Understanding pathology report.........

Could someone please help me understand the pathology report I received from the Endocrinologist - he said "nothing to worry about".
The readings were;
Reproductive Hormones:
units ref range
New Oestradiol 1311 pmol/L
New Prolactin 245 mIU/L <650
Reference ranges:
Follicular <550
Midcycle 300-1400
Luteal 85-850
Menopausal <100
If I am reading them correctly I figure that being way past menopause but on an Estrogen Implant I should be under 100, or, does the fact I have an implant put me in the "midcycle" range? and my reading is 1311. So I'm way, way above. No wonder I feel off!!!
The Endo. professor and my GP don't seem concerned.
And to add to the fun..........I came down with the most savage UTI on Monday - pain in whole urogenital area right down to knees. Am on a cocktail of antibiotics AND PROBIOTICS (so I don't get the dreaded candida AGAIN!). 3 days on and my whole tummy area is still sore. I was in the city (400 kms away) with DD and g/children to see "Disney on Ice" on Sunday. Had a fantastic time with G/c and really crashed after they left for home on the Sunday night. I ended up in major hospital ER on Monday morning. Grrr! Thankyou for any info.

pakline,

The estrogen reference levels usually refer to the various results on the general population who are not taking any supplemental estrogen. Menopausal women who are not taking any estrogen would most likely be well below 100. I have read that the average blood level is somewhere around 24. But remember that there is a range. Most women feel just fine with where ever they are at after the transition of menopause.

If you are on an estrogen supplement then your blood level would be affected by how much estrogen you are taking. Do you know what your daily dose is? or what the endocrinologists thinks is an acceptable blood level? How long have you been on the current dose? What is your goal with estrogen treatment? Does it match the endocrinologists goals.

I am 53 and would not want my blood level up at the level of a mid cycle premenopausal lady. My goal is the lowest dose that manages my hot flashes at a level that is acceptable to me. My last blood level was 41 and I am happy. In time our bodies do get used to the lower levels. Abrupt changes are traumatic to most of us.

Thanks Pearl for your reply. To put you in the picture: I have an Estradiol implant 100mg and it (the 4th one in 2.5 yrs) has been in since March. I was well past menopause (1994 & never experienced hot flushes, or any other worrysome symptoms - breezed through) when I had the hyster (2003)and 2 subsequent surgeries for prolapses (2004) & adhesions (2005)and because my urogenital area was so troublesome my GYNO put the implant in - I can't seem to tolerate vaginal estrogen as it causes thrush and much irritation. I have thought for a long time that it is too much estrogen and when this pellet dies I don't propose to have another - if I do need anything I will use patches as they are much easier to control. You seem very knowledgeable about these matters so could I please ask another question of you: 2 weeks ago I completed a 10 week course of Diflucan (candida again from trying to use minimal vaginal estrogen) and 10 days after finishing the course my breasts were so "stimulated" for several days (I actually had an orgasm whilest gently rubbing some moisturing cream into the nipples to see if that would relieve the feeling!)
I assumed at the time that the Diflucan had blocked the estrogen and when I finished it, the Estrogen rushed in. I have to wait until end of Sept until this implant dies so I expect to be feeling "off" until then. It's been 3 yrs of hell and I certainly regret that I ever had the hyster. Thankyou again, Kerry

pakline,

Does this sum up your situation? Implant 100mg in since March (approx 16 wks). Diflucan for last 10wks. Not able to use the vaginal estrogens due to persistant candida infections. Increased breast sensitivity after Diflucan treatment completed.

I am not aware of any estrogen blocking effects of the Diflucan. This would be a good question for a pharmacist. If it did block estrogen which would surprise me, the estrogen would not be likely to rush in after the prescription were finished. Drugs have what is called a half-life. Doses are given to keep up with the rate of metabolism of the drug. There are drugs which build up but I don't think estrogen is one of them which is why we take it daily or continuously. Your blood level of estrogen does seem pretty high for a steady state dose. I don't know if those implants are available in the US and have no idea what the 24 dose would be. While there are differences in individual woman's blood levels given the same prescription, there is an expected response. If you can't get more information from your MD, go in and discuss this with your pharmacist. Your experience is interesting and I wonder if it is coincidental or related to your prescriptions.

PS, Is there any way to remove the implant before September? I would want it out too!

I feel the same way about my surgery. I don't know why so many women are happy about hysterectomies?

Kerry,
I don't understand them either, I actually did go back to my DR yesterday and got results of blood tests I had done 6 weeks ago,
like you I had a 100mg implant, I had tests in January this year and it still was working fine ( 16 months in) well it must have run out sometime between Jan and June because now the DR says my blood tests show almost nothing??? wish I understood more.
I am happy though that it explains alot, I also like you am not having another one put in, I found it OK but I did at various times seem to be showing many symptoms of estrogen dominance.
I'm giving Progynova 1mg a go, at least if it doesn't seem enough I can up the dose to 2 tablets a day ( DR OK and suggested this)
I do know that certain medications can affect estrogen , I'm sure antibiotics are one of them.
Ask your DR, I'm on Oroxine and I had some problems with the implant and that medication when I had it put in.

Goodluck
Wendy

Thankyou dear friends for your input. Yes, Pearl, that pretty much sums up my situation, except that the vaginal estrogen seems to cause Candida - I know it's not supposed to, but it does. I am currently on ABs for severe UTI and also taking Yakult and pro-biotic capsules (the ones you keep in the frig), so hopefully I won't get candida this time around. It's taken 5 days to get the UTI settled, and the ER I went to put me on a 10 days course, so, 5 to go. I've also had vulvodynia (2nd time) but that is settling too, thankfully. That seems to be flared up by Diflucan oral - who knows?! My GYNO told me that if I needed the pellet removed before time it was a major, major, job!
I think I can live with it until Sept. but am NOT having another put in. Mine only last 7 months max. - supposed to last 9-12 - but then again, I am a bit on the "fluffy" side. I phoned the Endocrinologist yesterday to discuss the readings with him - he didn't seem to be at all concerned, and said whatever I want to do next time is totally up to me (gee, don't I know that!) and didn't think I had estrogen dominance. Because I can't seem to use vaginal estrogen, I've been using Replens - am scared that when the pellet runs out, the Replens won't be enough and the water works will muck up again. Honestly, I'm so sick of all this!!!Thanks again, girls, I do so much appreciate your support, knowledge and friendship. Kerry