a question for women on HRT

I had bloodwork done outside of my regular clinic and I am trying to make sense of it. I will see the gynecologist at my clinic on video in November and would like to prepare questions for her.

I am on Mirena and the lowest dose of Estradiol (I use Vivelle-Dot patches). I have been on Mirena since 2004. Not the same IUD, obviously, but the same type. I have been on Vivelle-Dot for one year. I am 52, soon to be 53. I do not have any overt symptoms of menopause or perimenopause. I had a very late menarche in case this is relevant (I was just 2 weeks shy of 16).

Mirena initially erased my periods (back many years ago), but now I spot on it more and more regularly. Last time it was even enough to wear a thin pad for one day. Usually the spotting is so light that I do not need pads.

Here is my bloodwork:

Estradiol (pg/mL) reference range 19 - 144, my level 20
Progesterone (ng/mL) reference range, 0 - 21.5, my level 0.5

These are reference ranges for ovulating women, I would think.

Still, considering that I am on HRT, aren't my levels a tad low? I wonder if I should be taking a higher dose.

I have never had this type of blood test done before and I do not know what my levels were in the past; nothing to compare to.

I have a very heavy skeleton so osteoporosis is not a concern now, but down the line, wouldn't it be better to have a little more estradiol in the system to protect my bones??

If you are on HRT, what is the target range for estradiol and progesterone for you? How often do you get tested?

looks like my low libido might be caused by low estrogen. I will try taking more.

Hello. I too am on HRT but have just begun. I know this is an older post and you may not see it.
I have not had any blood work done yet. I am on estradiol. 025 and progesterone 100mg. I am going to switch to Mirena IUD because I feel so sleepy and moody with this much progesterone.

Do you have any side effects? How do you like the IUD?

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Thank you for posting!

I love the IUD. I had my first Mirena inserted in 2004. Since then, have had several swaps. I think it is the best. I sometimes have spotting but that is all.

I am on the same dose of Estradiol as you. Mine comes in the form of Vivelle Dot patches which I change twice a week. How about yours? My patches stick to the skin of the stomach really well and do not come off after I shower or swim. They are very convenient.

But in terms of libido, mine was due to my taking Latuda. It was an unusual side effect to Latuda, the low libido. I switched to Geodon, in December. They are cousin medications, Latuda and Geodon, but for me they act very differently. On Geodon, I am far more alive.

I possibly still need more estrogen, though.

When will you have your bloodwork done?

So we are similar
My estradiol is a sticky patch too.
I'm going next week to have the Mirena put in. This current dose of progesterone is too much for me. I'm too sleepy.

No one has mentioned any blood work to me yet 🫨

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I had bloodwork done outside of the clinic. At the clinic, they did not mention bloodwork, either. But next time I see the gynecologist, I will ask for it.

So it's a good idea to monitor the levels right?

Does progesterone make you sleepy?

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I have never been sleepy due to progesterone. I now am sleepy possibly due to narcolepsy which is a new thing for me, but Mirena is not new and I was not suddenly sleepy when I began wearing Mirena.

My gynecologist says it is not necessary to monitor hormone levels if you are ok symptom-wise, but I prefer to know.

Thanks for the reply!

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I have read up more on the subject. Apparently, estradiol blood tests can give erroneous results and for this reason, HRT is adjusted based on symptomatology rather than blood markers.

Very interesting. Would you know if HRT can have any effect on vision?

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I do not know about vision, no, sorry.

Apparently, there are some positive effects on vision:

Visual function in menopause: the role of hormone replacement therapy - PubMed.

Just FYI. I went in to have the Mirena put in and the Dr wasn't able to do it. She said I'd have to go outpatient to have it surgically implanted.

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I wonder why, what the complications are that necessitate surgical implantation. Normally it is a quick in-office procedure. Actually, my very first Mirena back in 2004 was inserted by a family physician, not even an OB-GYN.

The Dr said my cervix wouldn't open enough to insert it. It was really quite painful

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Oh I am really sorry to hear that. When is the outpatient procedure?

Oh thanks! I haven't scheduled it yet.

Sorry I didn't mean to hijack your thread

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So I finally saw my ob-gyn for a well woman exam and she said that all my levels are OK. That testosterone is pretty low (11) is normal "as we age" and she referred to herself and me. So I guess since I feel just fine, I will go with her judgment and not change anything.