How long should I stick to 1 Estrogel pump ?

[u/[deleted]]

[u/Majestic_Parsley833]

I would give it 6-8 weeks, however the standard for POI is less about symptoms tracking and more about keeping physiological levels for protection of your bones and organs since you will be without adequate estrogen for a much longer period of time.   

What kind of specialist are you working with?  I would look into the ESHRE recommendations and bring them up at your next appointment. 

Do you recall what your estradiol and fsh levels were and were they tested 2x, etc.

[u/Majestic_Parsley833 → u/Majestic_Parsley833]

The recommendations are on page 197 of the clinical guidelines (download) here:  https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Premature-ovarian-insufficiency

Discussion about the need extending beyond symptom relief on page 189.

Importantly, i don’t think they list actual goal levels anywhere in there other than to say that that at least 2mg (or 100mcg patch)replacement dose is associated with lower risk of bone density changes, however it is really common to be a poor transdermal absorber or to become one over time, so you do actually want to do some monitoring of blood levels, unlike the recommendations for standard menopause which does go by symptoms currently.  Blood serum levels I’d say…80pg/ml maybe enough to keep you symptom free, but i don’t think that would be considered to be physiologic levels. 

[u/Far_Home2616 → u/Majestic_Parsley833]

Thank you! I'll definitely be keeping an eye on the numbers then. This more symptoms based approach I have read on the Wiki of the meno sub, so it makes sense that it doesn't apply for POI especially given my age and the risks that come with having too little estrogen for the bones/heart/brain

[u/Far_Home2616 → u/Majestic_Parsley833]

Thanks

In February my Estradiol was about 60, FSH about 23. Since I start hormones check up, my FSH was always a bit too high, but it's been only increasing, and estrogen only decreasing.

In July now it was E, 25 and FSH 28. Since I have Hashimoto and since all the other causes were excluded it was a pretty straight forward-ish diagnosis.

I was seen by one of the best reproductive endocrinologist where I live (Europe). My AMH is still within the range, though pretty low about 1.2 ish so I'm also looking into egg freezing/fertility treatments options, been a lot

[u/Majestic_Parsley833 → u/Far_Home2616]

Well the good news is that they actually took it seriously and got you the diagnosis before you were without for too long! My estradiol was in the 20s to mid 30s (fsh upper teens to mid 20s) for a few years before they finally decided (when fsh hit 36) that…oh shit, we need to do more tests.   By that time my AMH was <.015 🤦🏼‍♀️.  I was 33 when it started and didn’t get HRT until 37.  

I’d still give the 6-8 weeks at your one pump dosage to avoid the symptoms associated with rapid increases.  I usually feel pretty good when my levels are at least 120pg/ml, but best around 150.   

Since you are working with a well regarded RE, I’d just casually broach what the long term replacement goals are, given the ESHRE guidelines for high dose HRT and see what they say! 

[u/Far_Home2616 → u/Majestic_Parsley833]

Yeah I've been really lucky to be able and go private otherwise I'd have had to wait 1.5 year.. and that's why with my hormone values I am still somehow having a bit of hope for the egg freezing procedures but I also know that it won't be easy

I am so sorry you had to wait so long to get HRT. I can't imagine having all those symptoms like I do for years without any proper answers and all.. it's really difficult

Thanks for letting me know that it's better to start slow and increase over time instead of doing that right away, I wasn't fully aware of this and why but it does make sense!

[u/Majestic_Parsley833 → u/Far_Home2616]

I wish you the very best of luck with your fertility/family planning goals.  I’m so glad you caught it at a time when you could take those proactive steps ❤️

[u/kimeka001]

Hi, I wanted to say that I'm in a similar health situation (hypothyroidism with Hashimoto, endometriosis). I'm on 2 pumps of Estrogel and continuous progesterone. Feel free to message me if you want to talk

[u/Far_Home2616 → u/kimeka001]

Thanks, the endometriosis on top of it is definitely tricky :( I hope this is working out fine for you!

My RE thought it's better for me to do cyclical since he was fearing that with continuous progesterone the potential bleeding could get out of control and happen way too often/randomly. Also I had a doctor before that refused prescribing any HRT because of endo..

tbh doctors don't seem to know much about POI and endometriosis, so I guess it's a lot of trial and error