Oestrogen levels qu

[kos88]

just looking for some thoughts please: been taking transdermal oestrogen past 3 years, with progesterone. Generally 2 pumps. When I wanted to start testosterone my gp did blood tests. Testosterone was nil, oestrogen a big high. I was told to reduce to one pump. Then test again six weeks later where my oestrogel was even higher (2,000) and now told to reduce to one pump every other day.

that was about a month ago and now I’ve had a weird early bleed and night sweats for the past week, waking up frequently at night. Sleep was the one thing that HRT had really sorted out.

i have a meno team appointment in February. I did say to my Gp maybe oestrogen is high at points because I’m not post-meno and still have some of my own estrogen but she didn’t think that was the case. Now I’m being sent for pelvic scans etc as they clearly think something is wrong.

Anyway. Surely surely with night sweats now I can’t have really high estrogen?? The reduction has upset everything now it seems.

There is a huge misunderstanding over blood tests and estrogen when using HRT.
Basically, they are not accurate.

I'm sharing what I've been told by my consultant. They are one of the best in the UK for menopause/fertility.
In over 15 years on HRT I've never had a blood test because they've told me they are not accurate. They are only accurate if done constantly over 24 hours.

Why are you with a 'meno team'? Does this mean you've a history of some issues with meno?

TBH and if you can afford it, I'd suggest you find a private consultant who can discuss this with you. The fact you've got symptoms back shows you need more estrogen.

Thanks for this, I’m aware the tests aren’t accurate but have been instructed by my GP who spoke to the gynae to reduce the dose.

im being referred to the meno team and have an appointment in feb so I’ll probably hold on for that I think. I initially felt a bit better in mood on the lower dose of estrogen but the sweats at night, upset stomach and not sleeping aren’t a good sign for me.

sorry to add I’m not sure why I’ve been referred to the meno team but possible relates to history of depression and feeling that mood symptoms were one issue I have currently maybe related to peri.

Thanks for this, I’m aware the tests aren’t accurate but have been instructed by my GP who spoke to the gynae to reduce the dose.

There is a lot of misunderstanding about HRT and menopause even among some gynaecologists.

This is a medical site, written by menopause specialists.

https://www.mymenopausecentre.com/gp-resources/oestrogens-and-blood-testing/#:~:text=Routine%20blood%20testing%20is%20not,can%20be%20prone%20to%20error.

Why might I check my oestradiol levels if I am taking HRT?

Routine blood testing is not recommended when you are taking HRT. The blood level is not predictive of your response to HRT or the symptoms experienced.

The oestrogen level of an individual does not predict therapeutic effect.

This is because blood tests to check your oestradiol levels can be prone to error. The blood level can fluctuate widely over 24 hours and blood testing cannot tell the difference between the oestrogen from your HRT and your own oestrogen. This means that your oestrogen dose should be adjusted according to your menopausal symptoms.

TBH I'd not suffer as you are while waiting for an appt.

Why is your GP referring you without a full discussion?

I'm sorry you're going through this.

Is there someone else you could see?

@kos88 If you're suffering with symptoms and aren't seeing another Dr for weeks, you might want to make your own decisions. It sounds absolutely mad (to be honest) to advise someone as young as you are to reduce their estrogen to alternate days. Your GP ought to know that in peri, estrogen levels are all over the place and having a high result on a blood test is meaningless- and it doesn't mean you have anything 'wrong' with you or need to reduce hrt.
And although they have asked a gynae for advice, be aware that some gynaes know little about HRT. All specialists have their own 'specialisms' and HRT is not necessarily one of those.

I’ve spoken to the GP today because I’ve been unable to sleep well and had sweats and she said I cannot increase estrogen as my levels are so high and they don’t know why. The scan is in case I have a tumour. I’m having bloods again next week and then she says we can see. I queried whether not being post menopause that perhaps I have my own estrogen etc but she just said again they’re unexplained and so high that we have to do the test and then I’ll see the gynae team.

im too scared now to increase the dose tbh and worried maybe I have a tumour or something 🤷🏻‍♀️ So I think I will wait and see what the blood tests next week say, I hope they are lower and given I’m now symptomatic it would suggest that would be the case. At least that hopefully means it’s nothing sinister.

thanks again for taking the time to reply I really appreciate it

Not much help, but my meno clinic advise to stop HRT if my levels go over 700.

Yeah mine were so much higher. Although I am wondering now whether there is a chance the blood was taken from my arm I applied the gel to that morning 😬😬😬 because I had reduced from 2 pumps to 1 for some weeks and it had spiralled even higher. I will see next week what the results say.

It’s good that you have been referred for a scan. Any anomalies should be investigated. A high oestrogen level in someone who is post menopausal could indicate the presence of an ovarian tumour. They need to rule this out before looking for other causes.
Hopefully it is not anything sinister. But I would follow your GPs advice until they know more.

Have you had a CA125 test done?

This is discussed on a medical website I read a while back about how blood tests are not reliable. The drs writing that info said that there are so many factors that affect the results especially when the gel was applied, where it was applied and I'm sure they even mentioned NOT taking blood from an arm after applying gel- it makes sense surely?

https://www.mymenopausecentre.com/gp-resources/oestrogens-and-blood-testing/#fc-how-can-i-help-to-make-my-blood-tests-more-reliable

Can oestradiol levels be checked on any type of HRT?

You should check blood levels for oestradiol if you are using a patch or gel preparation. Levels may be checked with Lenzetto spray – and all women using the oestradiol implants have their blood oestrogen monitored.

If you are swallowing oestrogen as a tablet most of the oestrogen is metabolised in the liver, and absorption relies on the gut.

Absorption can be variable – for example depending on when you last ate and the blood level can vary significantly over 24 hours.

If I am using a gel or patch preparation how reliable are blood tests for oestradiol?

When a gel or a patch is applied to the skin the oestradiol in it will move across the skin layers into small capillary blood vessels. There are however many factors that can affect this process including:

• Variations in skin thickness.
• Variations in how closely packed the cells are in your skin.
• Skin temperature. Blood levels of oestradiol seem to be higher in the evenings and lower in the mornings. This is thought to be due to circadian variations in blood flow[1].
• The number of blood vessels present in the area of your skin that your HRT is applied to.
• Surface area of application.
• Pressure applied.
• Skin irritation – you may not be absorbing very well if your skin is irritated by your patches.

Oestradiol levels will also vary considerably from the time of application with any form of oestrogen absorbed through the skin.

Because of these variabilities blood tests can be prone to a lot of error and variation. Even in the same person, results can vary a lot from day to day.How can I help to make my blood tests more reliable?

• Blood tests are more reliable if you are postmenopausal meaning you have not had a period for more than 12 months.

• You should only have a blood test for oestradiol checked if you are using a patch or a gel.

• You should avoid taking a blood test from the arm you have applied your gel to that day. The hand used to rub any gel in is included in this [3].

• Bloods should be taken at least 4 hours after any application of gel – or before you apply it.

• If you wear your patch on the upper limb then your blood test should be taken from the non-patch wearing arm.

• It is preferable that you do not have a blood test just after your patch has been changed. The best time to have a blood test is the day before your patch change is due.

• If you are having repeat tests for monitoring you should try and keep your routine the same each time including the timing of the dose.

• It is preferable to use the same lab company if you are having more than one test. Different labs use different methods for testing levels (assays).

No that hasn’t been suggested, just the ultrasound.

Thanks JinglingSpringbells I think the only thing to do is have the blood test and scan to check but yes I’ll be much more careful about not using the gel the same arm / same day 😖