Anyone here a poor absorber of oestrogen? Need high dose?

[TheUsualChaos]

I'm at my wits end. Over the past year I've gradually gone up to a 100mg patch (Evorel). Just had bloods done and my estradiol levels are still despressingly low despite being on the highest dose patch. Some of my symptoms have improved such as achy joints and headaches but I'm still so low in energy and motivation and have started getting night sweats again, bang on 3am every night. I'm only 40!

My GP said I'm on the highest dose I can go and that it's too risky to go up but if my levels are so low even on this dose then how can I be at risk? I've read that some women just don't absorb it very well and need more? Anyone have any experience or knowledge about this?

I haven't had a blood test (keep meaning to call GP), but I am also on 100mg patch and have huge hot flushes during my period, which I imagine means it might be inadequate estrogen.

I'm also 40, my menopause specialist did mention younger women sometimes need higher levels of estrogen. Not sure how true that is, or even if mine are still low... I only seem to get really bad symptoms during my period or just after ovulation. The rest of the time HRT has helped me with symptom control.

I keep reading people talking about HRT has made them feel wonderful and fixed everything within 2 weeks and feeling a bit depressed about the whole thing.

Thank you for replying. That's interesting about possibly needing higher doses when younger. When I first started I was on the 50mg patch and I didn't notice any improvement at all!

I just don't know what to do. Considering private but then have also heard worrying stories about women being put at risk with high doses. I just feel so flat all the time. It's not even the time of year as I wasn't any better during the summer either! Its like a constant feeling of apathy.

What was your GPs suggestion if your levels were still low ?

I know nothing about other forms of HRT as I've only ever used patches, but I think I've seen other people talk about using gel instead to see if you absorb that better.

The impression I got about the younger age comment was that it was related partly to greater fluctuations earlier in peri, and partly due to there usually being higher levels in general at 40 than 50. That was my impression of what she was saying though, I'm not sure it is accurate.

I'm afraid I'm not very helpful as in a similar boat, although my boat is quite specifically only a problem during my period, and my symptoms are physical (flushes and early waking) rather than emotional on the whole.

I do absolutely know what you mean about the flat hormonal mood though. I was like that pre-hrt, when not filled with rage.

This is tricky.

Testing estrogen when on HRT isn't accurate.
My very experienced meno consultant does not test estrogen.

The British Menopause Society has guidance on this.
They say no woman needs more than the maximum dose and if HRT is not working, changing the type is better.

However, you are very young to use HRT.
Had your periods stopped?

ask your GP to refer you to a specialist gynaecologist.

One option is to use the combined pill which is often recommended for young women - it's higher in estrogen than HRT and some of the newer types like Zoely and Qulaira are more natural estrogens.

GP didn't really suggest any alternative tbh, said carry on for another 6 months and we can review how it's going. She said it must be doing something as the joint pain has stopped but ever since I started peri it's been the cognitive/mood symptoms that have bothered me far more than anything physical.

No, I was still having periods although they had started to become quite irregular with short cycles ( I believe that is due to lower progesterone in peri). But definitely had multiple symptoms of perimenopause which in part have been helped by HRT. Just not so much the low energy and brain fog type symptoms. So hard to focus on work sometimes as well.

Sounds like I should ask about trying a different form of oestrogen..some say even a different brand of patch can make a difference 🤷‍♀️

@TheUsualChaos You say you're on Evorel 100- that's only estrogen so what progestogen are you using? You can't have only estrogen if you have a womb.

You should be using either the Mirena coil, Norethisterone as a tablet ,or micronised progesterone.

Little point carrying on for 6 more months if it's not working.
Guidance is a review every 3 months and carry on if all's ok but if not, re-think. GPs are not experts in menopause or HRT- many have had no training at all and don't have a clue beyond prescribing at a very basic level.

The patches didn’t work for me but the Estrogen gel does applied daily, 3 pumps - inner thighs and arm.

My DSIS is on a very high level of Estrogel, currently 8 pumps and still has low levels of absorption. She is a body builder with a very high level of muscle which they think is something to do with it. She has been referred to the menopause clinic for them to assess. I would have thought if your not absorbing the patch properly they would try a different route like oral. Some people just don’t absorb well with patches. If there is some alternative reason like my sister then you could ask for a referral to the menopause clinic?

Was 8 pumps prescribed by a specialist?

I'd assume she possibly has high testosterone or very low estrogen already but 8 pumps is unheard of , almost. It's 4 x the medium dose of 2 pumps. Is she also increasing (doubling or tripling) the progesterone side of HRT too? She ought to be.

@JinglingSpringbellsyes this is all consultation with a meno consultant and gp. She hasn’t seen the meno consultant in person yet, that is the next step.

I swapped to gel. It’s so much better for me. I actually feel human!!

Did you feel it was more effective than the patches for symptoms ?

When you say changing the type, do you mean changing from patches to gel or something? As in changing the route ?

100% better.

Thank you !

Did you just switch straight to the same equivalent dose of gel that you'd previously had in patches? Or start lower?

@JinglingSpringbells yes I take a progesterone only pill every day. I tolerate this much better than Utrogestan which was 14 on, 14 off.

@101trees yes I was wondering if changing to gel or oral tablets for the oestrogen may work better. I tried the gel briefly but when the dose was increased I was changed to the patches, can't remember if there was a particular reason why. Interesting to see a couple of people saying that gel can work better for some women. It's more faff than the patches but if it works then I'd live with it!

Yes, I also wondered if you would start on the same dose if switched to gel. A lot of this is trial and error isn't it and, when each change takes 3 months to assess, it's slow going!

@101treesI take the same dose just as gel instead of a patch. I would say it has improved my symptoms by at least 80%. (Mood, joint pain, sleep, frozen shoulder, I just feel so much more myself).
I’ve been on it for about 2 months. I felt a difference within about a week.

I’m also on testosterone.

That's so helpful to hear, thank you.

When I first started estrogen I initially felt great for about 6-weeks, I felt like I'd unlocked this secret source of wellbeing. But since then it's never really cut the mustard.

The whole thing just really confuses me. Anytime I look online it just says 'return of your symptoms means increasing the dose may be needed' but I'm already on a high dose.

I also didn't find cyclical progesterone worked for me. I switched to continuous utrogestan (200 daily) to see if it helped migraine, which it did, but it also completely regulated my cycle.

Before that I'd have periods which were getting closer together with increasing spotting between, my periods were tailng off pre-HRT for a few years. After starting cyclical HRT the shorter cycles continued but with much heavier periods.

It's strange, the continuous utrogestan which is supposed to stop periods in almost-menopausal women has supported my menstral cycle and periods are back to how they were 10 years ago. I guess maybe I was low in progesterone? Certainly feel better for having a high stable dose of it.

I do feel I haven't got the estrogen part quite right though. I'd love to get rid of the crazy hot flushes and migraines twice a month.

We only have progesterone after ovulation. It's not a case of 'not having enough'. We don't need it otherwise- it's there to help the womb lining change to receive a fertilised egg.
Post menopause, women on hrt only take it to prevent overgrowth of the womb lining.

The reason it's working for you is you're taking double the amount for continuous- which is 100mgs. It's unusual though for you to get a period with that amount because usually it stops the womb lining growing.

I’ve been on 3 pumps of gel for a year and my levels are low. My GP has put me up to 4 pumps and also given me vaginal pessaries to add in. She said if that doesn’t work I could swap to oral tablets of oestrogen- so seems there are options?

I had this too with the patches. I gradually progressed from 25 to 100 and then that wasn’t helping. I tried cutting up patches and using extra (not advising this, but I was desperate) and that helped so I spoke to my GP about the fact I seemed to need more and she confirmed some
women need a higher dose as they don’t absorb it, but said that as it’s higher than the standard dose she needed to get advice from a specialist - the specialist told her to refer me to the gynae team. The doctor there was happy for me to stay on the higher dose if I topped up the progesterone. She also gave me testosterone. She did blood tests just to check there was nothing to contraindicate - I think to check oestrogen and testosterone weren’t already high. Sharing this in case it’s worth going back to the GP to ask for a referral. I feel I’ve been very lucky, but also think it was the GP I had as previous GPs have been less helpful around menopause. Hope you get some help - I know some women sail through peri / menopause, but for those of us who don’t it can be a rocky road.

It's worth giving gel a try. I started HRT at 43 and have often been told that younger women need more oestrogen. I started on one sachet of gel (1mg, which is equivalent to 50mg patch) and had to go up to 2 sachets. I changed to patches a few months ago and tried reducing the amount but had to go up again (so I'm now on 100mg, same as you). I think even if you switch to the gel you can't go higher than you're already on, but maybe the different format will work better for you.

Similar situation i'm now on Elleste Solo.

Worked my way through all thetransdermal HRTs available in the UK.

If I was as young as you are, I would try the combined Pill.