High dose HRT & POI

[spinkupromise]

Hi everyone, so sorry if this has been asked before.

I was diagnosed with POI / Early menopause when I was 36, 40 now. Without HRT my Estrogel levels are below the measurable level, IE: ZERO.

I am currently on (as a minimum) 4 pumps of Oestrogel, utrogestan 200 X 14 days, and 1/5th of a sachet testosterone daily.

I get regular blood checks and all are normal except E2 levels are consistently low (110 - 150pmol/L).

I have increased to 5 pumps, and I have changed gel to a different gel brand (in sachets and pumps), and I have also tried patches in 100mcg.... my oestrogen levels never really rise :-(

In the past I have also tried tablets but want to avoid these again, besides they didn't raise estradiol levels.

Just wondered if anyone had some magical suggestions, ways to better absorb the oestrogen, different techniques? Application sites? Twice a day rather than once a day application? Combination of patch AND gel? IF you get your oestrogen levels checked, where are you at? (I know some people advise against this). I have osteopenia from the menopause and need to be regularly checked, I need the health benefits oestrogen brings, rather than symptom relief!! I don't want my next DEXA to show osteoporosis. I am already suffering with osteoarthritis from this shitty deal I've been handed!

Thanks for reading... sorry for the essay!

What has your specialist advised? If you don't see one, you must ask your GP!

I asked mine recently about blood tests for estrogen levels and was told that it's almost impossible to get an accurate reading because the blood has to be taken and monitored 24/7 (my consultant is an top expert in endocrine/ fertility / menopause).

The dose for prevention and treatment of osteopenia or osteoporosis is given on the type of hrt. eg with gel, it's 2 pumps a day. This obviously applies to women post meno who don't have much estrogen naturally.

You really need a DEXA every 2 years and be guided by that as to the dose of estrogen you need. Are you having these? I know some women only have them every now and then, but every 2 years is best if you have risks.

Consultant 1 says you can't have more than 2 sachets/4 pumps

Consultant 2 says have up to 6 pumps

Gynae who's fairly au fait with menopause says you need more estrogen

All menopause specialists and I also see an endocrinologist for hashimotos but he doesn't advise on HRT

Last DEXA was in March/April 2023 so I am up to date.

🤯

That must be frustrating.

So what's the score for your osteopenia at the moment?

Are you doing other things like getting enough calcium in your diet and specific resistance exercises?

Calcium, phosphorous, magnesium etc levels are good already, advised not to take extra supplements due risks outweighing benefits.

Taking Vit D supplement

Currently can't exercise due to joint pain: hip, wrist, fingers, knees. Previously VERY fit and healthy, running, netball, swimming, cycling, weight training.

I am still trying to go walking and still trying to do SOME resistance training where I can but its quite limiting the joint pain, which is why I want to increase Estrogen, or oestrogen absorption again to counteract this because its made worse when oestrogen is low.

My last T score was -2.1 on Femur and -1.3 on spine.

I don't know what to say, really.
My consultant says categorically that estrogen measurements vary over 24 hours and it's not possible to get accurate readings. I asked because I am partly on HRT for my bone density but didn't have POI and am older than you. (I've been on it for 15 years.)

Have you had previous DEXA scans? Can you see an upward trend on HRT between the scans?

There is no rule about only 4 pumps, it's more about protecting the womb lining. Has anyone suggested the Mirena coil? You could increase your estrogen without worrying about the lining if you had a Mirena.

I was given a retrospective diagnosis of POI following an assessment by a menopause specialist in my early 40s (my Osteoporosis was picked up on a DEXA in my late 30s). I'm due my next DEXA in 2024 and hoping that three years on HRT including testosterone will have made a noticeable difference. I'm on 150mcg patches as in addition to being concerned about my bone health my symptoms have been pretty unbearable. I'm no expert but 4 pumps for someone in a similar situation doesn't seem particularly high. I have had my estrogen levels checked a few times as it's a good indicator of where things are, taking into account where I am in my cycle. Same with testosterone.