estrogen level for surgical menopause HRT under 40 years old
December 10, 2018 11:24 AM   Subscribe

YANMD. I have my estradiol level lab results, but my surgeon is on vacation, and the reference ranges do not cover my specific situation.

I am under 40, taking estrogen-only HRT due to surgical menopause. My GP suspects my estrogen level is too low and is the cause of the debilitating fatigue and cognitive issues I've been having, since she's ruled out every other possibility she can. My surgeon ordered a blood test at my 6 month follow up last week, and I have the results of that, but he is on vacation and I cannot find any information on what the appropriate value range should be in my situation. Does anyone happen to know what the reference range should be for a woman under 40 taking HRT due to surgical menopause?
posted by Ruki to Health & Fitness (9 answers total) 1 user marked this as a favorite
 
Did your GP already review the results? It seems like they would be the best person to ask.
posted by pinochiette at 11:25 AM on December 10, 2018


Response by poster: Oh, right, important detail. My GP will not discuss results. She wouldn't even order the bloodwork and told me to ask the surgeon to do it. She considers this outside the realm of her expertise. She does not get involved in anything that involves another doctor.
posted by Ruki at 11:31 AM on December 10, 2018


She thinks your estrogen is too low but won’t order the test to check? That’s odd, to me. Is she the one prescribing your HRT?
posted by cabingirl at 12:23 PM on December 10, 2018


Response by poster: No, the surgeon who performed the hysterectomy and oopherectomy is the one who prescribed the HRT. He’s part of the same practice as my GYN, so I also can’t ask her, as they don’t get involved in other doctors’ cases. Yes, it is ridiculous.

I’ll stop threadsitting after this, but I had the surgery in July. I had a difficult recovery. In September, the surgeon, who I had been seeing weekly, referred me to my GP for the fatigue issues. GP ran a bunch of tests, which were normal, and told me to tell the surgeon to check my estrogen level. This is the first time it’s been checked since the surgery. I take 1 mg of estradiol daily.
posted by Ruki at 12:45 PM on December 10, 2018


Best answer: I'd definitely recommend the Google group mentioned here as having a wealth of information & experience to help you sort through things. One of the things I've learned from that group (as a surgical menopause-r myself, though just over 40 now) is that standard blood levels of estrogen aren't as important as how you feel. Take a look at the posts on that blog I linked up above, for the symptoms of low estrogen -- you could indeed be having estrogen levels that are too low for you.

(For me, low estrogen does come with fatigue, but also noticeably achy bones. Too high for me looks like insatiable hunger -- of the "I'm eating two lunches a day" variety -- & uncontrollable sugar cravings -- of the "where's my daily chocolate bar?" variety.)

Good luck getting sorted out! Playing with doses isn't fun, especially if your GP isn't helpful.
posted by diffuse at 1:06 PM on December 10, 2018 [1 favorite]


Best answer: I am no kind of expert on this topic but here is what I found in a few minutes of googling that might be helpful:
  1. General overview and discussion
  2. Serum estradiol level and postmenopausal symptoms in surgical and natural menopause
  3. Mayo Clinic Q and A: Estrogen replacement therapy after ovary removal
So source #2 has some values for serum estradiol that might at help put some perspective on yours (surgical menopause: 20.49 +/- 3.16 pg/ml natural menopause: 27.41 +/- 5.08pg/ml). That study has a pretty small sample and represents results from one hospital in one country. And, the subjects might not be in your age range. But my biggest takeaways from that study were:

- There is definitely a difference between estradiol levels between those who have had surgical vs natural menopause
- But there is just as much or even more individual variation within each of these groups.

That immediately makes me think something that is then confirmed by source #3: "It is not standard practice to check estradiol levels in women on replacement therapy. Instead, the dose of estrogen replacement therapy typically is adjusted, as needed, to control menopausal symptoms effectively." In short, there is enough individual variation in dose & response that your best bet if you're having symptoms is to try adjusting the dose and see what happens.

Having said that, she does give a target range, though--another thing to think about between now & when you see your doctor: "That said, for young women like yourself, it is a good practice to have your estradiol levels checked annually and after dose changes to ensure that the level is around the desired goal of 100 picograms per milliliter."
posted by flug at 1:24 PM on December 10, 2018


Response by poster: That's exactly what I needed! It does make a difference when you start HRT under 40 because there can be serious health issues from long term estrogen deficiency. I had already found that second link via google, but it didn't apply to me.

I will also check out that group because, uh, my medical support is lacking.

By the way, my level is 52 pg/ml.
posted by Ruki at 2:07 PM on December 10, 2018


My gynecologist has mostly menopausal and post-menopausal patients, whether they came to it naturally or by surgery. He doesn't go by test results at all, but rather looks at the symptoms and considers their risk factors. He'll order a test if someone wants it. He says that if someone is going to benefit from HRT, it will happen quite quickly. If added estradiol helps, there's the proof that a patient was deficient.

When I started using estradiol, I felt a lot better and then in a couple of weeks the improvement had dropped about 50%. So I was prescribed a higher dose, felt great for two weeks, and then went back to how I was on the lower does. The explanation I got was something about, "some women generate more receptors in response to more HRT..." and the rest I can't remember.

Soon after my hysterectomy, I also found out I was hyperthyroid. The symptoms for that and low estrogen overlap a lot; in my case, that includes the cognitive symptoms. Just something you might want to keep in mind.
posted by wryly at 3:55 PM on December 10, 2018


Here is a rather extensive discussion of Serum Estradiol levels at various ages etc. from the Mayo Clinic.
posted by flug at 8:20 PM on December 10, 2018


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