Already on max oestrogen and really struggling

[TulipsAndZombies]

I’m 41 and have been in peri for a few years, on HRT for about 18mo. I’ve been through all the forms and am finally settled on 2mg tablets plus a 50mcg patch and a coil. The tablets only go up to 2mcg and this wasn’t enough for symptom control.

It was fine for a few months but now all my symptoms are back and I’m really struggling. Does anyone else get this?

Even at 2mg tablet and 50mcg patch my oestrogen is only 336mmol which is low. All my other bloods are good, I don’t drink, exercise 4x a week etc etc etc.

I feel like I need a higher dose, but it always feels high? Is anyone in more?

I’ve got an apt with an NHS consultant at a menopause clinic next week and I’m really worried they will tell me there is nothing else they can do. I can’t work like this.

You're not on max oestrogen. Most brands of patches are 25, 50, 75 and 100 mcg. I'm on 75, but I don't take progesterone as I have had a hysterectomy. When you say you are on a tablet, is that oestrogen too?

Sounds like you need a bit of a MOT, some women don't absorb oestrogen through patches, or gel or whatever.

Sorry yes the 2mg tablet is equivalent to a 75mcg patch, so that plus the 50 patch should be similar to 125mcg patch, which is higher than the usual dose

Ah right, gotcha. Still think the best idea is to go back to the consultant/GP and ask for a review as you are still experiencing severe symptoms.

The problem with tablets is that a lot of the active ingredient (estrogen) can be lost in digestion. So a 2mgs tablet might not be giving you 2mgs at all.

You'd be better off using gel, where you can go up to 4 pumps a day = 3mgs estrogen.

Or a 100mcg patch.

Not many women use tablet form now partly as they carry a higher risk of blood clots (although that's more of an issue for older women.)

I've been told many times by my consultant (who's also a fertility specialist) that single blood tests for estrogen are not accurate (and I've also read this in medical papers) because the levels change over 24 hours. So I'd go by your symptoms, not just the blood test.

What symptoms do you have?

How's your diet?
Have you considered adding foods that work alongside estrogen such as soy products, flax seeds, and other phytoestrogens? Sometimes it needs a multi-factor approach, on top of hrt.

Thanks for your replies, I appreciate them. I’ve been on the 100 patch, tried multiple pumps of the spray and also the gel. Ultimately my GP thinks I don’t absorb the transdermal route well, as evidenced by poor symptom control and blood test results (acknowledging that they aren’t great to start with).

My symptoms are palpitations, insomnia, very dry skin and brain fog. Also tearful which isn’t like me at all!!

my diet is really good, lots of protein, fibre and good carbs. I make healthier flapjacks with flax in it, and also take various supplements.

The symptoms have been controlled well for a few months, they’ve just come back strong the past couple weeks.

Not sure how helpful this is but my sil uses the gel, she thought it wasn’t doing enough and her gp advised her to double up the dose - I’m NOT recommending just doubling your meds willy nilly but do go back to the doctor and see what else they can do.

ha! Thank you @TheChosenTwo that’s how I ended up with the 50 patch in addition to the tablets as I felt rough for weeks and couldn’t get a GP apt so just stuck a spare one on. Felt loads better. GP eventually said it was fine to continue given my blood results. Tempted to stick another one on frankly

My consultant gynae said he is a advocate of younger women on v high doses of oestrogen - so 150/200.

He has given me the go ahead to increase my oestrogen, I'm 46 and 100 isn't working.

Hopefully the consultant will say the same to you next week.

@Droolylabradors that is so reassuring to hear thank you!!!

I’m 47 and use 100mg oestrogen patch (I wasn’t absorbing gel after months of trying). 75 was too low for me.