Not absorbing transdermal or Oral HRT.

[Lioney]

I've been on HRT about 8 years.
Currently on 2mg Elleste Solo.
Utrogestan.
Testosterone
Estring.

I attended an NHS menopause clinic and was having bloods etc due to Premature menopause.

Estrogel initially was great but stopped absorbing it.
Moved to Estradot, then Everol but still my estrogen levels were below 100.

Then started 2mg Elleste Solo, felt a bit better and symptoms improved.

Now the hot flushes are back. Zero labido. Vaginal Atrophy progressing despite using the Estring. Brain fog, fatigue and anxiety...
Menopause clinic discharged me and GP won't increase the oral HRT.

What would be the reason I don't absorb HRT?
How can I address this?

TIA

You could try an estrogen patch rather than gel- some women find one works better than the other.

There are some specific instructions that come with gel, which you may know of but if not (it's on the leaflet)- don't apply straight after using strong skin cleansers (I assume they mean shower gel or soap), don't apply over body lotion, alternate the place you use it- inner thighs/ upper outer arms.

Consider splitting the dose (eg 1 pump am, 1 pump pm - and more relevant if you use 4 pumps- split morning and evening.)

Loofah your skin to get rid of old dead skin cells.

I haven't tried oral hrt yet but have not been able to absorb gel or patches so that is my next stop. It's so frustrating!

I find a really good body scrub once a week on my arms where I apply helps, and also really rubbing it in until it’s dry. There was a phase where oestrogel was a bit funny and didn’t seem to be working but it seems fine again now so maybe give it another go? Sorry if you’ve already tried this, so frustrating

I was on the hrt patch and then after about a year it seemed to stop working, I now use the gel and find it much better, but its another thing that I have to remember to do in my list of things.

Not sure what to advise. Gel and patches didn't work for me. Tablets better (I take 3mg) but labido and memory aren't any better - menopause clinic didn't think HRT would necessarily help with that, but I now sleep for 4-5 hours continuously most nights so I'm happy with that.

I'm a poor absorber and, as my username suggests, am on a substantial off-licence dose of Sandrena because the standard dose of Estrogel wasn't helping. I do have to obtain it via a private clinic and I know that some prescribers would not approve but I feel well on it.

How do you know how well you absorb the estrogen? Do you have a blood test?

@Zeldasie my GP wouldn't entertain increasing my patch dose or doing a blood test. The first thing the private GP did was sort out a blood test - she said the result was consistent with someone not taking HRT so was happy to prescribe oral oestrogen immediately.

That's interesting. I know in several European countries women get regular blood eats to check their hormone levels while taking HRT. Shame that we have to pay privately for it, Glad the oral estrogen is working for you

Sorry tests

@Fuckthecamelyourodeinon Have you tried testosterone for libido (and memory but you can’t say that’s what it’s for or you won’t get a prescription)

have you tried checking on your skin health microbiome? Watched a menopause video about how the skin flora affects the absorption of transdermal HRT. These are skin integrity, barrier function, skin's pH levels, skin hydration. Any fluctuations of these affect the absorption and level of efficacy.

@Summerdew alas my GP made it very clear to me that my health district really doesn't like to prescribe testosterone. In her defense, she did include it in the only blood test they would do (which was at the beginning when I approached them for HRT) and I came in at 0.3 (the range being 0-1.8) so in the normal range. The private clinic also wasn't keen to discuss testosterone (in their experience getting the estrogen levels right would have the biggest impact on symptoms and that I now sleep 4-5 hours continuously most nights she was right).

Absolutely fair enough @Fuckthecamelyourodeinon and great your sleep is sorted.

Yes.

I'm not interested in transdermal HRT.

I hoped to find a way to absorb it as all my bloods showed estrogen levels to be really low, under 100.

The VA is possibly the worst symptom even with an Estring and Ovestin.

@Lioney my results have consistently been under 100 too. Have just started on oral hrt to see if that makes more of a difference. Have been on highest level gel and patches

@Lioney Hi there I am a nurse and specialise in helping women and with the menopause. I have some info on this I will have a look on my laptop when I’m home and send it to you asap. X

@Lioney also do you have a mirena coil ?

4mg of oral oestrogen here. Last year was the worse year of my life until we found the right HRT for me. (Private medic)

Yes, there's a blood clot risk. But I believe it's lower than oral contraception. Yet you don't hear of the pill being refused 🤷‍♀️

@CuriousRunner how were you feeling before you got the dose sorted?
I'm absolutely wrecked, feel I can't get much lower.
Did it take long to kick in?

@Lioney This is interesting- written by menopause consultant Dr Currie.
https://www.menopausematters.co.uk/forum/index.php?topic=71486.0

Blood tests are often discussed with recommendations being given on changes in HRT based on levels of estrogen--measuring estrogen levels are rarely needed since they are unreliable, vary significantly over a 24 hour period and do not represent how you feel. There is no target level to aim for, we are all different, with many postmenopausal women with very low estrogen feeling very well. Even when our ovaries are functioning normally, our own estrogen levels fluctuate throughout each cycle. Many women experience premenstrual symptoms before a period when estrogen and progesterone levels fall, but generally we don't feel different on a daily basis while estrogen levels change. If a type of HRT is used and is not controlling symptoms, then the type can be changed, while considering other contributory factors to the symptoms, and are the symptoms really hormone related, rather than relying on blood levels and continuing to increase the dose.

It reiterates what I've been told by my consultant, that blood tests when on HRT are not accurate as estrogen levels need 24 hr monitoring. I've never had one in and the reason is that it's symptoms that dictate the dose.

It's worth having a range of other blood tests for overall health if you've not already. Or looking at other reasons for not feeling any benefits from HRT.

Your VA - could it be helped by doubling up on the treatments available?

It's not great, to be honest, that the NHS is doing these tests when an NHS top consultant (Dr Currie awarded an MBE for her work on menopause) knows they are inaccurate.

You probably already know that with oral estrogen, a huge amount is lost in digestion. I hear you say you aren't interested in transdermal but it's worth trying again and 'prepping' your skin with exfoliation ( brush scrubs, loofahs, etc) if you'v e not done this already.

How old are you now @Lioney ?

It's worth joining the Daisy Network for support and advice (charity for women with POI) and you might find something there to help. It's run by consultants and women with POI.

@Helpagirlout222 it was gradual because after binning off the patches (which took ages because we tried all sorts and all sorts of strengths) I started on 2mg, waited, 3mg, waited, before settling on the 4mg. But I seem to remember that I felt a bit of an improvement at 2mg pretty quickly. But yes, saved me in the end. I was googling "what is a nervous breakdown" and other such stuff before we got this sorted. But now I feel (mostly) sane!

@Helpagirlout222 sorry! I misread your question 🤦‍♀️ how did I feel before getting the right oestrogen? The absolute worse I've ever felt. Ever. (And I've had depression before and my fair share of life's troubles)

My mood was through the floor. Going to bed at 630pm. I kind of knew I wasn't depressed in the normal sense. If that makes any sense. I couldn't cope. At all. I could barely cope with one to-do or meeting a day. Definitely not two. I thought I was going mad. I never considered any kind of self harm. But I did have a deep affinity for folks who leave their keys and phone and just walk off. As I mentioned asking ChatGPT if I was having a nervous breakdown.

Hang in there. But you have to be really dogged to get what you need.