty much on the same dose for years which is why I'm puzzled but will reserve judgement until a hopeful retest - but if it's been like this ( v low at patch change) for years without symptoms but yet reducing the dose consistently does cause symptoms it's really odd! At this point I can't contemplate stopping HRT for a while - I feel at my age that once I come off it will be for good as probably not realistic to restart in late 60s once I've stopped. I only tried this once - in early 2011 for 3 months!! To be honest I'm scared to believe it or not as I've been on for so long and have so much to do!

Sorry Hurdity, just catching up! Can't add much to the other comments but wondered what your SHBG was, particularly in comparison to previous tests?

I think the issue about osteoporosis could be worrying for a lot of women. I wonder how many are on the standard 'prevention' dose and relatively symptom-free but are unaware that their blood levels may not be high enough?

Hi there Saffy SHBG was pretty much the same as approx 1 year ago - the only time it's been tested. yes the osteoporosis issue is worrying if absorption is not happening on patches despite the dose being licesned for osteoporosis. I presume anyone who has been prescribed HRT for osteopenia or osteoporosis and especially if less than menopause age - has tests to ensure levels are sufficient. If not - they should do so!

Thanks also Kathleen!

Hurdity x

[Rhiner]

Hi again Hurdity, In response to your question, I had the blood test done at the time my patch was due to be changed, ie still the old patch.

Rhiner X

[Kathleen]

Hello ladies

 Hurdity - I take your point that women at risk of osteoporosis should have their oestrogen levels tested to ensure against the condition. Do you know if there is a minimum level required? Also  do you think that women who don't use HRT are destined to develop osteoporosis and if infact their levels are fine where could they be getting their oestrogen?

Wishing you well.

K.

[Joaniepat]

Kathleen, I was told 250 pmol/l at the Chelsea & Westminster. I'm not sure how much consensus there is about this. Women with a low BMI and family history of osteoporosis are among those at risk. There will, of course, be other categories.

JP x

[Hurdity]

Hi again Hurdity, In response to your question, I had the blood test done at the time my patch was due to be changed, ie still the old patch.

Rhiner X

Have your levels ever been higher eg during the middle of patch application period of time or do you think yours are always lowish?

Hurdity x

[Hurdity]

Hello ladies

 Hurdity - I take your point that women at risk of osteoporosis should have their oestrogen levels tested to ensure against the condition. Do you know if there is a minimum level required? Also  do you think that women who don't use HRT are destined to develop osteoporosis and if infact their levels are fine where could they be getting their oestrogen?

Wishing you well.

K.

Kathleen, I was told 250 pmol/l at the Chelsea & Westminster. I'm not sure how much consensus there is about this. Women with a low BMI and family history of osteoporosis are among those at risk. There will, of course, be other categories.

JP x

Hi there - I did read a paper some time ago which mentioned approx 160 ish pmol/l (might be remembering wrongly but definitely less than 200) - and also the product monograph for Estradot (revised 2017) says this:

"For optimal prevention of post-menopausal bone loss in women for whom the drug is indicated, therapy should be initiated as soon as possible after diagnosis of menopause. The dosage of estradiol-17B may require adjusting according to the patient's clinical status, the plasma estradiol-17B levels and the patient's clinical status. Ideally plasma estradiol-17B levels should be maintained at 183 pmol/l (50 pcg/ml)."

I haven't managed to find the paper where they got this from although there is a reference from 1989 - sorry haven't got time to look into all of this now! Sounds like the C and W have approx the same "ball-park". As far as I understand it is dose dependent ie higher oestrogen dose confers greater bone protection ( ie minimises overall bone loss) - and I guess the main desired outcome is reduction in fracture risk, so not sure how the stated level ( 183) relates to this without doing lots of reading! Maybe someone else would like to!!!

Re who develops osteoporosis - as Joaniepat says there are lots of risk factors, which are both environmental and genetic and absolute low levels ot estradiol may not automatically mean a diagnosis of osteoporosis. Also it's age dependent isn't it - a lot of older women have it anyway? Sorry I'm just talking off the top of my head at the mo! There is a lot of info out there on osteo development...how mwany studies on hpow this relates to oestrogen levels i don't know?

Kathleen we still produce oestrogen post-menopause but they are converted from androgens produced mainly in the adrenal glands, and I understand the post-menopausal ovaries still produce a small amount of hormones. WOmen will vary is in all our biochemistry - as to how much they produce. Fatter women will store more oestrogen because estarone (which converts to estradiol) is stored in fat cells. Not an argument for being fat (having too much more than needed!) though as this comes with other health risks as we age!

Hurdity x

[Rhiner]

Hi Hurdity,
In response to my oestrogen levels and if they have changed. I have only ever had the one test unfortunately and I asked for this as I felt that my level had dropped, but do not know what is was before. I have asked for it to be checked since but this has fallen on deaf ears and was told as long as you are feeling OK thats what counts (and I am feeling great). I am the lady with no ovaries, so not producing any myself any more.
Rhiner X