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

@Helpagirlout222 Hi there this made me sad initially reading your snippet of how you’ve suffered because what you’ve described is something so many women experience during perimenopause and menopause, yet it can feel completely isolating when you're in the middle of it. The kind of exhaustion, brain fog, and emotional weight you’re feeling isn’t just "normal life stress"—it’s real, and it’s often hormonal. It is also often misdiagnosed as being typical depression and treated with AD which doesn’t work so then your left feeling even worse. 🥲

It makes complete sense to me anyway, that you didn’t feel like this was typical depression—because when hormones are at play, it can feel different because it is. The overwhelm is unreal, the shutdown like nothing else, the inability to cope with even small tasks makes you feel worthless, and that unsettling feeling of losing yourself—it’s not in your head, and it’s not a sign of weakness. It’s your body trying to function with depleted oestrogen, progesterone, and testosterone, which all affect brain chemistry, energy, and emotions. I’m so glad you got the help you needed and hopefully are now feeling much better? Yes menopause is not an illness but can quickly turn into one of many. So many times in the past I’ve googled am I having a nervous breakdown?! The struggle is real.

@Menoglow I think your reply was to @CuriousRunner but I appreciate it anyway as I feel the same!
I can't go on like this. High hopes pinned on the oral oestrogen but then I had my high hopes pinned on the gel, then the patches!
@CuriousRunner thank you for sharing your experience. I'm glad you're out the other end

@Helpagirlout222 do your own research so that you understand the risks (and also what is not a risk, or at least a minimal risk). Someone will have to prise the oral oestrogen from my cold dead hands! Even if I'm dead because of a fecking blood clot. Because I wouldn't have survived that close to the edge

I'm pretty sure I started feeling better at the 2mg, with testosterone (Androfeme) and creatine supplements. (Loads of good research about creatine. It's not just for folks who lift weights.). But things got increasingly better as the oestrogen was increased.

Thanks @Menoglow. There was another thread here recently ish where the op quit her job. It made me so sad it came to that. But I can totally understand how it gets there.

I have oestrogen (and testosterone) pellets every 6 months at meno clinic (NHS) because I don’t absorb. They’ve been a life saver for me. Apparently there’s a national shortage of pellets and I’m dreading my next one not being available when it’s due.

Oh what are they @Anonym00se , like high dose infusions?

Yes. My levels went up to 800+ when I couldn’t get above 100 with gel or patches. They’re like little pellets the size of a grain of rice. They make a little nick low down on your abdomen and insert them.

Fab @Anonym00se that you found something that works for you. (I had been assured that there were other options after patch>gel>oral... ) I hope the path to finding this option wasn't tooooo hard. Hope that stock shortages don't hit you.

No. I take utrogestan.

I'm 51 now

I use an Estring and Ovestin for VA.

I have had numerous bloods done over the years and no underlying health issues.

I used to exfoliate and rotate where I applied the gel/patches.
Especially the gel was imconvient after 2 or 3 pumps as it took so long to dry, etc.

Do people not read the OP. It's hardly buried in the small print

@Summerdew Thankyou!!

I have tried patches and gel and have been on bio-identical oestrogen and progesterone tablets but blood tests put my oestrogen as less than 200.

I use vaginal pessaries and an oestrogen cream topically on my labia and vaginal opening to deal with atrophy. This has been successful and painful sex has been minimised. Apparently I am now better oestrogenised but I still get hot flushes.

It's interesting what's been said about blood tests because my gynaecologist has said I need to move to synthetic HRT, but physiologically my atrophy is nearly gone. Maybe the oral HRT is doing something but it's not reflected in the tests.

Can I flag up that my GP advised they were movi g away from.oral HRT as it was causing problems with women's livers. Please ask your GP to ensure oral HRT is safe and right for you.

Oh yes, we've had conversations, particularly about blood clots. I've said I'm prepared to take the risk. This version is bioidentical and they're moving away from synthetic. However the blood clot risk from synthetic HRT is lower than the risks for the pill which I was on for 20 years.

I'm not going to go back to patches or gel. I don't know if the tablets are working (though I think they are because the atrophy is manageable). I'll probably wait and get another oestrogen test in a month and ask to go to synthetic HRT tablets after that.

The oral HRT was prescribed by an NHS gynecologist after using transdermal HRT for 6 years.

I appreciate your difficulties, but I'm presuming as I posted this thread, the response was to me...?

@SENDMumma My post was for the OP- @Lioney

@FlowerUser I have a different view on blood tests to Jingle. In post menopausal women at least. Doc and I have found them useful and informative. (She makes no money as I get them done outside of her organisation.) And I've had regular blood tests which have been in line with my symptoms. Ie feeling crappy, blood test shows low oestrogen. BUT since moving to oral oestrogen, we've dropped the blood tests. Oral oestrogen is processed (might not be the best word, but can't think of the right one) in the liver. And oestrogen doesn't show in the blood in the same way as transdermal. You're going to have to rely on how you feel.

It's not my 'view' I was quoting the precise words of an NHS consultant. Just to make that clear.🙂

@JinglingSpringbells I get that ❤️ other opinions are out there too. It's all okay.

@Lioney I hear you!
I can’t get my HRT to a therapeutic level despite trying everything - oral, patches, gel, spray, (all max NHS doses), Vagirux, Mirena and testosterone.
GP orders blood tests more out of curiosity and my oestrogen is usually just above 200. Had meno clinic appt recently, they ordered an estradiol test and it was 355 - I couldn’t believe it! Meno clinic ready to dismiss me, ignoring my symptoms but I cried on the phone and begged for a trial of higher dose of oestrogen. Instead they referred me to endocrinology to investigate why my HRT isn’t therapeutic. Endocrinology ordered a whole raft of tests, some I’ve never heard of, and I’m waiting for all the results to come back but estradiol came back first and it was 75!
I’ll be amazed if endocrinology don’t just tell meno clinic to trial higher dose oestrogen, but I’m happy that they’re ruling out any underlying problems.
Good luck in your battle because that’s what it feels like!

PS
GP had mentioned oestrogen implants to me before endocrinology referral.

I'm pleased you're sorted, but I wanted to explain what I posted was a direct quote from Dr H Currie on Menopause Matters website,(which she owns) so it's medical info from an NHS consultant. The info she posted is based on science/ research into estrogen levels and blood tests.

No it was.to.the user who said that doctors were advising against oral HRT because of liver issues.

@Lioney Sorry for the delay. It sounds incredibly frustrating to be doing everything right but still struggling with symptoms. As I always say “You're definitely not alone in this”. I know you’ve had many responses and may have had all your questions answered but I’m going to send you all of what I can find. I’ve tried to simplify it as much as possible. 🥰

I have had a good deep dive into this and here’s why you might not be absorbing HRT effectively?

• Gut absorption issues– Some women don’t absorb oral estrogen well due to gut health, medication interactions, or individual metabolism.
• Liver processing– Oral oestrogen is broken down in the liver, which can reduce how much actually reaches your bloodstream.
• Skin absorption problems– If you didn’t absorb Ostrogel or patches well, factors like skin type, hydration, or application method could play a role.
• Hormone resistance– Some women naturally need higher doses or different types of oestrogen to reach symptom relief.

What can you do?
👉 Check your oestrogen levels again– If they’re still low, this may confirm absorption issues.
👉 Consider switching to an implant or higher-dose patches– Implants deliver estrogen directly into the bloodstream, avoiding gut absorption issues.

👉 Ask about vaginal oestrogen alongside Estring– A separate vaginal estrogen (like Vagifem or Ovestin) might help more with vaginal atrophy.

👉 Look at testosterone levels which I know someone else has already mentioned (amazing btw that you’ve been R.X this already)– Since you’re already on testosterone, low oestrogen might be affecting how well it works for libido and energy.

👉 Challenge your GP (in the nicest possible way) or request a referral to see another specialist always good to get fresh eyes on your individual case– If symptoms are returning, you deserve a review of your treatment plan.

If you’re still feeling stuck, a private menopause specialist (if this is an option?) might be worth considering for a second opinion. You shouldn’t have to suffer when there are options out there! There’s always options to try it make take time and a battle but be worth it in the end.