High oestrogen levels - blood tests

[Namddf]

Recently switched from oestrogel to Sandrena due to symptoms returning with the new packaging.

I was on 4 pumps of oestrogel before and this managed my symptoms quite successfully until the new packaging debacle, so I have swapped this for 3 x 1mg sachets of Sandrena. I finally feel better again.

However, the GP says this is above the licensed dose for Sandrena and as my oestradiol levels were v high on my last blood test she wants to test again.

My levels on my last blood test (in May) WERE high - around 1400pmol. But the thing is, on anything less than 3mg of gel I feel utterly awful.

Ive got another blood test on Monday to check my levels. I did ask how accurate it would be as surely things fluctuate (for example, the last bloods were taken just before ovulation), but the GP said that my levels should be steady on HRT as HRT stops them from fluctuating so it will be a good indicator.

If my levels are still high I’m worried she will tell me to reduce my gel, but then I can’t function! I’m not convinced that she knows all that much to be honest.

Does anyone have any experience of high oestrogen levels? It’s like I need my levels to be super high to feel ok. Is that a thing? Am I putting myself at risk with 3mg a day?

I’m 42 btw.

2 sachets of Sandrena is equivalent to 4 pumps of Estrogel so you’re currently on the same as 6 pumps, which I couldn’t get prescribed even when my levels were below 100 and I felt like I was dying after I had my ovaries removed. If you’re at 1400 you shouldn’t be feeling any bad effects from reducing to 2 sachets. Maybe try splitting your dose and doing 1 sachet twice a day to even things out.

I know this is what the tables say, but there’s actually 0.75mg of oestradiol in a pump of Oestrogel and 1mg in a sachet of Sandrena, making 3 sachets equivalent to 4 pumps of gel.

It doesn’t make any sense to me?

I am also having the 3 sachets vs 4 pumps argument due to dosage. I believe it's due to absorption and the type of estradiol? correct me if I'm wrong and anyone knows better.

I'm on 4 pumps and/or 2 sachets and my levels are 100-150pmol/L and feeling rough as anything.

40, POI, HRT for a year...

@bellaciao explained this in a post about the new type of packaging for gel.

Bellaciao · 18/11/2023 10:22

Just to add - if it hasn't already been said - that Sandrena gel is nearly twice as concentrated as Estrogel - Sandrena is 0.1% and Estrogel is 0.06%, as well as being a different consistency as Jingling said, with different "fillers" (excipients). It is therefore a completely different product in this sense, despite the active ingredient being the same, and will be absorbed differently. It is not possible to make a direct comparison in terms of total oestrogen.

From Medicines.co.uk
Oestrogel
One gram of gel contains 0.6 mg of the active ingredient, Estradiol (0.06% w/w).
Each pump actuation delivers 1.25 g of gel which contains 0.75 mg of Estradiol.
Excipients with known effect: Ethanol.

Sandrena
Qualitative and quantitative composition
Estradiol hemihydrate corresponding to 1.0 mg estradiol per single-dose container.