What Are The Optimal Levels For HRT?

In menopause. I have my uterus but only 1 ovary. 49 years old

I am realizing that too much estrogen can cause a lack of sleep as well as too much estrogen lowers testosterone which makes me not be able to sleep. It seems all Dr.s think that a dry vagina and lack of sleep is from not enough estrogen but for me I had a dry vagina and lack of sleep from not enough testosterone. 

Yes! I am sooo impatient. I can't stand waiting. I am finding that too much estrogen is a bad thing. Like I told the reader above that I found that too much estrogen caused me not to be able to sleep, more hair growth, and a dry vagina. It is weird because most Dr.s think oh, she needs more estrogen, but in my case the more estrogen I took the lower my libido, the drier the vagina, and less sleep. Estrogen lowers testosterone. I look at it this way......If you have enough estrogen but not enough testosterone then you might be able to lubricate but you can't because you can't get aroused. That was me! I am doing so much better now on 1 spray Evamist and testosterone cream

Hope you don't mind sharing, but how do you take the progesterone?  Is it a 100mg prometruim pill?  Cream or vaginal?  So you notice anything different when you take it?  Any odd sensation?   

 

Hi Gailannie,

Yes, it's a 100mg prometrium pill. I can't honestly say I've noticed any strange or unusual sensation that I attribute to it. Have just started taking it on its own later in the evening so if I notice anything I will certainly update you.

Thanks for that.  And please keep me updated.  

Testosterone is a huge thing for me! My levels were so low that I was losing all my hair, loss every muscle I had, droopy skin, no sleep, and zero libido. My testosterone was way too low so I found that actually lowering my estrogen and upping the testosterone helped me way more. I don't like the go by symptom thing alone because too low of estrogen can cause vaginal dryness as well as too low testosterone. I have been doing this HRT thing for a year and realizing that testosterone is very important to sleep, libido, strength, blood sugar issues, etc.

I am using ZERO progesterone. I know my gynecologist is one of the rare ones that doesn't agree with you have to use it. She said it can cause more problems than good. NOW, that being said I am using one spray of Evamist so my levels of estrogen are very low. The chances of any uterine problem at that low of a dose is actually very, very low. When I was on the prometrium I had horrid hypoglycemia, massive weight gain, sleep problems, so she put me on the lowest dose of estrogen HRT I believe there is available and added testosterone. I am feeling so much better already. Most Dr's insist you use progesterone and I am not opposed to it but I won't use the 100 prometrium because it is wayyyyy too much. I have a gynecology appt soon and I will be asking her about it again. If she still believes I don't need it then I won't use it because she is a younger Dr. and she is very wise with hormones. I have had more help with her than 3 endocrongologists. If she thinks it is good to use a progesterone then I will have her compound one but maybe like 20 mg. The prometrium is just way, way too much unless you use mass amounts of estrogen and then I just bloat, swell, etc. On the one spray Evamist I have actually lost the bloating, weight, etc. The oral pills are hard because you lose 80 percent in your liver according to my gynecologist and everything I've seen online so you are taking 4 times the amount to get the same affect of a tiny amount on your skin. I am loving the skin route and see way better results than the oral.

The oral pills are hard because you lose 80 percent in your liver according to my gynecologist and everything I've seen online so you are taking 4 times the amount to get the same affect of a tiny amount on your skin. I am loving the skin route and see way better results than the oral.  [smile]

 

Hi gailannie. Just a brief update. As you know from above my gynea reduced my eostrogen to 1mg (from 2mg) and left my progestrone at 100mg. I made the change on Tuesday last and, lo and behold, I'm bleeding heavily again!!!

I don't want to run off to him again with yet another issue, so am just wondering if this is normal when the level of eostrogen has been changed? And, if so, does it eventually settle down again?

I am so sick of bleeding at this stage and I'm worn out from it.

I'd call the office and let him know.  What this is saying is that the estrogen you were taking 2mg, was enough to stimulate your uterine lining, Your drop last Tuesday down to 1 mg. dropped your level enough to cause bleeding.  You are in menopause, CORRECT? 

The goal in menopause with HRT is to get your estrogen high enough to satisfy your body's need and illiminate symptoms, but protect your uterine lining with the progesterone so it doesn't overgrow and cause bleeding.  Are you taking progessterone daily (continuous therapy) or 14 days a month (cyclical therapy)?  

This new adjustment may take a while to settle in with your body.  But I'd at least call your doctor and let him know what's happening.        

Thank you gailannie.

I am taking the progestrone (Prometrium) every day. I am well and truly in menopause (aged 55) and had no bled for years until Christmas when all this began. At this point, with the exception of 4-5 days, I have been bleeding constantly since then. This is by far the heaviest bleeding I have had though.

As I only made the change on Tuesday of last week I had planned on waiting until early next week to see if the bleeding settles down again once I have allowed time for adjustment to the new lower dose. But perhaps that is not a wise decision? I feel like the last two months have been a constant round of doctor visits and trips to the gyneacologist - they must thing I'm a hypochondriac!!!!

Totally get feeling like a hypochondriac.  But it is more than obvious that the combination you are on, isn't right for you.  the correct hrt after menopause SHOULD handle common symptoms, yet protect your uterine lining, and shouldn't cause bleeding.  So some adjustment is definately necessary. Let us know how things go.  

Will do. Have just called gyneacologist and am being referred to Emergency Dept at hospital to have it checked out. Just waiting for hubby to get home to take me there. Thanks gailannie.

Oh sorry.  But don't panic about this.  Just get in, let them look at some things and take it from there.  

Please let us know how it went.

Hi gailannie. Spent all day at the hospital (most of it waiting!) Was examined by a gynecologist, had bloods done etc. The hospital gyneacologist then contacted my regular gyneacologist and it was agreed between them that I stop HRT altogether and immediately  - I was not expecting that. They have given me a tablet called cyklokapron (tranexamic acid) to take every six hours to (hopefully) stop the heavy bleeding and then I have to return to my own gyneacologist early next week.

My head is now all over the place. The HRT was working perfectly well for me for 3 years (and two years prior to that on a different one) until Christmas Eve when I first started bleeding. That bleeding was investigated and showed thickened endometrial lining and the subsequent biopsy showed no issues. So, to reduce the thickness of the lining he halved the dose of estrogen from 2mg to 1mg and left the progestrone at 100mg - and the bleeding got much, much heavier. Now they are stopping it altogether?? What will happen when the ckylokapron is completed? Will I just start bleeding again? Will the menopause symptoms all return? Why, after all these years, has everything become so complicated?

I don't want to stop taking HRT at this point as I was having no menopause symptoms while on it until now. My gyneacologist asked me at my recent consultation if I would consider stopping it and I flatly refused and he didn't push the issue or seem to make a big deal of it.

But I feel he won't prescribe it for me again after all this and I will be just left with menopause symptoms. I am wondering if I should ask him about a hysterectomy or is that too drastic? At least, if that happened, I would have no further issue with bleeding and could take HRT?

I'm so confused at the moment I just don't know what way to focus my thoughts.

I'm so sorry about this for you.  There are some women who do fine with a hysterectomy, but there are others who are sorry they had it done.  I think it would be an after the fact kind-of-thing that you can't undo.

But yes, this puts you in a pickle.  Hope you are feeling somewhat better and the bleeding stops.  Please keep us updated on how you're doing.

  

Hi.The bleeding is finally easing. It hasn't stopped but is lighter and the break from it is wonderful.

Seeing my gyneacologist on Monday.

Back to gyneacologist again this morning. Taken off the cyklokapron - he seemed surprised that I only stopped bleeding yesterday having been on it for 4.5 days??? Sticking his heels in on the HRT - wants me to stay off it due to the extent of the bleeding.

Have to go into hospital on Friday for a hysteroscopy and D&C so he can take a closer look inside and establish the cause of this bleeding. He says it's more thorough than the biopsy (which I didn't find very reassuring as I thought the negative biopsy ruled out any possibility of a 'sinister' problem?)

He says that if nothing is found and 'all seems well inside' he will consider giving me the HRT again, although he'd prefer not to. I'd prefer if he did as I don't want menopause problem if I can avoid them.

The word hysterectomy didn't come up at all, so obviously its not on the radar at this point.

Well good, glad to hear things are going as well as they can for now.  

Possibly you need some other doctor to help you get better adjusted on HRT.

Just a thought. 

Yes - I had thought of that too. But I think its important first to get everything checked out before I do anything else.

His reason for not wanting me to continue on HRT is that I've been on it for approx 6 years and he wants to see how I'd be without them. But I feel there are benefits to HRT such as mood stabilizing, bone health, better skin and hair etc - maybe I'm wrong to base my wish on taking it for this?? He says the risk of cancer (breast and endometrial) increases by 2% after being on it this long and its not worth the risk. Are we both right??

This a an issue I also grapple with. There are many "experts" who truly believe that we are healthier WITH LONG TERM HRT, than without.  Whether it's heart health, bones, brain, even depression. Some doctors believe that it helps keep us stronger.  I'm afraid I'm one of those who has bought into that argument.  Not sure if it's right or wrong, but it does make some sense to me.  There are days where it feels like you're damned if you do, damned if you don't.  

The worst problem I've had, is that I can't seem to find an HRT regimine that makes me feel normal.  Everything seems to have it's drawbacks.  

The perfect HRT is one that gives you some estrogen while protecting your uterus.  Hope you can get there.  

Sadly, like so many others, I have almost forgotten what 'normal' is. At this stage I'd quite happily settle for 'able'. Able to live without constant reminders of menopause, able to stop worrying about excessive bleeding, able to go to work and not feel exhausted, able to have a proper sexual relationship with my husband, able to leave the house without pads in my pockets and bag, able to plan a weekend away and not worry about bleeding - just 'able in general'!! Which, after writing all that makes your statement right - just be 'normal', which I kinda thought I was until Christmas Eve when all these recent problems started. The 'normal' I completely forget is the one before the menopause. But I've pretty much realised that the me from those days is gone forever - HRT or not.

What I have no idea about though is what the future holds? The menopause and all its weird changes must settle down at some stage?? So which 'me' will remain??  Will the pre-menopause me return or a new and totally different 'me' emerge? Will it be better or worse? What can I do to influence it and ensure that I am not just left as a little old lady before I'm ready to be a little old lady??!!

Boy do I get that!   It's amazing the changes that come, ready or not.  Just a couple years ago, I was sporting a swim suit, cute little dresses, and feeling pretty good.  And that was even after menopause!  But boy did things change.  It seems it happened pretty quickly.  My first real indication that I was estrogen deficient was vaginal atrophy and dryness, painful sex.  And nothing will kill a sex life like painful sex.  

Yet, my body seems to reject replacement estrogen.  I can't seem to figure this out, and it drives me crazy.  Sure seems like my body should react in a positive way, but it doesn't.  So somethings off.  Seems the only time I feel half way normal is when I add progesterone to the mix.  So what's up with that?  Even my hair looks weird and is really funky with estrogen only.  Add the progesterone, it looks, moves and acts more normal.

Don't know what you were taking, but have you experienced any odd reactions to HRT?  I mean, besides that horrible bleeding.

Maybe it's just my old body, I turned 60 a couple months ago.  But know I must do something or this vaginal atrophy and dryness will only get worse.  It never goes away, so all we can do is try to keep things semi normal there also.  

I just wish people were more honest about this aging thing.  It might not have caught me so off guard, if older folks would share the experience and prepare us for what's coming.  Honestly, my heart kind of breaks a bit, for all those women posting they are now in perimenopause.  Cause I know what's heading their way.  

And as far as which "me" will remain?  I believe it will be a morphed person that will not be someone I really know.  Things have changed so  much already, I can't imagine it's gonna get any better.  Even my interests have changed.  Much like the difference from being a child, then becoming an adult.  While our essence may still be there, we are very different people.  And I see nothing wrong with grieving our loss, unless we get permanently stuck in that hole.  But this is a huge change, and I think grieving it, is somewhat healthy and will allow us to move forward after processing everything.  

One of the things I simply hate is, I never had to worry about anything. Certainly not lab work at the doctors.  But then you go into menopause, your BP changes, your cholesterol changes, bone density changes, what you can eat changes And all of a sudden you don't even know your body anymore!  That's a pretty unpleasant situation to be in, when you have always known exactly what your body needed, or how to handle things.  My doctor used to say he'd never known a women who knew her body as well as I did.  Now I don't even have a clue!!!  It so new, and foreign.  And the constant thought of something going wrong is awful.  I'm sure you can relate.     

Exactly how I feel! I don't even know me anymore. I am severely depressed. I used to wear cute clothes and feel vibrant and now I feel dead inside. I want the old me back and yet I cannot find the right HRT to help with that. I also grieveee for women going through this. It is so very hard!

Just thought I should mention that I've seen huge differences in use of oral progesterone vs vaginal delivery.  So keep this in mind if you are told you need some progesterone.  Cause boy the vaginal route is so much smoother for many women.  You can use some FDA approved products, like Crinone, or you can even insert Prometrium instead of taking it orally.  And there are plenty of compounded options as well.  The one I liked best is small amounts of progesterone in a capsule containing olive oil. 

But I'll also mention that the only time I feel right on esrogen is when I am also taking progesterone at the same time.  

So while I know your aren't feeling quite right, possible progesterone might be somehow involved.  But I think it's often so over prescribed, as you said 100mg is WAY TOO MUCH, a smaller dose might more closely match your need. I was given 2.5 - 5 mg vaginal capsules, that's huge differnece from 100mg (even taken orally)  

Just a thought.