How to Know when your Estradiol Dose is Too High | Drs. Valorie & Maki Explained

Intro: Signs Estradiol May Be Too High 0:00

That is one symptom is spotting, uterine bleeding. That could be a sign that your estradiol level is too high. >> Your dose is too high. If you're having consistent, erratic, or irregular consistent bleeding. >> What symptoms mean my estradiol dose is too high? Hi, I'm Dr. Valarie Davidson from the Progressive Health Podcast. >> And I'm Dr. Mackey from the Progressive Health Podcast. Uh so, as you already mentioned, so today we're going to talk about how to know when your estradiol dose is too much.

>> Exactly. So, a lot of women will talk about, you know, dosing, maybe you do labs, maybe you don't, but what symptoms physically or emotionally can you find that would show that your estradiol dose would be too high? >> Yeah, I mean, you know, I I can tell right now once we get into this episode, there's a paradox there. Um when you're talking about, you know, the dose being too high or too low. Uh and sometimes it can be a little challenging. Now, sometimes it's very obvious. We'll talk about what some of those are. Um but um the subtlety of HRT can also be a little bit confusing to know if it's too much or not.

>> Well, I think it also has to do with your progesterone dose, too. So, you have your estradiol dose or your bias with estriol and estradiol, and then you

Breast Tenderness and Sensitivity 1:12

got your progesterone, which will do the next podcast we'll do on if you if your progesterone dose is too high. But, definitely if the estradiol is too high, you're going to have some breast tenderness. Like, that's probably classic. I'm sure a lot of you already know that that there's going to be breast fullness, there's going to be breast tenderness. Sometimes there can be almost like even little lumpies cuz if your estrogen's a little too high, it can actually aggravate women that have a tendency towards fibrocystic breast um conditions. >> Yeah, and usually those things appear like if you're new to HRT, uh especially on the estrogen side, you might have that for a little bit, and then it usually goes away.

>> Right. So, her body can get used to it. I've even backed it off a little bit, so we're going to kind of titrate up a little bit slower cuz some women and way more sensitive to the estrogen. >> And is pretty remarkable uh when you look at the different types of dosing and how different women are. Like there is not one one dose, one form, one anything that fits all women. There is There is as many responses as there are dosings in some respects. So you can't really go based on what what the what the standard prescriptions are available are.

>> Yeah, you have definitely have to tailor it to the patient cuz everybody's different and there's never going to be a forever dose. Like this is my perfect forever dose. Life just doesn't work that way. Same with the breast tenderness. Some women more susceptible and some are. But it definitely is a key is if you're having breast tenderness that continues and continues, your estradiol dose is probably a little bit too high or you need to do some things to help bring down those estrogen metabolites. One other thing that I find that's interesting when the estradiol level is too high is headaches.

Headaches and Mood Changes 2:48

>> Oh, true. >> Which we'll do another podcast on this in the future. You can get headaches from having your estradiol or your estrogen level too high. You can also get headaches if it's too low. So you want to find that right happy medium. So if you're having high, you know, having the headaches, you want to pair that with the other symptoms you're having. But I'm sure you're probably aware of headaches and estradiol levels. And then did you know that your estradiol level if it's too high, it can make you moody? I'm sure you all know that, right? But it it is true. If your estrogen levels are too high, so you're on HRT and you're finding yourself more weepy, more emotional, uh more irritable, it can actually be because of that estradiol cuz estradiol has a huge impact on your neurotransmitters in your brain. It can have an effect on serotonin, on dopamine. It can actually raise up your glutamate which can make you a little irritable. So if it's So that's kind of like the Goldilocks paradox with the estradiol. You don't want it too hot, but you don't want it too cold. You want it just right. >> Yeah, yeah.

And that's a subjective. Like there isn't a blood number that you can determine what that number is. Um which is makes it for the Yeah, for the mood. I I mean, a lot of those symptoms in general, like the some of those numbers, you know, you sort of have to see where they end up in a lot of cases. Uh so, what else besides um besides headaches behind besides breast tenderness? What else would >> Moodiness. Is fluid retention. So, you'll see that when that estrogen at level goes up is even some of the changes and fluctuations of estrogen if you're doing a rhythmic dosing, you can notice some of the fluid changes, but but not so much I mean, sure, there's going to be like some breast tenderness, maybe some breast fullness from the water retention in the breast tissue, but you can also get it in the hips and the thighs and the stomach. You can get that water retention. Estradiol doesn't directly cause weight gain, but I do feel like, you know, you can have that water retention. And then speaking of weight gain is sometimes when that estrogen's elevated, you can get more munchy. Like you know, munchy or I just I'm not full or I'm full, but I want to still keep eating. So, it can increase up your appetite if it's a little too high, which that could increase up, you know, weight gain. And I wish it was that simple of oh, my estrogen's too high, so I'm gaining weight. Really has to do with the other hormones, too, like you would mention about cortisol, your androgens, you know, testosterone, your progesterone. But I have had some women where they they go on the estrogen and then when I see them again, they're like, "Wow, you know, I lost 12 lb. I feel fantastic." Is that because they're sleeping better? Because they don't have hot flashes? Because their brain fog is gone? Maybe their motivation is better.

And then I've had other women that have gone on some, you know, estradiol levels and they were too high or they come see me cuz they were put on some kind of

Fluid Retention, Appetite, and Weight Gain 5:30

estradiol and said, "Oh my gosh, I put on 20 lb in, you know, a little over a month. Is this because of the estradiol?" And some women are susceptible to that. So, you have to take that into consideration. Cuz I will say in since working, you you with women with HRT since 2004, that I have run across quite a few women that gained weight on estrogen. So, that's why I if you're going to do the static dosing, I really like the biest where you have the estriol and the estradiol. And I don't even sometimes do these ratios that, you know, you can do ratios, but I'll even individually based on someone's symptoms and their labs determine what dose of estradiol they should have to the estriol or what dose of estriol to the estradiol so you can find that balance there. I have some women on very low low doses of estrogen because that's what they can tolerate or they might be I have some women on quite a good number and good level of of estrogen because they feel really good. So, it does come down to the individual, but I will say one symptom of your estradiol being too high could be weight gain and water retention.

And I will say I probably should have said this number one is if you have a uterus and you're doing HRT that has estradiol in it, if you're bleeding, especially if you're doing static dosing, if you're bleeding or or having spotting, that means that that endometrial lining has gotten too thick and that's because that estradiol level could be too high. Now, well, could be also that the progesterone needs to be needs to be balanced out where that the progesterone might be too low, but we'll talk about progesterone in a different podcast, but that is one symptom is spotting, uterine bleeding, that could be a sign that your estradiol level is too high.

>> Yeah, yeah, yeah. Um but that, you know, that sort of tells you right away if your dose is too high if you're having consistent erratic or irregular consistent bleeding, you know, um any woman that starts HRT, okay, as the practitioner, you might made expect there might be a little bit of that um early on. Let Let's say they're newly into menopause, you put them on some estrogen, and they might get a little bit of spotting right away. Whether that was a remnant of their old old period or it was, you know, as a result of the HRT, but it shouldn't be an ongoing issue. It shouldn't continue It shouldn't continue. Um usually the body's going to acclimate, it's going to change, and then the bleeding should short it should uh short sort of stop. And if it doesn't, then you got to make some adjustments.

>> Uh so you said um breast tenderness, weight gain, um certainly bleeding or spotting. >> Headaches. >> Um definitely headaches or migraines. I would put that on the list for sure. Um honestly, those are probably the big ones. Um you know, and based on the timing of what what they're using or how much they're using and for how long. Um

Spotting and Uterine Bleeding 8:12

so there's quite a few factors that go into determining is just is this just from your prescription or is this from something else? >> And I feel like the moodiness kind of gets skipped over a lot when you're talking about estradiol levels. Like people are thinking, "Oh, you know, my estrogen is too low too low, brain fog, brain fog, brain fog." Which sure, um estradiol levels are low, you can have a lot of brain fog, but when it's high, you can be moody. And that's where people you know, one one day you might feel a little teary or something that normally wouldn't tear you up would tear you up. Or you could be even overstimulated because that glutamate is too high and you're feeling um overwhelmed or your bandwidth is at its length. Like you can have that, you can have the irritability, you can even have you know, even some anxiety cuz estrogen can be stimulating. So you can even have that So you can have all of that. Now granted, you when I'm talking to a patient about their mood, there's so many other contexts to it. You know, family members might be ill, there might be a situation going on, or it's tax season, or something. So of course there's all those factors that can influence your your mood, but I feel like when that estradiol level is too high, it can just almost shorten that bandwidth where you just can get irritated, overwhelmed, anxious, and upset and weepy really a lot quicker than if it were in that right level. So I always talk to uh women when we're talk when we're doing HRT regardless of their labs, is what is your mood like? >> Well, yeah, I mean, if you think about it, HRT really is supposed to increase a woman's bandwidth, give her more tolerance to the stresses around her, not sort of make it, you know, worse.

Right? It's supposed to give her more um a resilience uh to those things. Because if you think about it, you know, when a woman's, you know, finally in menopause, um she's usually probably has a lots of things on her plate. Uh so, she has lots of things to be doing. You know, she shouldn't have time to, you know, be dealing with that. >> It's part of the one of the reasons why women go on HRT in the first place. So, um that definitely gives you a red flag whether if the dose is, you know, too much if her ability to cope has actually gotten worse as opposed to better. >> Which kind of swings back with estradiol and libido. Like estradiol is really good for sex drive. I know people talk about testosterone. Testosterone can be helpful for libido, but the estradiol level is For a female, that's really great for libido. But, if it's if your estradiol level is too high, it'd be awesome if, oh, wow, my libido is really high. It doesn't really work that way. If anything, if your estradiol level is too high, you're going to feel moody, and that's going to do nothing for your libido. Oh, absolutely. Yeah, for sure. I've had blood tests come in, and they'll be, you know, like this one patient not

Lab Timing, Symptoms, and Individualized Dosing 10:48

recently, her estradiol level was in the 200s, and she had been saying, you know, I'm feeling just really emotional. Um she had been spotting. Right? She'd been bleeding. I'm feeling emotional, but, you know, weepy, and just not like my usual self. And she ran some blood work, and it was like 208 or And I'm like, yeah, that's cuz your estrogen's high. And I've had other women, too, where I'll have a blood test, and we'll have an appointment, and I'll say, "Feeling a little moody cuz your estradiol level is 168."

And they'll say, "Yeah, I have." Even if they're not spotting, or maybe they don't have a uterus. So, I feel like that's a big context, and that's why I wanted to do this podcast is I love estradiol. Estradiol's awesome. It's like it's, you know, it it's the cake. It's like everything else is just accoutrements or the frosting like testosterone and DHEA, but estradiol is like the main hormone for females, but sometimes too much of a good thing isn't a good thing. So, that's why I wanted to do this podcast. >> Yeah. No, I totally agree. I know granted like you said some of those numbers obviously the numbers too high if they're having some spotting. Um, but just looking at the number itself um, can be a little bit um, a little bit ambiguous sometimes.

>> And their levels are really high and I'll say, "Oh, they must have just put it on and went and got their blood drawn." And then I ask them and they say yes, they they did and then we and that's where those symptoms come in. So, sure we want to see that that objective data. I'll say, "Yeah, you're definitely absorbing it, but this level probably is not reflecting your true estradiol level because you would just put on your cream and you just ran down to the lab and got your blood drawn. So, you need to pair that all together."

>> The subtleties and the nuances that um, go into managing someone's HRT over time. Uh, none of it's none of it's uh, an exact science. I mean, it's all sort of uh, you know, pr- and definitely an art and a person-by-person scenario um, because everyone's going to respond to whatever hormone they're using, they're going to respond a little bit differently. Um, but that uh, so what you're saying it it does come down to both the physical symptoms, right? So, like I said over breast tenderness, um, their emotional stability, uh, whether they're bleeding or not.

Those are all all all would be uh, sort of classic indicators that their estrogen dose is too much. >> Sometimes when it's a little high, you

Histamine Reactions and Wrap-Up 13:00

can have a bit of a histamine reaction which can be part of that bloating or that puffiness. Some women can feel like their skin is a little itchy or their nipples are itchy because that's a little bit of a uh, histamine reaction coming from the estradiol level being too high. So, I've seen that. I haven't I I wouldn't say I've all I think only one person I can think of out of 20-plus years of practice that the estradiol level being too high caused breakouts. I you don't necessarily see the pimples from high estradiol levels. Sure, estrogen does help with your skin and that moistness and the lipid membrane, so it might cause a little congestion perhaps, but it wouldn't cause acne.

That'd be more with the androgens, but it can cause a little bit of a histamine reaction in certain individuals that are susceptible to it. You know, that'll be our next podcast. We're going to talk about progesterone levels being too high and we'll probably circle back to different levels of the estradiol and the progesterone, but I definitely wanted to do this podcast cuz people are cuz I do like, "Hey, let's take some more estradiol. Let's take some more estradiol." But like I said, too much of a good thing isn't always a good thing.

>> Yeah. Uh until next time, I'm Dr. Maki. >> And I'm Dr. Valarie. >> Take care. Bye-bye.