In my experience oestradiol is an unrealiable and generally inaccurate
predictor of oestrogenisation and deficiency symptoms, unless it is very
low. In general one should expect the FSH/LH to drift back gently toward
normal once an appropriate "dose" of HRT has been found. Often this dose
can be much more than we would have assumed should be necessary. Some of
the difficult patients - in particular those with premature menopause
symptoms - seem to need especially large doses and seem to do better on
patches. Perhaps they have an entero-hepatic utilisation problem?
Unfortunately "there are no EBM studies" (quote of the year !!) to support
this suggestion and patches here remain unavailable for "ordinary" doctors
(ie. GP's) as a Government subsidy.
Who the hell invented EBM anyway ??
Jon Wilcox
----------
> From: Paul Caldwell <[log in to unmask]>
> To: Prof Purdie <[log in to unmask]>; GP-UK Bulletin Board
<[log in to unmask]>
> Subject: TESTING FOR THE MENOPAUSE AND HRT
> Date: Wednesday, 2 October 1996 07:42
>
> Testing of FSH, LH and oestradiol is widely performed in women who have
some
> symptoms of the menopause. What should be the timing of the tests and is
it
> necessary to measure oestradiol after HRT has been started to obtain
adequate
> bone-protecting levels? Are resolution of symptoms on HRT a reliable
clinical
> indicator of adequate bone-protecting oestrogen levels? If a women with
high
> FSH + LH has a normal oestradiol level, presumably there is no need to
start
> HRT, but should it be repeated in what time interval?
>
> Paul Caldwell
> [log in to unmask]
> GP, Beverley HU17 7AQ, UK
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