What dose of estrogen are you on?

[ladygindiva]

Hi just curious, how much estrogen most ladies are finding necessary to alleviate symptoms. I've pushed myself up to 3 pumps of estrogel daily and have been on estrogel for six weeks after an unsuccessful 6 weeks on evorel 50 but am still getting distressing symptoms. Do I need to go up to 4? The insomnia is still killing me, I quite frankly am not sure how much longer I can take this. Especially interested in hearing from women who are similar in situation to me, I am 46 and still menstruating fairly regularly so also using utrogestan 200mg x12 days.

I have tried to make an appointment with the very esteemed private menopause practitioner Dr gray ( I am in Cornwall) but she is booked up until the end of October and can't schedule an appointment until then. Feel pretty down tbh.

I moved up to Evorel 75 from Evorel 50 a couple of years ago (oestrogen only) after I had a hysterectomy and also had my ovaries removed.

There is an Evorel 100 - would that be the equivalent of four pumps?

I'm thinking, if Evorel 100 exists, then presumably some women must need it?

But ... if you're still menstruating regularly your ovaries must still have some function. OTOH, best practice is to treat the actual symptoms of perimenopause, not play tick-box exercises.

What's your GP like - any use? My new GP is awful - hasn't even read the NICE guidelines or NHS advice. Makes me so frustrated.

Thanks for your response. I've tried about 5 gps at my surgery all pretty useless. Am now on a waiting list to go private. I feel lost.

I was lost until I came to MN and this menopause board, and found this community with knowledgeable and sympathetic posters. They have given me the info and the gumption I need to stand up to the GPs at my GP Health Centre (as well as my gynae surgeon!

You're not alone.

Hello @ladygindiva I'm also in Cornwall and on that waiting list! A friend goes and is very appreciative, she's been gradually moved up to a higher dose then the NHS generally suggests and is also on testosterone.
Me I'm on the floor with blasted anxiety, losing my mind. I know it's just chemical but I've put on a huge amount of weight, my confidence is wrecked, thirty years ago I would have been committed. Everol 50 is not enough now.
my GP is lovely but just a GP ( he honestly phoned his gp wife to check) and there are no menopausal clinics in Cornwall except the private one. We sat in our local last week for the first time, the lovely tourist trainee gp put on our table got told very firmly to step up and make a difference during her career. Apparently I wasn't very very scarey.

I’m not an expert but I’m a GP- I’d try the 4 pumps for a few weeks to see if things settle (I think 4 is the maximum licensed dose) but you’re still suffering then there’s a possibility your symptoms aren’t all coming from menopause.

That said, individual women respond differently to the various preparations so it may also be worth looking at trying an oral oestrogen or combined HRT. Hope you find someone to offer proper guidance soon!

@KateOr

Hello *@ladygindiva* I'm also in Cornwall and on that waiting list! A friend goes and is very appreciative, she's been gradually moved up to a higher dose then the NHS generally suggests and is also on testosterone. Me I'm on the floor with blasted anxiety, losing my mind. I know it's just chemical but I've put on a huge amount of weight, my confidence is wrecked, thirty years ago I would have been committed. Everol 50 is not enough now. my GP is lovely but just a GP ( he honestly phoned his gp wife to check) and there are no menopausal clinics in Cornwall except the private one. We sat in our local last week for the first time, the lovely tourist trainee gp put on our table got told very firmly to step up and make a difference during her career. Apparently I wasn't very very scarey.

Oh this has lifted me a little. Thank you for taking the time to post and pp who made me know I'm not alone. My anxiety and insomnia are overwhelming me and life feels indescribably hard. I'm going to persist with my self diagnosed 3 pumps and speak to ( another!) gp tomorrow demanding something to help me sleep or there is a slight danger I might top myself. Don't mean to be flippant or dramatic but sometimes this is just too hard.

@RedLemon

I’m not an expert but I’m a GP- I’d try the 4 pumps for a few weeks to see if things settle (I think 4 is the maximum licensed dose) but you’re still suffering then there’s a possibility your symptoms aren’t all coming from menopause.

That said, individual women respond differently to the various preparations so it may also be worth looking at trying an oral oestrogen or combined HRT. Hope you find someone to offer proper guidance soon!

Thank you so much redlemon that is useful advice, I think I will do this.

It's horrible for you that you still feel it's not working. What symptoms do you have?

To be honest, I'd not keep increasing your gel so fast. I know everyone is different, but I started on half a pump (I was almost 53 and my periods were petering out) and only moved up very slowly to 2 pumps in a couple of months. I found 1 pump helped a lot but I needed a bit more to help me through the night with sleep and overheating.

The other thing is, HRT is great BUT I think we all need to do other stuff to get on top of symptoms. Exercise is really recommended - at least 30mins a day to get out of breath - and really make an effort to have a healthy diet with loads of fruit/ veg / oily fish/ pulses etc ,and reduce refined carbs etc. Some meno specialists also suggest yoga and mindfulness exercises (using apps) to help psychological issues.

What are your worst symptoms?

@RedLemon

I’m not an expert but I’m a GP- I’d try the 4 pumps for a few weeks to see if things settle (I think 4 is the maximum licensed dose) but you’re still suffering then there’s a possibility your symptoms aren’t all coming from menopause.

That said, individual women respond differently to the various preparations so it may also be worth looking at trying an oral oestrogen or combined HRT. Hope you find someone to offer proper guidance soon!

But the transdermal HRT routes (patches and gels) reduce the risks to near-zero, don't they?

Also, if sleep is an issue are you following a 'sleep hygiene' lifestyle?

Admit I haven’t read all the replies but if you’re still having periods something to consider is taking the mini pill and then taking one utrogestan every day rather than the cycle type way. I found the utrogestan really helped with my insomnia and wanted to take it all month round and by taking the mini pill as well (as this also gives you progesterone) you can level out the amount you’re taking over the month and take the utrogestan every night which stops the ups and downs. And clearly you have contraception covered as well (if that’s any interest/ issue to you).

I am 40 and in early menopause due to autoimmune issues and take 4 pumps of oestrogel every day, one utrogestan at night and the mini pill.

God yes I'm obsessed with sleep hygiene. As far as I'm aware I follow all the rules.

The insomnia to be more precise is caused primarily by a tinnitus that keeps me awake. A low rumbling vibration in my ears. I can't find any answers for what is causing it but it is driving me insane.

@Bagelsandbrie Out of interest, why the doubling up on progestogen? Is the mini pill for contraception? It's just that the progestogens cause so many women side effects that I'm wondering why :)

@ladygindiva

The insomnia to be more precise is caused primarily by a tinnitus that keeps me awake. A low rumbling vibration in my ears. I can't find any answers for what is causing it but it is driving me insane.

Have you seen an ENT specialist for that?

Thank you bagels this is something I'm considering but am a bit nervous without gp blessing. I may just go for it. Does this more continuous lower dose of progesterone level out the hormonal variations? I've noticed my tinnitus and insomnia is waaay worse during and for approx 1 week following period.

I’m early days and on two pumps. I also have low ferritin so have three months’ of iron supplement. I’m waiting til that’s finished before I assess my symptoms and tweak my dose. My GP advised me to play around with the doses up to four a day until I found the best dose for my symptoms so it’s fine to do I think. Just make sure you give each change a few weeks to bed in.

@ladygindiva

Thank you bagels this is something I'm considering but am a bit nervous without gp blessing. I may just go for it. Does this more continuous lower dose of progesterone level out the hormonal variations? I've noticed my tinnitus and insomnia is waaay worse during and for approx 1 week following period.

I find it works best for me. It was the regime prescribed by one of the consultants at Newson Health clinic - have a google. If you can afford it it’s well worth having a private consultation with one of their doctors. They can then write to your GP for you and you can continue their recommendations on the nhs.

@SpindleWhorl transdermal reduces the risk of DVTs/clots to near zero so these preparations are the first port of call, but it’s still worth considering oral preparations for some women depending on risk factors etc.

I definitely agree with other posters about addressing the tinnitus with an ENT assessment too though.

This website is great for more info too- knowledge is power.
www.menopausedoctor.co.uk

Good luck!

Jingles it definitely appears to be worse (tinnitus) at certain times of the month and at the end of last year I went two months without a period and it disappeared altogether for a few weeks. I'm sure that means it is linked to my cycle somehow?

Cross post with Bagels!

[quote JinglingHellsBells]@Bagelsandbrie Out of interest, why the doubling up on progestogen? Is the mini pill for contraception? It's just that the progestogens cause so many women side effects that I'm wondering why :)[/quote]
I like to stay on the mini pill as I don’t have periods whilst on it. I can’t stand them. I have lupus and other issues and my periods are always full of huge clots so I don’t want them. The contraceptive side is good as well but the main reason is it stops my periods completely.

I had surgical menopause at 34 and have been on evorel 100mcg for last 12 years. Never had any hot flushes thankfully.

Overwhelmed with gratitude by the way for all of your useful responses. Sometimes this feels such a lonely situation but I always feel bolstered after a visit to this board and like my hope has been restored. Thank you. Will have a more thorough read later.