Is there a maximum amount of estrogen you can take?

[Luckycatt]

I'm on evorel 2x50 patches, but feeling recently like my symptoms are coming back. Over last 18 months gone from 50 to 75 to 100 and so I've been here before and increasing the estrogen did help.

My pharmacist (he's the meno 'expert' at my surgery) said 100 is the max they'll give. I don't know if this is some sort of regulation? Or just their own policy? They've not exactly been very reliable with their advice and guidance, and I like to go into a conversation knowing as much as possible. Anyone on more than 100?

I don't know the answer to that specific question but if you are having symptoms still on a high dose, can you have a consultation with your GP? You could try having your estrogen levels checked.

The max dose for tablet form is 2mgs a day - that's all that is available.

With gel, the maximum is 4 pumps a day = 3mgs.

Roughly that is the same as the patch you use.

This is from the Newson website

1. One 50mcg patch is roughly equal to 2-3 sprays of

Lenzetto

1. One 50mcg patch is roughly equal to 2 pumps of

Oestrogel

1. One 50mcg patch is roughly equal to 1mg estrogen only

tablet

What else are you doing to try to control your symptoms ?(eg lifestyle measures) and what are the symptoms that are coming back?

Ask to be referred to a gynaecologist at the hospital.

Ideally yes, @EndlessMagpies but judging by the news today on 7million on waiting lists, it's likely to be a very long wait. Some GPs have posted on this forum recently and they say that waits for non-life threatening things can be years.

I know, but if you don't ask, you stand no chance at all do you?

The only other alternative would be to go private for those who can afford it (I must admit I'm beginning to wonder whether all this is deliberate and designed to make more and more people do that).

If you ask your GP for a blood test OP they can assess how much estrogen you have. They ought to agree to that. You don't need a meno clinic for that.

If you can afford a private appt, that's one other option.

If you can't, the consultant (Dr Heather Currie) who runs Menopause Matters website and is an NHS gynaecologist in Scotland, answers questions like yours by email for £30. The fee goes towards running the website. The link to her email is on the Home page.

I do know that many women are on more than 100 but I think that is 'off licence' which means it is not specifically licensed for that amount but it can be prescribed. I'm on a couple of FB groups and there are women on 200 prescribed by their GP or Meno specialist

Apparently Gp's have a 'legal/ legitimate ' amount they prescribe and I think this is around 100mg.

However, I had a consult with Louise Newson clinic this week and mentioned this (as my Gp had said the same to me) and the response was - this is nonsense. Babies are given calpol and nurofen (combined) when it's a contraindication why shouldn't they prescribe a higher dose of estrogen

They also said you can do bloods on two different people on two different doses and their levels are the same, which means different people require different levels to feel normal.

Hope that makes sense

This is a very good point.

Is there a relationship between bmi and how much oestrogen to use? The higher the bmi, the more oestrogen you need?
I remember reading about this a while ago, but haven't had a chance to follow up

No.

The only relationship between anything and dose is how far into menopause a woman is, or her age.

Younger women often need more as they are in peri (and they would normally have more than women in their 60s or 70s+)

apparently estrogen can encourage fibroids to exist/persist/grow. Fibroids can cause erratic bleeding is why I paid attention. Also high Estrogen is linked to cancers. Like any medication, there are good reason to take the minimum effective dose.

I haven't read the full thread but I started HRT at 41 and I'm on a 100 and a 50 microgram Estradot patch via the NHS.

Just marking my place - I'm on 100mg estradot and don't feel that it's enough.

And to add to what @UsernameFail said, there are different absorption rates too, so two women can be on the same dose but absorb different amounts. I'm sure I get less from Estradot as considerably less sticky than Evorel patches.

My gynae says that for a lot of women that the patches can run out of steam before they get to the changeover day. For me if I’m on 100 patch she suggested supplementing with a pump or 2 of gel on the last day.

Have you tried changing your patch over slightly earlier or anything like that to see if that makes a difference?

I know from my own experience I feel more consistent on the gel than patch.

No I haven't @PortiaWithNoBreaks as I'd then run out (my GP will only prescribe three months at a time 😣). I have recently started to take Testogel so hoping that will sort ongoing symptoms (early days but already feel better).

That's interesting @PortiaWithNoBreaks you should say patches run out of steam as I've felt that but thought I was imagining it.

A friend also mentioned she noticed at certain stages of her cycle she required a higher dose of Everol (she's on 50mg)

I went private and I'm on 2 x 100 patches.

Wasn't getting notifications - thought nobody had replied 😢

Thanks for your replies, this is really, really useful. In particular, your experiences of patches wearing out before changeover day. Originally, before I had 2 50mg patches, I was on 1 x 50 patch and topped up with gel, 2 pumps. This worked so well for me and I felt the best I'd felt since peri kicked in. When there was all the chaos with shortages of gel, I was switched to the 2x50 patches, and it never worked quite as well, and has deteriorated.

To answer some of the questions - I'm under 50, still having periods. I've had blood tests (which were to rule out any other medical conditions, as my GP said what PP has said, that measuring estrogen once tells us pretty much nothing - I was prescribed HRT based on symptoms and the fact I was over 45) and my estrogen was "on the low end".

I used to have pretty regular reviews with the pharmacists, but that's petered out and the answers I get depend on which pharmacist i get - one of them keeps trying to put me on anti depressants, despite the fact I've absolutely no history of depression. But one of my most debilitating symptoms is my mood swings. I like to go into these meetings armed with as much info as possible so that I'm not fobbed off. Last meeting I was told 100 is the maximum and I didn't really push it at that point.

Thank you so much. I think I need to go back to gel.

Should also add - I'm on sequi for 1 patch and just estrogen the other. So I do get progesterone too.

Along with the hrt I've been upping my exercise/movement, cleaned up my diet (to some extent), go outside more, cold/open water swimming (for mindfulness and it's great for the temperature regulation!), and mindfulness/breathing.

I'm on 5 pumps of oestrogel. Went private as no one at my GPs has any idea about the menopause. Was on four pumps but still having symptoms, blood test showed lowish levels so was upped to 5 pumps. Notes sent to GP and they give me a prescription every three months.

This is interesting. Both my friend and I are on the Evorel 75 patches, and have noticed symptoms returning- me achiness and fatigue, her hot flushes and drowning in sweat.

I started on the 50, then the 75 and when I went private was advised to go to doubling up the 75's. After three months I felt my symptoms returning and had some bloods before my follow up which showed my levels were still low so we went up to 2 X100 patches.
If your symptoms are returning I'd go back.