Serum Estradiol levels with estrogen implants/injections

Hi, I'm sorry if my post was confusing. I was referring to 3 different docs and didn't do a very good job in explaining which one is responsible for this or that treatment. So let me explain that a bit better. And, I live in east Tennessee by the way.

Okay, I've been seeing the same local GP for 20 years. I was already taking the oral estradiol I mentioned when I became his patient. A 4th doctor that I didn't mention in my first post...the gynecologist who did my partial hysterectomy prescribed it to me 6 weeks after my surgery because he determined that the removal of my uterus had caused ovarian failure. I might also add that he retired shortly after he performed my surgery.

I started seeing my long time GP a few months after my surgery and being placed on the estradiol pills. I THOUGHT I was doing okay as far as the recovery from my partial and that the estradial pills were serving their purpose. I initially saw my GP because I was having muscle spasms in my left shoulder. He prescribed the xanax to me to relieve the spasms and after talking with me, diagnosed me with PTSD and generalized anxiety disorder. He also prescribed an AD during my first visit which I could not take. He tried me on a few more AD's and none of them agreed with me. So, I just continued with the xanax. After I was notified of my surgeon's retirement, I asked my GP if he would pick up prescribing my estradiol pills for me and he agreed. It was shortly after the WHI study was conducted that suggested that ALL forms of HRT caused cancer that I stopped taking my estradiol pills.I had been taking them 7 years at the time. As you probably know, they have now proved that study was VERY inaccurate as it was based on ONE synthetic estrogen/progestin combo pill! I might also mention again that I was totally ignorant regarding all the symptoms that low estrogen can cause. I didn't even bother with informing my GP that I had stopped taking the estradiol pills. But, it was HE that I went to see when I started developing stomach issues, and he that I saw for other symptoms that I developed over the 2.5 years that followed my stopping the estradiol tablets. He did what any good GP should and sent me to a different specialist for each new symptom as that popped up over that 2.5 year period. So, I was being treated for several different conditions by several different doctors. After 2.5 years of a host of symptoms and various diagnsoses, I started to have nightsweats. Again, I saw my faithful GP regarding this symptom. It was he that then ran the hormone panel and discovered that I had no estrogen in my system. It was also obvious that I was well past post menopause. It was also then that I told him I had stopped the estradiol pills over 2 years before because they caused cancer. He explained to me that I NEEDED my estrogen replacement and tried to restart me on the same estradiol pills that I had taken for 7 years. I had a massive panic attack after taking the first pill! He then switched me to the Vivelle Dot patch because he said most women had fewer side effects with the transdermal delivery. After tweaking my patch dose several times, we finally found a dose where I felt pretty good using. It was only after I got leveled out on the patch dose, that ALL of the conditions I had been diagnosed with were cured! So, low estrogen was the culprit behind the acid reflux, fibromyalgia, tmj, etc. I also realized that I did NOT have PTSD or GAD that my GP had diagnosed me with years ago. The estradiol pill that I had taken all of those years simply did not agree with me as well as I thought. I started studying everything I could get my hands on about menopause and hormones after learning this. And, sure enough, every symptom I had during the 7 years on the estradiol pill and the symptoms during the 2. 5 years of NO estrogen replacement at all were common menopause/low hormone symptoms. Someone mentioned having burning mouth. That was also a symptom I had that started shortly after my surgery and continued for 9 years until I started using the patch! It was horrible...not sure how I could have forgotten to mention it! Anyway, I continued to use the patch for 12 years. My GP also did my annual well woman visits, and ordered my annual mammograms, and bi-annual ultrasounds of my dried up ovaries.

I felt fairly good using the patch for 12 years but it suddenly stopped working in the spring of 2013. I should add that my stress levels had also increased tremendously during the months prior to it no longer serving my needs. My GP actually did try to switch me to compounded creams during this time. He described the intensity of my symptoms to the compounding pharmacist and allowed him to decide on my doses because although my GP supported compounded BHRT, it was out of his field. The cream doses were adjusted a few times but did absolutely nothing to help me. It was then that I sought out a doctor who offer pellet therapy.

Pellet doctor number 1: hot shot gynecologist in Nashville...40 years experience. I drove 3.5 hours one way to see him. It was HE that pumped me full of testosterone and very little estrogen which I happen to need a LOT of in order to feel well. I told him that I was NOT new to hormone symptoms and had been post menopausal for nearly 20 years and knew my body quite well. He insisted that testosterone was latest and greatest cure for these symptoms. I was a total mess after he dosed me with the first pellets. He had my levels tested through blood work every month during the 3 months of those first implants. The first 2 lab results showed that my total testosterone was much higher than my total estradiol which was dropping fast while my testosterone levels were barely dropping at all. I still had a few estrogen patches so I started using them, too! The testosterone was causing acne, hair loss and hair growth in places that women do not want it. My hair and skin were also extremely oily. My anxiety was through the roof, and I was SO aggressive and angry that my husband feared me! LOL! By the time, my 3rd set of labs were ran, I was feeling much better and most of the high testosterone side effects had stopped. The 3rd labs revealed that by supplementing with the E patches, I had managed to get my estrogen level higher than my testosterone level. I thought "ah-ha!", pellet doc number 1 needs to decrease my testosterone and increase my estrogen dose and I'll get straightened out. When I told him this, he laughed at me and told me the only symptoms estrogen addressed were hot flashes and nightsweats! I asked him to please explain to me then WHY my using estrogen only for nearly 19 years had kept all the symptoms I told him I had experienced under control. He then insulted me even more by telling me NONE of the symptoms I mentioned had anything to do with menopause or hormones and asked if I had considered seeing a psychiatrist! I was livid! But, I allowed him to make me feel stupid, and after he gave me the "I'm the doctor, you're the patient" lecture, I foolishly allowed him to insert a second set of pellets in which he increased the estrogen a little but also INCREASED the testosterone a lot! The NEXT 3 months would have been a living hell if I hadn't of had refills left for my E patches. I had to wear two full patches at a time to keep the high testosterone symptoms under control. I never had labs ran during that time nor did I call that doc to report how I was feeling. I was done with him AND with pellet therapy...so I thought!

Pellet doc #2: I then learned of an NP who had worked with and trained under a highly regarded reproductive endocrinologist who specialized in fertility and menopause issues...a hormone specialist. The reproductive endocrinologist was trained to do pellet therapy by the doctor who invented the pellets. And, of course, he trained the NP in the same manner that he was trained. The NP took over the reproductive endocrinologist's practice when he retired. He is the only pellet provider that I could find within a day's drive of my home who administers higher estrogen pellet doses. However, he bases the dosing strictly on a woman's symptoms as he was trained to do by the reproductive endocrinologist who mentored him and still does. I have now received two founds of pellets from him and he is getting me straightened out. Also, the lady who referred him to me receives 100 mg. estrogen pellet as I do, takes oral E, uses oral E vaginally, and is also prescribed the shots to give herself when she feels that her estrogen is dropping. He has never tested her levels, either. However, I have been having to supplement with the estrogen shots more than I should because I continue to have experience low E symptoms. The shots relieve those symptoms immediately. So, I assumed that when I see him again for my next round of pellets on August 5th that he would increase my estrogen pellet dose. This NP is located in NC and is about a 2.5 hour drive one way from my home.

Back to my GP: It was time for my annual well woman visit and mammogram a few weeks ago. I saw my GP for this exam 9 weeks after receiving my last pellet inserts, and had also been having to supplement my estrogen by giving myself 2.5 mg. of an estrogen injection every 8-9 days. My mammogram results were fine as was an ultrasound that was also ran to check my breast health. I felt balanced when I saw my GP and told him how much the pellets were finally helping me with my new pellet provider. As part of the routine well woman visit, my GP runs labs to check various things including my hormone levels. All of labs for various things were normal except that my estrogen level was 985.3. My testosterone was 122 which made me extremely happy since it had stayed near the 300 mark during the time of seeing pellet doc #1 while my estrogen levels were in the double digits until I added patches to get the level up. My GP freaked when he saw how high my estrogen level was! I told him that I felt great! He told me that I needed to inform my pellet provider that my estrogen level was that high so I did as I was instructed. Now, my pellet provider who has helped me feel the best I've felt in nearly 20 years, and who said that labs were "just numbers" and that how a woman felt was all that mattered is flipping out over my high estrogen level. I don't get it! He has NEVER performed labs on the other patient of his that I know who receives much more E from him than I do! Now, I'm terrified that he's going to cut my estrogen dose and my living nightmare will return again. I honestly feel that my estrogen level was SO high because I had just given myself a shot a couple of days before my labs were drawn. I suppose the estrogen pellet was contributing SOME estrogen but it obviously wasn't enough or I wouldn't have needed to supplement with the shots in order to feel well. 

And, yes, I realize that a postmenopausal woman having an estrogen leve of 985.3 probably isn't ideal but frankly, I feel that it's just as safe as a woman having testosterone levels as high as 300-800, while she's growing a beard, going bald, and covered in acne!

 

Hi Sheryl, I AM what I would consider pear shaped. I've always been thicker through my hips and thighs but was very thin all of my life. I'm 5'4" and my average weight stayed around 118. I have been as thin as 108 but never weighed over 120 except when I was pregnant. I didn't gain any extra weight through my pregnancy, either. The weight was ALL a bouncing baby boy who is now 34. The only time I've ever gained weight is when I thought it would be a good idea to suddenly stop taking my estradiol pills. Duh. I gained 20 lbs. in less than 2 months! I now weigh 130 and although I FEEL fat after being so thin all of my life, I realize that I am not overweight. I'll check the conditions you mentioned. I've always felt that I had low estrogen. Even in my youth, I had migraines that were helped by birth control. A lot of people with a history of migraines couldn't tolerate the old bc forms that contained estrogen only. I loved them!

So, tell me, when implants were available in Australia, how were most women dosed? Average mg. of E pellet? And, testosterone? 

The only self medicating I'm doing is with my doctor's blessing which I MAY lose is giving myself the shots. I just don't think he expected that I was going to need them with the 100 mg. implant but it simply did not provide the amount of estrogen that I need to feel well. Or, maybe my body isn't metabolizing it but my body certainly didn't have any trouble metabolizing the ton of testosterone I was given by the first pellet doctor! I felt fortunate that I still had Vivelle Dot patches after the first pellet doc pumped me full of testosterone. I self-medicated then but only because I've been dealing with my hormone woes for years and easily recognized that I HAD to have more estrogen!

Actually, the shots DO release slowly but over the period of a week to 9 days. They last some women 2 weeks and even a month. I burn the shots up as quickly as I use the pellets. So, the shots reach peak level around the second day or so which is when I had my labs drawn! They work sort of like the MX patches but last a tad bit longer. I don't get a RUSH of estrogen after a shot although it starts to improve my symptoms almost immediately and continues to improve them until it starts wearing off over the last couple of days. And, when the shot is used up, I can certainly feel that it is GONE! 

Well, that blows my theory then, doesn't it?!  Implants - 100 mg of oestrodiol for 12 months or 50 for 6 months.  No testosterone.  Personally, I have not heard of anyone getting testosterone.

I actually take Androcur (which is an anti-androgen) to prevent excess hair, acne, hair loss (that part not working anymore!), and have done so for years, because of the acne problems I was having back then.  Whenever I try to reduce it, I get greasy face and deep pimples - so not going back there.  It is also prescribed for women with PCOS, which also causes all those problems.  Maybe I had that, but no-one diagnosed it.

My current gp would flip at the idea of prescribing shots that were self administered, I really think I meant.  Hard enough to get the patches and gel out of her.  Well ... not really any more.  A previous dr did and now she has to too.  I don't think I have heard of estrogen injections here anyway.

Maybe testosterone is available for women if one is desperate for increasing libido but I would not like those side effects with it.

One patch is supposed to last 3.5 days but does not, and if I forget that morning, I suddenly find I am having a wave of anxiety or depression for no reason, then I realise I had forgotten to apply a new patch.  Now I replace it every 3 days, and Sunday I apply the gel.  Earlier this year, I was experiencing that a lot and using the gel more often but it seems to have settled down now.  I cannot equate it with anything, except I think I have a dose of Helicobacter pylori and it was really affecting me then.  I have since started using kefir (which is like a strong yoghurt which I make from a culture and sip a couple of tablespoons before meals).  It has made a big difference to my gut (pain, bloating, etc).  How and if it effects oestrogen I have no idea.  Maybe it is the stress of dealing with the pain, etc.????!

Because I had endometriosis, my earlier enlightened gp put me onto progesterone too, as she said any remaining bits of endo will be 'menstruating' - for want of a better word, as it is activated by the oestrogen.  That has gone down well - no probs with that.

Here's how crazy our docs are here in the states and sometimes, I question the women's sanity who trust them. Testosterone pellets ONLY for menopause symptoms is the latest trend! The idea originated from testosteroning helping relieve menopause symptoms of ladies who had had breast cancer or who had a strong family history of it. For the women who haven't had breast cancer and without a history of it in their family, they are pelleted with anywhere from 6 to 25 mg. of estrogen, and up to 200 mg. of testosterone. And, some are told they do not need estrogen at all. Get this, the theory is that our bodies will convert the testosterone to the amount of estrogen that we need! Also, the "progesterone gurus" have now converted to "testosterone gurus" in that they believe ALL women are estrogen dominant due to the xenoestrogens were are exposed to in cosmetics, pesticides, food, and cleaning solutions. Well, I am NOT estrogen dominant although my level DID test very high for the first time EVER, and based on several lab tests, my body does not convert an ounce of testosterone to estrogen. The other thing is that most ladies using pellet therapy receive new pellets every 12 weeks. Some get them sooner. I'm going to try my best to refuse getting ANY testosterone when I'm repelleted. It does nothing for my libido and now that my level is coming down, I want it to stay down. I'd LIKE to work on getting my estrogen dose RIGHT first!

Hi Sheryl

no me neither .. not heard of testosterone given, i know us ladies all have abit of it... 

i am sure that ladies who have not had a hysterectomy have a different peri, as we have time to reduce our hormones naturally, if natural route chosen, where as if you have to have a hysterectomy, its sudden wham.. and needs assistance... 

I had endometriosis when i was early 30' was given progesterone bedore treatment ' Danazol' then after a a few months or so had 4 hours of laser surgery and told to have a hyster as the endometriosis would return after 5 years, I said no to a hyster, and thank god, as it never did return...

I am slim, no extra weight, but the Danazol when I took it, I packed the weight on, but it dropped off again after surgery...

i just found this about the hormones, it mentions Testosterone for those ladies that would like to read it.. good luck ladies Jay xx

Oestrogen, Testosterone and Progesterone

Women produce a number of different sex hormones including oestrogen, progesterone and testosterone. After the menopause, either naturally or surgically, these hormones will begin to diminish in quantity – some more quickly than others. It is this reduction which causes most of the menopausal symptoms that women can experience.

OESTROGEN is a powerful female sex hormone that regulates many aspects of our lives. Initially it makes girls develop into women at puberty by stimulating breast growth, laying down fatty deposits, thickening the vagina and causing it to secrete mucous. It affects how our skin looks, whether our bones are strong and healthy and it can protect us against heart disease. It also regulates our menstrual cycle. At the beginning of our cycle about 30 egg follicles will start to ripen and produce oestrogen. When levels of oestrogen in the blood are highest the hypothalamus in the brain release hormones that make a follicle release an egg, therefore if you are not producing enough oestrogen you will not ovulate. It is produced by the ovaries and naturally declines after the woman goes through the menopause.

PROGESTERONE is one of the female sex hormones produced by the ovaries and adrenal glands. It plays an important role in maintaining a pregnancy. As well as helping to sustain pregnancy it also regulates the monthly menstrual cycle.

Its most important function is to encourage the endometrium to secrete proteins in the second half of the menstrual cycle in preparation for a fertilised egg. If no egg is fertilised or implanted then oestrogen and progesterone levels fall and the endometrium breaks down and is passed out through the body through your period bleed.

High levels of progesterone are thought to be responsible for symptoms of PMS (pre-menstrual syndrome). These can include breast tenderness, bloat and mood swings.

There is some debate whether a woman who has had a hysterectomy that removes her ovaries needs to supplement with progestrone as well as oestrogen. The feeling is that it might balance any oestrogen supplements and prevent women from becoming oestrogen dominant, which is what may have caused problems in the first place. However the adrenal glands continue to produce small amounts of progesterone and we also produce some from dietary cholesterol. In most women this will be enough to prevent oestrogen dominance.

TESTOSTERONE is a male hormone but women still produce small amounts of it in their ovaries. Testosterone is produced by the ovaries and helps to regulate sex drive (libido), energy and mental state. Following a natural menopause testosterone will continue to be produced by the ovaries in significant amounts for approximately twelve years, therefore a woman that has her ovaries removed will no longer produce testosterone and this may be responsible for a poor libido, depression and lack of energy following surgery.

Testosterone may also have a role to play in conserving bone after menopause and supplementation with it may be more suitable for women that are unable to take oestrogen who have an increased risk of osteoporosis. However testosterone should not be taken orally, in the form of tablets as it can damage the liver. The usual form of administration is by implant or by injection at regular intervals. 

I just bought some coconut oil yesterday! lol! Yes, they are made by a compounding pharmacy and they are implanted in my butt cheek. A very small incision is made and they are injected with a special tool...seems like it's called a trocar or something similar. The only painful part is the shot I get to numb the area with before the incision is made. The incision doesn't even require a stitch...just a steristrip. The doc suggests no heavy liftingng or intensive workouts (no need for him to be concerned about that with ME!), and showers rather than baths for a couple of days. Then, I am free to resume my normal lifestyle. Some women feel the effects of the pellets right away while it takes others 3-4 weeks. I HEAR, there will come a time when I no longer feel the effects of the implants wearing off or kicking in IF my doc ever gets my dose right.

Hi barter

hope you feel better soon hun...

what ever blood tests we have anything we take should not be taken for 7 to 10 days before a full bloods even vits etc... so the results are true ..

easier said than done i know..... as we need them 😥

jay xx

Yes! I have now learned that the hard way! Now, I have no idea what my true estradiol level was and I really needed to know. That was a lot of spent $ for NOTHING! 

Hi barter

dont blame yourself, when you book blood work ... they should be asking what you take etc and explain all this... they should be checking before hand, like you say though, they wasted your money...

Jay xx