What would be the impact of missing your oestrogen dose?

[Mustardfan]

Does anyone know how long it stays in your system? If you took a patch off and didn’t replace it, would there still be some in your system after 24hours or 48 hours? And is there likely to be any immediate impact on you?

I know from when I’ve had to had cortisol blood tests that you have to stop taking oestrogen for 6 weeks prior to any blood tests as it takes that long for it to completely leave your system (oestrogen affects cortisol blood tests so they ask you to stop taking it).

Within a few days I'm getting symptoms. Irritable, angry, pmt, jittery etc.
I did an experiment once. Three months on my patch ( 75) Oestrogen was 462. Then I took it off for two weeks ( maybe less) Oestrogen was non detectable.

Thanks so much Afterfire, your reply was really helpful as I’m asking my GP for a cortisol test, and I was wondering if I would have to stop my HRT. How did you feel for the 6 weeks when you stopped it? Have you had to do it more than once?

Runaround50 thanks for your reply too, it seems to have come out of your system really quickly.

There is usually guidance on the product which says that missing a dose may cause spotting. If you are on a sequential patch you should try to wait until the withdrawal bleed at the end of a cycle before stopping (so a complete 4-week cycle.)

Oh I’m pleased I could help 😊

I felt a bit rotten but not as bad as I did before I started the HRT. It’s just annoying more than anything else! I did have a bleed though which was irritating (I normally take the mini pill as well as oestrogel and utrogestan and I don’t have any bleeds at all on HRT, I’m only 41 but in early menopause due to autoimmune issues).

If your morning cortisol level is low then they should refer you to an endocrinologist who will then do an sst test (google this) so I would wait till you know the result of your initial cortisol test as you can’t take the HRT if you’re going to have an sst test - same as before, can’t take oestrogen for 6 weeks or longer prior to testing.

(Meant to add- once they know you have Addison’s / adrenal insufficiency if you have low cortisol you wouldn’t need to keep having tests - so you can start the replacement steroid treatment and start your HRT again).

This group may be useful -

www.facebook.com/groups/175948922471395/?ref=sharewww.facebook.com/groups/175948922471395/?ref=share&exp=9594

Thanks Afterfire. So would I need to stop HRT for the initial test with my GP? If so, I wonder if my GP might agree to skip that and just refer me to an endocrinologist. I’m imagining that I’ll have to wait quite a while for an appointment, and I don’t want to keep stopping and starting - or would they treat it as quite urgent if the GP’s test showed up low cortisol?

If you have a cortisol test whilst taking HRT it is useless because HRT (specifically oestrogen) leads to falsely elevated cortisol levels. (Mine were 260 on HRT, which was enough for endocrinology to discharge me (!)- I got a second opinion and stopped my HRT for 6 weeks and re tested and my cortisol was undetectable, it really does make a huge difference). The first point of call is a morning cortisol blood test which needs to be arranged via your Gp, and you do need to stop your oestrogen for that as above - they probably won’t refer you straight to endocrinology without that.

If your morning cortisol is under 200 it should mean a fairly urgent referral (google adrenal crisis - it’s an emergency and you don’t want one of those).

Thanks. I’d be really interested in hearing more about your story, it might help me navigate my own situation. Would you mind if I PM’d you?

Go ahead… although being honest my own medical history is super complex! I have lupus, sjorgens, Addison’s, hypothyroidism, early menopause, pituitary tumour issues, anaemia etc….!! So I’m not sure how relevant my stuff will be as it’s all so linked and complicated but I will do my best to help. 💐

You guys sounds like you live in a similar world to me!

I have a pituitary tumour that causes increased prolactin and Conn's Syndrome (adrenals producing too much aldosterone). My DHEA is extremely low and my cortisol does odd things - it's normal in the morning and evening, but low during the day. I pass the short synacthen test (although my middle score only just scraped through). No one has ever mentioned HRT to me before though!? I use gels and tablets. Can't remember when I started though, it might have been just after the SST - going to check dates!

Lots of endocrinologists don’t even understand cortisol at all, let alone how oestrogen affects cortisol levels. I’ve had to become my own expert in Addisons etc as I’ve been nearly killed by the sheer incompetence of various consultants at Norfolk and Norwich (I’ve made two formal complaints about this). I simply don’t believe anyone medical anymore and always do my own research. There are leaflets out there that do mention the whole avoiding oestrogen thing though for example -

www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/short-synacthen-test-sst/ (Half way down the page).

If you passed the sst and were taking oestrogen at the time or hadn’t stopped it for 6 weeks prior the results are useless it needs re doing.

Lots of endocrinologists will tell you that they will adjust the results to account for the HRT and that is also complete nonsense because there is no way of knowing how much an individuals cortisol levels will be affected by HRT so how would they know how to adjust the results?! Madness. All that they should know is generally peoples cortisol results are much higher when on HRT or the combined pill.

This Facebook group is amazing -

www.facebook.com/groups/175948922471395/?ref=sharewww.facebook.com/groups/175948922471395/?ref=share&exp=9594

@Afterfire sadly I can well believe it. Your journey sounds like it's been sh*r and complex.

Every single discovery has been made by me. I've had to do my own research to unpick what is wrong with me. Looking back, anyone with medical knowledge should have spotted it. I paid for private tests, pushed for tests via endocrinologists when I could. Hopefully I'm in the final straights of unpicking it all and getting the treatment I need. But the lack of knowledge endocrinologists have is shocking.

I think my issues is Conn's Syndrome and that there is a tumour on my adrenals as well as on my pituitary gland. Two rare endocrine tumours suggests MEN1 also unfortunately.

Afterfire it sounds like you’ve got a lot to deal with, and I’m sorry to hear that your endocrinologists haven’t been as knowledgeable as they should be. I’ve tried to pm you, but it keeps coming up that your username is invalid. I don’t know why.