why not a lower dose of oestradiol?

[llama74]

Hi, I’m 45 and noticed perimenopause symptoms since age 40. My cycles went from 28 days to 20 or shorter, weight gain, brain fog, tiredness and PMT. I tried natural progesterone cream and had real improvement, cycles back to 26 days, weight became manageable, brain fog eased. However, I was concerned that I wasn’t able to control the dosage applied very well, and I still had huge mood swings around the end of my bleeding/’ovulation’. I went to see a GP with an interest in women’s health, and she put me on HRT 50/140 oestradiol/norethisterone transdermal patches (oestradiol for weeks 1-2, then combo for weeks 3-4).
This seems like a high dose of oestrogen, as the patches are classed as medium rather than low dose. I am not using the patches for contraception (husband had the snip). Why would she not have put me on a lower dose of oestrogen please? it's early days of using them, but I'm 2kg up already (I'm still in 'normal' BMI) though not feeling hungry. I appreciate that I'll need to settle down on oestrogen but I can't help feeling I should be on lower dose. I hated the combo pill in my younger years, always gave me weight gain, acne or horrendous PMT.

Progesterone only didn’t fix all your issues so I can see why the GP went to a combined method.

If the new method alleviates all your issues but creates some new ones I can’t see why it wouldn’t be looked at again.

At 45 you are young for peri menopause and the likelihood is that a 50mcg patch is right for you rather than 25 or 37mcgs.

I am not using the patches for contraception (husband had the snip)

HRT is not a contraceptive!

It’s also worth knowing that there are 3 different estrogen replacements and I think at least 3 progesterone replacements. If you had problems with the combined pill if you know the brands you can check which variants of estrogen and progesterone were in them. It might be useful.

I understand HRT is not a contraceptive; however, that fact that I don't need to consider oestrogen / progesterone dosage levels for contraceptive purposes is relevant.

I had problems with the combined pill some years ago. I tried at least 6 different brands, plus the minipill. I haven't been on the pill for at least 10 years now, so the options now will be different, for sure.

My question was why the GP didn't start me on a lower dose of oestrogen than 50. What might her reasoning have been?

@CatalogueUniverse Not correct really. There is one type of estrogen used now estradiol. There ae a few types of HRT which are made from a different source- conjugated equine estrogens- but these are not used so much now and are not in patches, only tablets starting with PRE.

Also, HRT bears no resemblance to the Pill. The Pill is a) higher doses and b) synthetic hormones. Most HRT now is made from plants. (yams)

@llama74 HRT is completely different to the Pill and hormonal contraception.

1 It's a differnt type of hormone
2 it's a very much lower dose
3 it's replacement (H R T) and simply replaces your own hormones with the same type.

You are on a medium dose.
The lower dose will not give bone protection for someone your age going through early peri.

The kind of cream you bought and used does not work. It's not absorbed through the skin in any kind of strength needed to help.

In peri your hormones vary hugely so the improvement you had was short lived as it was your own hormones settling down for a while.

You are on a medium dose.
The lower dose will not give bone protection for someone your age going through early peri.

Thank you, that makes sense.

"The kind of cream you bought and used does not work. It's not absorbed through the skin in any kind of strength needed to help."

I understand there's a lack of rigorous evidence, not the same thing as
does not work. The dr I spoke to said there are concerns over ensuring the quality of the ingredients and the method of synthesis, and that people often present having overdosed on it, which wouldn't be possible from what you've said. I had a few symptoms of overdosing (occasionally) which is why I was there to see her. Perhaps you're thinking of a different cream, I applied mine directly to the vulva/vagina.

"In peri your hormones vary hugely so the improvement you had was short lived as it was your own hormones settling down for a while."

Well, I disagree. I had a cycle average length 19 days, this lasted a year. I started the progesterone cream, my cycles averaged 26 days for a year. I came off the cream, cycles returned to 19/20 days. I went back on the cream, cycles back to 26 days.

Perhaps you're thinking of a different cream, I applied mine directly to the vulva/vagina.

Good grief! Which cream and which dr are my questions!

The type of cream you can buy over the counter (usually by mail from Channel Isles) cannot be absorbed through the skin and converted into a type of progesterone that is any use. if it were it would be used by all women as part of HRT and believe me, as I pay for my private meno care and have access to anything available, it's not something my consultant offers.

Your experience of using the cream does not prove it works. It's equally possible your own cycles went back to normal for 12 months. Also, you cannot overdose on the cream.

However, be that as it may.

Progesterone is not the treatment for peri meno as symptoms are caused by low estrogen.
The progesterone treatment was initiated by a Dr John Lee whose work is regarded as quackery by 'real' experts. He made the progesterone cream to sell it to make money.

There are still some private clinics who peddle this progesterone imbalance stuff but in all honesty it is not right or ethical.
Sorry to sound so harsh.

Hi, I'm not here asking about progesterone. I did not acquire it from a clinic, and neither did I order it from the Channel Islands.

For research indicating that OTC progesterone creams are absorbed by the body, see the link below. The question is not so much do you absorb it, but rather how should it be regulated. There is no evidence it provides protection against cancer in the way prescription progesterone does, but that's a different question.

www.ncbi.nlm.nih.gov/pubmed/15901742

I have no doubt whatsoever that the cream I was using was effective, and two GPs have agreed with my conclusion, and also stated that I had symptoms of overdose and that overdosage happens frequently in other patients seen who use the creams. Their objection to the use of the product was that:

• these preparations have not been tested for quality, safety or negative side effects - there is no way to know if these creams are contaminated with other additives - they are not regulated and standardised like pharmaceutical-grade prescriptions
  • dosage varies on application and with each batch made

I have no need for you to affirm my conclusions, but it matters to me that I explain here why I disagree with you in case others are reading this and assume that because some said these creams can't be absorbed that they can use them safely. I think it is wise that people read for themselves. Your information may be accurate; I'm offering a different professional point of view.

My current GP has been recognised in her chosen field of women's health, has received national awards and conducts training for other GPs in the field of women's health. I am very comfortable taking her advice, although I acknowledge that it disagrees with yours.

My question was about trying to understand her rationale for not putting me on the lower dose of oestradiol. Your explanation of osteoporosis prevention dosage makes sense, and I sincerely thank you for it. I will ask my doctor specifically when I next visit her, of course.

I'm not sure why you used it anyway as the peri symptoms you had are caused by low estrogen, not progesterone.

The reason it is not used is it does not give endometrial protection and if it were to, the dose would be unacceptably large. The trial you linked to was very small- 12 women- and the dose was controlled which is harder to do with OTC products.

If you did not get it from a clinic nor the Channel Isles- where did it come from? For the benefit of women reading you might like to leave a link.

The reason for the 50mcg patch- it's not a high dose is the lower dose swere unlikely to give you relief from your symptoms. if you are unhappy with it, ask your GP to change it to a lower dose.

This is really interesting and in some places totally contradicts what I’ve been told by GP.

Could really do with knowing all the ins and outs so I can be ready for my next visit. Is there anywhere I can read up?
45
Have had over 3 years of period changes and now have sweats, insomnia, anxiety, sporadic flooding.

matters.co.uk is worth a look lots of information.

Thank you

menopausematters.co.uk

I was on the patches until supply got difficult last year. Now I'm on estrogel and micronised progesterone. It's less convenient but i have found my pms symptoms reduced with the micronised progesterone compared to the noresthisterone in the patches. Something to consider if the noresthisterone doesnt suit you - i also didn't get on with the contraceptive pill so was nervous about hrt.

OP - I take progesterone only after being prescribed a duel hormone patch (Everol Sequi) and it made all my symptoms worse. I tried cutting the patches in half and still things were terrible, so stopped using them all together and things did abate a little.

In the end I went to see someone privately and she put me on progesterone only. All my symptoms disappeared within a manner of days. For some, falling oestrogen levels isn't the issue, it's the fact their body isn't producing enough progesterone that's causing the sweats, the erratic periods, brain fog, weight gain etc. etc.

For some, falling oestrogen levels isn't the issue, it's the fact their body isn't producing enough progesterone that's causing the sweats, the erratic periods, brain fog, weight gain etc. etc.

Vasomotor symptoms are caused by loss of estrogen. There is no debate over this.

No woman has progesterone post menopause because it's only in the body as a result of ovulation each month. We don't need progesterone because its role is to build up the endometrium to help implantation after conception.

Progesterone only treatment is not recognised as treatment and it won't protect against bone loss, heart disease , pelvic floor atrophy (prolapse etc) and prevent dementia.

"Progesterone only treatment is not recognised as treatment". Not as HRT but it is for other things, such as in fertility treatment. You apply it what the (public hospital) consultant called 'vaginal membranes'. For example, the brand Crinone is commonly prescribed to lengthen the luteal phase.

I'm only still engaging here because I don't want misinformation left for people to read. Here's another link. The medical profession seem quite content to accept that progestin creams can be absorbed by the body, and that they are effective in some treatments. I'm not sure what the issue is here, but I can assure you NHS doctors prescribe progesterone creams routinely and they're considered effective. If my body can absorb progesterone from crinone prior to perimenopause, I can't fathom why it wouldn't be able to during. Some things might be outside of your experience, doesn't mean people are stupid, visiting quacks, buying snake oil off the internet, or making it up. As a university lecturer (not in medicine!) I appreciate I'm not an expert but I'm not unable to conduct research and evaluate findings. I also listen to my medical team, who have always been top notch, evidenced by the birth of my second child

Perhaps we have had some kind of miscommunication, but I'd suggest perhaps it's not necessary to lecture people when you might not have all the information. I was asking about oestrogen, and you've borderline trolled the thread nit picking at everything such as my mentioning that I'm not using hormones for birth control. I can see you're the self-appointed expert here, and I'll duly move out of your way.

"The kind of cream you bought and used does not work. It's not absorbed through the skin in any kind of strength needed to help."

www.ncbi.nlm.nih.gov/pmc/articles/PMC2695240/

I'm struggling with linking to articles which are behind a paywall (at work I have access to research journals). Here are some that seem to be public / open access. Apologies if they are not.

www.ncbi.nlm.nih.gov/pubmed/20347079

journals.plos.org/plosone/article?id=10.1371/journal.pone.0133027

read.qxmd.com/read/8943507/luteal-support-after-in-vitro-fertilization-crinone-8-a-sustained-release-vaginal-progesterone-gel-versus-utrogestan-an-oral-micronized-progesterone

@llama74 Thanks but you're not telling me anything I don't know already :)
I am a health writer for national publications and websites and have spent the last 12 years reading research as well as talking about all of this with UK meno specialists which includes my own who is a meno and a top fertility expert.

Fully aware of how micronised progesterone is used- been using it for 7 years.

I don't need a lecture on how it's used. Thanks.

However, you will not find any consultants offering it as an alternative to estrogen. if you went off piste and ordered it from the US or wherever, and find it helps, fine. But for the benefit of other women reading, I stand by the points I made.

There is no miscommunication.

However, as a professional health writer i can't let things go which can confuse other women.

I'm simply explaining the facts and how women are best helped.

Your initial post showed you knew nothing about HRT . Given there is a legacy of women being duped by the Oestrogen Dominance theory by John Lee, it's totally valid for me to challenge why you used progesterone.

Jingling, while I appreciate you know a lot about HRT, menopause and perimenopause, you're not a doctor. Most pertinently, you're not my doctor, you don't know my medical history or the issues I've had with high levels of oestrogen since puberty.

Vasomotor symptoms are caused by loss of estrogen. There is no debate over this. I'm not saying this isn't true.
However, not producing progesterone can also cause them. It's what caused them with me, and taking progesterone only stopped the 60+ hot flushes I was having a day.

Some women experience different issues and need different treatment, I am one of them. OP might be another.

That is all.

@StellaRockafella I completely agree with you. I am not a doctor. However, in order to write about health issues, what I write is based on what drs tell me when I interview them and they often read the final copy of features for accuracy. My contributions to this part of MN are really my way of giving something back in the hope it helps women.

I cannot find any research showing that progesterone alone will treat hot flushes. Its role in HRT is to prevent overgrowth of the endometrium. In fact progesterone usually raises the body temperature (from ovulation up to when a period occurs.)

I'd be very interested to know which consultant you have seen who is happy to prescribe progesterone to you as that in itself could make an interesting topic on the whole menopause subject.

The problem is that Dr J Lee made his fortune on the back of estrogen dominance, and the need to 'balance it' with progesterone. There is no medical basis for that- estrogen dominance does not exist - and many women have been duped into buying progesterone creams over the web or paying for private meno treatment from drs peddling the same myths.

Has anyone talked to you about the longer term side effects of only progesterone like perhaps atrophy of the endometrium? Progesterone acting on the uterus once you have very low levels of estrogen? What's the longer term plan for your menopause journey?