Should I increase oestrogen or do I need something else

[Iusedtobecarmen]

Please help!
Started on HRT 6 months ago
Initially prescribed oestrogen 2 pumps per day and Utrogesten for 14 days(still having periods- although they were becoming infrequent).
I went on HRT primarily for anxiety as it was becoming horrendous. Low, flat mood at times as well(not depressed).

So I gave it 4 months and I couldn't really say that I felt much better. Sometimes okay, other times still the same.
So the end of AUG I upped my own dose to 3 pumps a day. And here I am now 6 weeks later and 6 months in, in total, and the same.

I'm really reluctant to see GP. When I first got prescribed, I spoke to a locum GP who was good, listened and he listened and got on straightaway with prescribing HRT. Second time I got the prescription though, I had an issue as Sandrena was given as no supplies of oestrogen. Not an issue with that, but that was also prescribed wrong. I had to kind of work my own dose to match the oestrogel.
Took a few phone call and visits to reception to put right.

They also, at times,haven't given me the right amount of progesterone. Like one box , per 2 oestrogen, so doesn't tally.
Anyway, what I'm trying to say, I don't have much faith in them knowing what to do, if I ask them.

Should I self medicate with 4 pumps per day as I know that this is okay. Or do I need something else- another form of HRT , or anti depressants alongside?

A lot of this depends on how old you are. If you are early 50s, you may need less estrogen than someone in their mid 40s.

How old are you?

It also depends on how much estrogen you are absorbing from the gel, if you are applying it exactly in the right way, etc. It can vary a lot.

Are you applying it to the inside of your thighs, or upper (outer side) of arms, that are clean, dry, no body lotion etc, no fake tan, and allowing it to dry (and not washing it off with a shower etc for at least an hour)? Have you tried exfoliating your skin with a loofah to get rid of any dry skin to see if that helps?

(And ideally, if you are doing all of that, your Dr could do a blood test to check your estrogen but it's often not that accurate.)

It might be worth looking at lifestyle measures as well (first) if you are not including them already.

HRT is good but it's only one 'weapon' in the management of menopause.

Do you do other things that can help low mood and anxiety?
Like exercising most days outside? Walking, jogging, etc- whatever you can do for an hour or so?
Or finding something like meditation or mindfulness? Yoga?

How's your diet? Any room there for more healthy eating without a lot of sugar?

Apologies of course if you are doing all of this, but as I said, HRT isn't the magic bullet for all meno symptoms.

Thanks for your detailed answer.
I'm 51.
Think I apply it correctly!
Now I'm using 3 pumps I do one on each outer arm and one inner thigh.
Spread it lightly.
I have a bath or shower at bedtime, not morning, so don't wash it off.
I do use body lotion, but again bedtime ,after shower. Same when I use fake tan really. But I haven't used that for ages as had lots of real sun!!
I put it in in the morning before getting dressed. It dries quickly.

I do exfoliate too!
Health wise, I'm pretty good. Slim, eat fairly healthy. Veggie for years, since a child. Don't smoke. Do drink too much though, which i know absolutely makes anxiety worse.
Walk loads. Fresh air every day. No formal exercise as such.
I have the Headspace app on my phone which I love.
I go to bed a bit late , but I sleep well, but combined with the drinking wine probably 5 days out of 7 , needs to be addressed. Some better bedtime times.

Should I stick with the 3 pumps then do you think?

I really think it's pointless speaking to the GP as although they have been good, it's been me guiding them.

I increased my dose from 2, to 3, to 4 pumps without going back to the GP as I was still getting menopause symptoms on just 2 pumps (night sweats, awful PMT etc) and 4 seems to be the right dose.
I figured that if I did eventually get a GP appointment, all they would say is, try a higher dose and see how it feels. I order the prescription online and asked to get more bottles (of Oestrogel) because I had increased the dose, and it has been approved the last 3 times, so I assume they are ok with it.

2 pumps is the absolute minimum dose, so it is likely that it won't be the right dose for a lot of people.

I switched from progesterone tablets (utrogestan) to a mirena coil as I didn't want the faff of having to remember to take the pills, or deal with bleeding every month, and while I had spotting for about 6 months but it stopped completely. It is also one less prescription charge!

I notice you say you spread the gel lightly - I understand that you have to rub it well in

how to apply oestrogel

The information sheet says to spread it. On the video the woman says to rub it in to make it dry more quickly. I’m not sure how much of a difference it makes and would be good to know if it makes a difference to absorption.

FWIW, my gynaecologist told me to spread it and think of butter on hot toast rather than trying to rub in moisturiser.

I thought it was meant to be spread like this too, rather than running like body lotion.

This debate on how to apply gel! It comes up all the time.

(Used it for over 12 years.)

I don't honestly know why the video (assume it's from Dr Newson) says rub in.
The video is quite recent and it contradicts other information that is out there.

The leaflet says not to 'rub in'. Besins says this -

Apply to top and bottom of one arm from shoulder to wrist. It is not necessary to massage or rub in Estrogel.

It's all subjective. You don't rub and rub like handcream or body lotion. I've read that some of the absorption takes place as it dries. So rubbing away until nothing is left means your hands are going to absorb some of it anyway.

I've not counted how much I rub it in, but as a guess, if I apply to my inner thighs it's something like down/ up then down/up, (so 4 strong swipes) from top of thigh to knee. The leaflet used to mention a template as a guide (I'm pretty sure it was the size of the leaflet- so about A4 size). It's more important to cover a large area, but not rub it in so it's all gone.

Two pumps is an average dose, the same as around a 50mcg patch. (there are 25mcg patches so that's around 1 pump of gel.)

Some of us get on ok with less. I feel ok on one pump but for bone density the dose is two.

@Iusedtobecarmen Your drinking may be an issue. If you are in the region of 10+ units a week you're close to the upper limit. (Not being critical of you, just from a health perspective. Alcohol is a depressive drug, not a stimulant.)

Maybe give the higher dose of gel a bit longer?

So I am on similar dose to you for similar time. I do have low mood and irritability but I think this is situational. I wanted hrt to address joint pain rather than mood but I had hoped that my mood might improve too. Anyway big positive impact on joint pain but nada on mood. I have concluded that my mood is almost certainly not hormone related given lack of improvement on HRT.

I don't know if this helps you at all. But I am confident the hormones are entering my blood stream given the improvements in joint pain.

Rubbing. Not running!

@MagpiePi
That's what I thought about GP. If they did say anything, it would be to maybe up my dose.
I don't fancy the MIrena though!!!

I probably do rub it like this already. I haven't watched any videos. Just read the leaflet. However, on my arm, I don't take it down to the wrist. I apply uf top of arm and shoulder and down to elbow.
I definitely drink more than10 units a week. Though I'm aiming mow for more drink free days.

@Jewel1968
See I have no other symptoms apart from the mood, so I can't say if it's working in other areas!
No joint pain.
No sweats or flushes
Only other thing is vulval irritation and I've got topical oestrogen for that.

2 pumps is not very much. Ring GP and meanwhile increase to 3 or 4 possibly? Ask GP is that's ok.

Please don’t up your dose of oestrogen without taking medical advice re how much progesterone you should also be taking. You need to make sure your sufficiently protecting your womb from the effects of the increased dose of oestrogen.

@Dontsayyouloveme Sorry, but it's fine to use 3 pumps of gel. The dose of gel can be 4 pumps a day without changing the dose of Utrogestan.

(4 pumps is mentioned on the leaflet in the gel.)

If this wasn't ok, the progesterone dose would be referred to on the patient leaflet.

Likewise, unless women have excessive bleeding on HRT, the progesterone dose is standard and only needs increasing if they are bleeding a lot.

I don't know anyone TBH who is on more than 200mcgs Utrogestan (on a cycle) regardless of amount of estrogen.

I've already upped to 3 since endof August.

As far as I know 4 pumps is OK.
And on 200mg Utrogestan for 12/14 days which is the correct dose.

I thought this too. My bleeding is light, same amount and duration as periods were tbh. Always been fairly light.

I switched from gel as was having to use 6 pumps, to spray at 8 sprays and now have patches. I didn't absorb the gel or spray very well.

@cleowasmycat
It's hard to know isn't it. Not sure what I'm expecting.
I did have a consultation booked months ago with Dr Newson but I cancelled due to the cost and saw GP.
Now I'm thinking perhaps I would have had better advice.

I'd increase to 4 pumps and you shouldn't run it in.
Also have a look at this brilliant facebook group

www.facebook.com/groups/384849495215750/?ref=share

Rub in!!

Think I will give it a shot.

I found the dispenser at my doctors surgery to be the most knowledgeable about doses - much better than the GP, so they might be worth a call. Also once you are going 3 pumps of gel, it might be easier to get patches - I currently do the patches plus one pump of gel.

I really wanted the gel to bloody work!