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[Jopurpose]

I’m not sure why I’m posting but I feel so low and I don’t think there’s anything I can do about it.
I had a tel. appt with the meno consultant yesterday, told her how I felt and said I thought I was no longer absorbing the max dose of oestrogen. My Oestradiol level was just above 200 last year and I was convinced it had plummeted further - yesterday’s result is in and it’s now 355.
It’s floored me and I don’t know where I go from here.
I’m 59 and under the meno clinic for zero libido and bleeding (my sister died of endometrial cancer 2 years ago).
I’ve had testosterone gel for a year and last year it was working but not now. I thought the testosterone had stopped working because my oestrogen had nosedived. The consultant advised me to stop taking it if it’s no longer working.
The consultant also ordered blood tests for FSH and LH. The results are back and they are very low  (FSH-1.6   LH-1.5) but I have no idea what bearing this has.
The consultant has already commented on the Oestradiol result, saying it proves I’m absorbing.
Do I just have to put up with feeling crap now?
Thanks for reading.

[bombsh3ll]

Of course you don't have to put up with feeling like this.

Firstly I am sorry for the loss of your sister, that must be incredibly painful, and in the setting of something potentially hormone related it does understandably change the psychological landscape.

(Slightly different situation but I am a non carrier within a BRCA family).

Those blood results at that snapshot in time do support reasonable absorption, however it doesn't mean you are therapeutic all the time, particularly if using gel, which can lead to a high initial peak on absorption and then drop off quickly.

My advice if the NHS are struggling to optimise your treatment, as is frequently the case with those needing more individualised treatment rather than the bog standard low-fixed-dose-one size-fits-all approach, would be to try and see an independent specialist like Dr Louise Newson, Dr nick Panay or the clinic started by the late Professor Studd.

You don't mention a progestogen, but I am guessing with your family history and bleeding you are on something pretty potent, which may also impact on psychological wellbeing.

[CLKD]

Hi.  Which menopause Consultant did U talk with?

How long have you been using the regime?  Some find that keeping a mood/food/symptom diary of use to chart progress.  It also gives an idea of the 'better' days.

U do not have to put up with anything.  Which symptom were you hoping to ease initially?

Let us know how you get on.

[Jopurpose]

Thank you bombsh3ll and CKLD.
I’m under an NHS meno clinic in the NW of England.
For progesterone I have the Mirena - meno clinic advised it because of my sister and I finally got a GP to fit it in September 2024 (an earlier GP thought she wouldn’t be able to fit it because of my age and put me on 200mg daily of Utrogestan).
I’m having a transvaginal scan on Saturday because I’ve had some spotting.
I do wonder if my Oestradiol result is higher than normal because of the high initial peak from Sandrena. I started Sandrena 2 months ago - GP said it would be good to be able to say to the consultant that I’ve tried everything.
Previously I’ve had patches and tablets and last year went from 4 pumps of oestrogel to 3 sprays of Lenzetto to now 1.5g of Sandrena.
I’d just like to be able to go to sleep at night, not wake up dreading getting out of bed feeling anxious and not feel overwhelmed by anything and everything. Sex is not my priority at the moment.
A mood diary would be a good idea.
I do think it’s a hormone imbalance but what can I do if the consultant disagrees? Would the NHS rather put me on antidepressants than try to get my Oestradiol higher?
Does anyone understand the relevance of my LH and FSH levels?
Thanks again.

[Dotty]

FSH levels are pointless if you are using HRT. It states this in the NICE guidelines.

You have cut your oestrogen drastically which is probably the reason for your symptoms.

[bombsh3ll]

Your FSH and LH (although the latter is virtually never clinically useful) are lower than I have ever seen, even in normally cycling young women.

This is not consistent with NHS doses of E/P/T in a postmenopausal woman.

Have you ever shown a raised FSH?

I would question a) are these accurate and b) is there any suggestion of hypopituitarism.

This is where getting a specialist opinion would also come in. It may not be of any significance at all.

Testosterone is also not just about sex (despite official insistence), we have androgen receptors all over our body including the brain, and its lack can have profound negative effects on both physical and psychological wellbeing.

Anecdotally symptoms like anxiety, dread and overwhelm often respond well to adequate testosterone.

[CLKD]

It may be that the 'consultant' has read a bit about menopause but hasn't actually much knowledge!  Which is a real shame and gets women nowhere.

How R U getting on with the Mirena?  It amazes me how many medics make excuses for prescribing rather than giving us what we actually need.  That earlier GP may not have known how to fit or isn't in agreement with that method!

I think that your GP should offer an anti-anxiety medication, valium saved my Life.  I was prescribed 10mg 3 times a day for a week followed by 10 morning and night then dropped after 2 weeks to 5mg in the morning.  Then as necessary.  My GP saw me every Friday to discuss how I was coping.

No one should have to suffer with acute anxiety. 

[Jopurpose]

Thank you again everyone.
The FSH result has thrown a spanner in the works and I do wonder why the consultant ordered it? She was quick to comment on the Oestradiol result but no comments yet on the FSH - I will follow up re. hypopituitarism - it could well be contributing to my symptoms, including hair loss.
I’m getting on well with the Mirena and I’ve stopped having period like bleeds - it’s now just the occasional spotting, hence the transvaginal scan tomorrow.
I’m convinced my symptoms are hormonal - woke up today and immediately knew I felt better and had a better day. I really want to try a higher dose of oestrogen before antidepressants, but will the meno consultant agree to this if my Oestradiol is 355? If I need a higher dose for it to be therapeutic, can I only get this by going private or can the NHS do this?

[Dotty]

The consultant should be going on symptoms, not blood test results. Some ladies need much higher levels.

[Hurdity]

Your symptoms of feeling low could well be due to the progestogen from the Mirena coil affecting you as you had it put in fairly recently. Depends how that ties in with your decreasing oestrogen doses too?  However I understand the need for extra caution and endometrial protection due to your sad family circumstances.

Some spotting or bleeding is normal during the first 6 months of having a Mirena or changing the progestogen regime and hopefully a scan will confirm that all is well. You may want to consider increasing oestrogen again despite those levels - which as has been said - may be due to a peak reading (depending where in your body you apply it, where the blood was drawn from and when it was taken in relation to gel application ie time of day).

Sometimes higher dose of oestrogen are needed to "counteract" the negative effects of progestogen - they don't balance each other as such (apart from in the uterus) but anecdotally women have reported this.

Hurdity x

[Jopurpose]

By way of an update, I had the scan and all is fine - endometrium still 4mm and fibroid 20mm.
I hadn’t noticed that the meno doctor I spoke to had written to the GP straight after my appt saying try tablets if my oestradiol level was still low. I got the impression she’s passed me back to the GP so I’ve just emailed the meno doctor asking for a trial of a higher dose of Sandrena to treat my symptoms because I’m already at the GP max of 1.5g and this isn’t therapeutic for me (even though oestrogen level at 355).
A couple of you have mentioned that I’ve decreased my oestrogen -  I’ve gone from 4 pumps of Oestrogel to 3 sprays of Lenzetto to now 1.5mg of Sandrena. These doses are the max my GP can prescribe.
Thanks to you all for your help - without it I wouldn’t have emailed the meno clinic back. Thank you

[CLKD]

Often Consultants can prescribe 'above' recommended doses.

How do U feel overall?

[Jopurpose]

Thank you CLKD.
I’m just feeling flat and occasionally tearful. I wake up with a feeling of doom in my tummy. I can cope with normal everyday life but as soon as something out of the ordinary happens, I spiral down. I have zero resilience.
I wrote to the doc who I spoke to at the meno clinic the night before last so she might reply to me this week. If not, I’ll contact my GP - although the GP can’t prescribe more oestrogen, she might be able to follow up on the abnormal FSH.

[CLKD]

That feeling is awful.  Hormones which fluctuate may cause weepiness etc..  How is your diet overall?

[Jopurpose]

My diet is bland/beige. I have ulcerative colitis and GERD/oesophagitis/hiatus hernia so don’t like to aggravate things too much.

I haven’t heard back from the meno clinic since I emailed the doctor so contacted the GP today. I’ve just received the text message below.

We have received a letter from the gynaecologist following your recent review. The letter gives instructions to change your HRT if your oestrogen levels were low and FSH/LH levels were high on the blood test they arranged. I'm just messaging to let you know all the levels were normal on 29th January, so I haven't made any changes to your HRT.

My GP is very good usually but this is a real kick in the teeth. The oestradiol level might have been normal but the FSH and LH weren’t and my symptoms are getting worse - I could barely get out of bed over the weekend. I feel like giving up.