Stomach pain/oestrogen gel

[NaughtipussMaximus]

Hello wise ones. Hoping someone can help me with a possible side effect from my oestrogen gel, or at least reassure me!

I’m on a pretty high dose of oestrogen gel (sandrena sachets) and wasn’t feeling much benefit until I spoke to my consultant again in November and discovered I hadn’t been applying it correctly (I’d been rubbing it over a large surface area until it all sunk in, instead of a small area and allowing it to dry). Anyway, after I started doing it properly I soon felt a lot better BUT since then I’ve developed really bad stomach pains. I was already having some reflux issues that have plagued me for years and these have worsened this month, but a newer development is tummy cramps, especially after eating. NOT period pain type cramps. It says on the leaflet that tummy pain is a common side effect but I’m not sure if it means period pain type cramps or actual stomach pains?.

I’ve spoken my GP who’s sent me for blood tests to see if I have a h pylori infection (thinking it may be an ulcer) but I couldn’t get a nurse’s appointment until early January. After I’d been applying the gel correctly for a month, my consultant requested I have a blood test to make sure I’m now absorbing enough oestrogen, and I just got those result today - serum oestrodial was 2400 pmol/L which seems a bit high to me.

I have massive health anxiety so am convinced I have stomach cancer even though my GP totally reassured me about this. So please if you think it might be that, don’t say anything! I don’t want to think more about that aspect of it. Please just can anyone tell me if they had similar side effects to high dose oestrogen and also if that level of oestrodial is particularly high? Thanks!

So as not to drip feed I’m on 3ml sandrena gel per day and it’s for premature menopause (started in late 30s but took several years before anyone would take it seriously, so only been on this dose for a few months and only applying the gel correctly for about 6 weeks.

Do you mean your stomach or is it more like period pains? Your stomach is quite high up in fact- just below chest height. why are you suing 3mgs gel? advice? You can reduce it to whatever works for you.

I've googled so you don't have to , and yes, stomach and intestinal pain is a common side effect. What you are experiencing is highly likely to be related to the Sandrena, and not a separate underlying health condition.

If you are feeling sick it's probably down to using too high a dose- it's like morning sickness with early pregnancy,

Are you taking any progesterone as well? I’m guessing as you’re in early menopause you should be if you still have your womb? (Generally you can either have the mirena coil fitted which covers the progesterone side, or you can take utrogestan tablets - either alongside the mini pill for contraception or alone). Progesterone often causes stomach issues for a lot of women. Many find it better to insert the utrogestan vaginally every other night rather than take the tablets orally for this reason.

That’s a v high dose. Maybe you need to drop back. Contact consultant and discuss.

Thanks for reading and commenting!

@JinglingHellsBells it’s definitely my stomach - the cramps after eating are just below my sternum, and when it’s the reflux/heartburn it’s behind my sternum, around the base of my oesophagus.

I’m on 3ml because that’s what my consultant (consultants actually, one private, one nhs) put me on, because lower doses weren’t working (probably because I wasn’t applying it correctly!). Interesting re pregnancy - I had terrible reflux when I was pregnant but while I also had bad nausea I didn’t have tummy pains, so I hadn’t really made that connection.

@BitOfFun thank you for googling! That’s reassuring!

@Bagelsandbrie yes, I’m also on progesterone - utrogestan tablets as I can’t tolerate a coil. But I didn’t take it this month for complicated personal reasons though I don’t usually miss a month.

@justilou1 thanks - I emailed my consultant yesterday when I got my blood test results back from the GP but I got an auto reply saying they don’t give advice over email any more and if they need to eg advise a dose change they’ll write to my GP which will probably take weeks over Xmas! And tbh my GP surgery isn’t great esp with covid - you call for an appointment that day and speak to whoever is the duty doctor on call, who can often be a locum, and none of them are experts on HRT.

I think I’m going to drop my dose down to 2ml and see if that helps. I did speak to one of the GPs earlier this week who had nothing useful to say re the HRT but has prescribed a high dose of omeprazole but I don’t really want a high dose of one drug to combat a high dose of another if I can avoid it!

Thanks again!

In all honesty, after using gel for 12 years and reading forums/ talking to women, I've not come across anyone saying they have tummy pain from gel. Tablet form HRT can cause tummy issues but transdermal rarely if at all.

It sounds like acid reflux and the only way you will find out other than having a endoscopy or other tests is to take the Omeprazole. If it works, then it looks like acidic reflux.

Hmmm that’s less reassuring! I mean, I have had reflux issues for years so there’s definitely that going on but this does feel different. Or rather, I’m getting reflux alongside the tummy pains. I wasn’t getting the tummy pains until I started applying the gel correctly and my serum oestradiol looks quite high. I really hope it isn’t anything else. It’ll probably be ages before the GP Will even consider referring me for a gastroscopy.

Bloody Instagram has just come up with an ad telling me to contact me GP if I have tummy pains for more than 3 weeks as it could be cancer. That’s helping my state of mind!

What else are you using? Utrogestan? Norethisterone? Mirena coil? If you have a womb you will be using something so it's worth thinking about that. Anything that's tablet form can affect the guts.
Also, some people - men and women- find that in menopause things like digestive issues can occur anyway. It could be something physical like a hiatus hernia that's become worse possible with a hormonal connection ( ie hormones relaxing the valve.)

You could do 2 things IMO

1 Change from Sandrena to Oestrogel - they are similar but very slightly different and the gel is in a pump bottle so it's easier to apply less than whole sachets.

2 Why not just stop the Sandrena for a week or so and see how you feel? Or go right down to 1mg?

How old are you now and are you using it for prem meno or because you have symptoms , or both? :)

Sorry I saw you are using Utrogestan. That can cause tummy issues but usually only on the days you use it.

If that is the cause you can insert the capsules vaginally.

Thanks @JinglingHellsBells I’m 42 now, have had horrible menopause symptoms since late 30s but only diagnosed with early/premature menopause in September 2019 (saw a infertility expert as we’d been TTC no 2 for years without success - I had a scan and she said I have the ovaries of a 55 year old and my AMH was virtually non-existent) . Obviously fobbed off before that as I was ‘too young’ for it to be menopause. It took until March to see a menopause consultant then because of Covid (I assume) it took another couple of months before the GP managed to prescribe me with my HRT and I started on 0.5ml to start with due to a prescribing error! Eventually in May I got moved up to first 2ml then over the summer to 3ml, then it turned out I wasn’t absorbing it properly so in mid November I changed the way I was applying it. Then finally I started getting relief from the worst of my menopause symptoms BUT then the tummy issues started. I don’t think it can be utrogestan as I had to miss my 12 days this month.

I’m going to take the higher dose of omeprazole and also drop down my oestrogen and see if it helps. I know strictly speaking I should try one or the other rather than both but I’m desperate to have some relief by Xmas!

My dad has had ulcers as has my uncle and apparently that ulcers/reflux can have an element of heritability/genetic susceptibility so maybe it’s just that as I’ve had reflux on and off for years.

I also have a very rare chromosome abnormality which everyone tends to blame for anything that’s wrong with me!

Problem with dropping back without knowing what you’re doing is that it can then affect your bone health and your cardiovascular health - increasing your risk of osteoporosis, stroke, heart attack & forms of dementia. I think you need to call your GP first.

The stomach issue may be something else entirely and it may be just coincidence that it seems to tie in with the oestrogen.

I am thinking more b12 deficiency, Addison’s disease, lupus, coeliac even, crohns, Ibs.... any or all of them can cause stomach pain and most of them are autoimmune conditions- early menopause is very common in women with autoimmune conditions (I am 40 and I have early menopause, Addison’s, lupus, sjorgens, anaemia, pituitary tumour etc etc etc).

I’ve already talked to my GP this week and they were useless! I’m not speaking to my consultant for another 3 months though I have emailed her with my blood test results. Even 2ml is a high dose so I don’t think my bones etc will suffer too much until I manage to speak to her - whereas I’m in significant discomfort every day with this at the moment. I’m also scheduled for blood tests to rule out h pylori and have increased my anti reflux medication as instructed by the GP.

@justilou1

Problem with dropping back without knowing what you’re doing is that it can then affect your bone health and your cardiovascular health - increasing your risk of osteoporosis, stroke, heart attack & forms of dementia. I think you need to call your GP first.

Bone health takes years to decline- DEXA scans are done very 3 years @justilou1 because bone turnover is very slow.

Likewise heart health- nothing is going to change in a month.

The OP is going to reduce from a very high dose - 3mgs- to 1mg- just to see if it makes a difference in the short term.

The advice on stopping HRT altogether is to do is slowly, but that applies to women who have used it for years, not just a few weeks.

Asking the GP is likely to be a waste of time as they know so little about menopause and HRT doses.

@Bagelsandbrie I’m pretty certain it’s not b12 related - I do have b12 deficiency but I get the b12 injections every 10 weeks and have done for the last five years, plus in September my levels were tested and were 390 so I should be ok there. Probably not anaemia or thyroid or diabetes either as all those things were tested for in September (actually because of some other unrelated issues I was having which have no resolved). Could be crohns or ibs or similar though I had colofac prescribed in November, which didn’t help. I do agree that correlation doesn’t mean causation but the tummy problems started when the oestrogen dose increased (or rather when I started applying it properly). But I’ve also been under a lot of stress recently (who hasn’t?!) so it could also be linked to that! It’s very frustrating and it’s so tiring to keep having to push and push for the GP to do anything!

@NaughtipussMaximus

I’ve already talked to my GP this week and they were useless! I’m not speaking to my consultant for another 3 months though I have emailed her with my blood test results. Even 2ml is a high dose so I don’t think my bones etc will suffer too much until I manage to speak to her - whereas I’m in significant discomfort every day with this at the moment. I’m also scheduled for blood tests to rule out h pylori and have increased my anti reflux medication as instructed by the GP.

That's right.

Most women are on the equivalent of 1mgs of estrogen.

Some go up to 2mgs if their symptoms are bad or they are younger.

Using 3 mgs is quite unusual but not unheard of in younger women.

I think you need- when you can- have an endoscopy. I know a close friend who had had acid reflux for years and when they had an endoscopy it was found to be a mechanical cause- hiatus hernia- where the valve at the top of the stomach didn't close properly. They still have to take Omep but they now know the cause.

Yeah I think you’re right. I have private insurance through work but it only covers us once we’re been referred by the GP... I’m planning to push for a referral

if the h pylori test comes back negative then I should be able to get a endoscopy or gastroscopy relatively quickly.

Thanks for confirming dropping my dose of oestrogen temporarily shouldn’t damage my bone health... it might very well be unrelated but I assume won’t hurt to try.

I get that, but OP is young and her natural oestrogen level should be higher than a post-menopausal HRT candidate. Her needs are quite different to those of a 50+ woman.

According to the blood test I had a couple of weeks ago, my serum oestradiol levels are about twice as high as a pre-menopausal women in her ovulatory phase, so that seems pretty high, and much higher than a post-menopausal woman. So hopefully I do have enough.

@justilou1

I get that, but OP is young and her natural oestrogen level should be higher than a post-menopausal HRT candidate. Her needs are quite different to those of a 50+ woman.

A few weeks or months won't make a jot of difference.

The longer term effects of loss of estrogen take years to be apparent.

This is why some women say they have 'sailed through the menopause' only to find out that 5 or 10 years down the line they have severe bone loss or early heart disease.

She's not talking of stopping hrt- she's reducing for a very, very short period of time.

I have private insurance through work but it only covers us once we’re been referred by the GP... I’m planning to push for a referral

Your GP should 'rubber stamp' this. Have you used your insurance before? You just need to say to your GP that you want some investigations done and will relieve the NHS of the strain so could they draft a letter to the insurance provider.

You may find your insurance provider offers a remote GP service at the moment so all you do is contact them to book a phone call with their GPs, explain the symptoms and they may email you a referral.