Declining Oestrogen? on HRT!?
A candid and open account from one of the founders of The Female Health Clinic
I count myself eternally blessed to be working in the Menopause industry. At 52 years old… how lucky am I to be in this place? As well as loving the job and our patients I am privileged to have access to colleagues who have specialist expertise on navigating both the perimenopause and menopause pathway….at the tip of my fingers.
So my hormones are perfect…or so I thought.
It was July 2022 (I had started HRT the previous year) and my levels were looking beautiful 🙂 – Oestrogen and Testosterone both in therapeutic levels and FSH 15!! Bingo, Bango and Brilliant.
I felt fantastic, no aching joints, hot flushes or headaches, low moods greatly reduced and my middle waist had appeared again. My hair and skin were fresh and I was firing on all levels at work with plentiful energy levels and zest for life. And so I continued on my perfectly working regime, 75mg oestrogen patches and a pump of testosterone twice weekly. The Mirena coil working well for me for womb protection required from progesterone. Perfectly perfect.
Fast forward to a year later, its July 2023
As a snapshot; my joints were aching daily (chronically in the mornings), I had lodged several complaints with my hairdresser (bad hair and bad mood 🙁 and I could not, for love nor money, get anything ticked off my “to do” list, work or otherwise. In fact I had even forgotten where my to do list was 🙁
The actual “wake up and smell the coffee” moment for me was when I realised that for the two weeks prior my sleep was also disturbed, I would wake up with matted hair from sweating and my general mood and ‘get up and go’ had got up and gone…and slammed the door on leaving!
That same week during a clinical meeting with a couple of colleagues I forgot three times during the meeting what I was about to say. An “angel” asked if I had checked my hormone levels recently. I replied “I am still taking my HRT. Why would I need to?”
“I wonder?” I thought as I left the meeting. I almost convinced myself that my levels must be fine as I was doing exactly what I was doing when I hit hormonal heaven in July 2022.
Let’s go back six months to the start of 2023. From that point until around July 2023 I had been under enormous pressure and stress. A very challenging personal matter (relationship) and work was very difficult. At the time I felt I was coping OK. However the enemy of female hormonal stability, cortisol (amongst others) was running riot within me.
In hindsight, knowing I was navigating stressful times I would have checked my hormone levels more regularly. However I didn’t and in July 2023 I retested and I was astounded by the results.
Unrecordably low on testosterone and lower than any therapeutic range of oestrogen for women of any age, even an older woman of much later years.
How can this happen without me even noticing? Because the symptoms of oestrogen and testosterone deficiency don’t just rock up one day, knock on your door and say ‘can I come in please?’ There is no one moment that you suddenly get an achy joint, or a bad mood or mojo fatigue and procrastination. These things seep in really really slowly, but very surely, each day, just like the perimenopause and then you hit a crisis point.
Looking back I can see my decline through my diary function and work ability throughout the early part of the year, however nothing was bad enough or chronic enough for me to really notice what was happening. Until July this year. That is six months of decline, slowly but surely into the feelings and physical state of “Who am I?” and “What is happening to me?”.
Following my blood test and under specialist advice I increased my Oestrogen patches to 100mg and my testosterone application to 3x weekly.
Now in September I am feeling great once again. No sweaty head (therefore much improved hair!), my joint pain is easing dramatically (no more creaking and groaning for 5 minutes when getting out of bed or off the sofa) and my energy levels are soaring. As for my brain function I can feel it alive, well and getting lots and lots of great stuff done. Amazingly brilliant.
I will retest my levels in October….watch this space….
As with all the services we offer, this got me thinking about access to blood tests for our patients. I am lucky I can access these services relatively easily. Perhaps we have patients who cannot but would like to?
While medical guidelines state that HRT can be prescribed based on symptoms alone and additionally symptoms should always be considered as opposed to dosage, I biologically know now that my levels were ok and then they dived. I know this simply because I had blood tests to refer to and compare.
Of course, if your doctor felt they needed to understand your pathology further based on treatment reviews and results then they would advise and recommend accordingly but you will never be asked by our doctors to have a blood test ‘just to see’. This is usually at a patient request not a medical one.
We would love to be able to give away free hormone blood tests so all of our patients can monitor (if they so wish) their own levels and adjust according to life’s demands, stresses and general curve balls. Sadly we can’t offer this, but it did make me think about what we could do…
So with immediate effect we will now be offering the following to our patients:
- Oestrogen/FSH monitoring for £50*
- Testosterone/SHBG for £45*
*When taken by your menopause doctor during your appointment.
In addition, we will deduct 25% off all other bloods requested at your doctor appointment.
This will make blood testing more accessible, I hope, to all patients.
If you have further ideas / thoughts or simply a view on the new approach to blood tests to check maintenance levels, I’d love to hear from you.
Perhaps you feel twice yearly would be great. Once at the start, in the middle and then again at Annual Review? Or perhaps you might just like to check in during stressful or ultra busy periods? All input gratefully received.
Our aim is to alway try and offer great value services to all our patients and I would very much like any feedback you would be willing to give! Please mark it for my attention and send to: firstname.lastname@example.org
And do read on if you’d like to know some more about stress and how it affects our hormones.
Thanks for reading, I hope you feel understood, enlightened and informed. Always our aim.
Explanation of stress and why this interferes with our hormone levels:
Stress may be defined as any situation which tends to disturb the equilibrium between us and our environment. In day-to-day life there are many stressful situations such as stress of work pressure, examinations, psychosocial stress and physical stresses due to trauma, surgery and various medical disorders.
Stress causes the body to release the hormone cortisol, which is produced by the adrenal glands. Cortisol is important to blood pressure regulation and the normal functioning of several body systems.
Excess cortisol alone can contribute to high blood pressure, mood changes, low libido, weight gain, and irregular periods. But a prolonged stress response can also interfere with other hormones, including testosterone, oestrogen and progesterone.
In women, one common way that stress affects the body is by causing hormonal imbalances. A hormonal imbalance occurs as a result of having too little or too much of a particular hormone in the bloodstream.
If you are currently using HRT to manage your perimenopause and menopause journey then this is “supplementing” your own levels. When you experience stress, trauma, illness or other upsetting events then your naturally occurring oestrogen and testosterone levels will reduce rapidly thereby reducing your overall levels even whilst taking supplementation.
Studies have shown that younger women experiencing symptoms of the perimenopause or menopause often tend to need higher levels of estradiol (and therefore usually higher doses of HRT) than older women do.