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[Mrs Spoon]

Hi,

I am really new to HRT and would be so grateful for any advice. (I read the recent thread started by Gilla but didn't want to hijack it)

I started 4 months ago on Estrogel (2 pumps) and Utrogestan (12 days per month) which originally worked really well with controlling insomnia, night sweats and worsening mental PMT symptoms. However, I found that the PMT symptoms got worse again and I had a Mirena coil fitted about 5 weeks ago.

I have been having continuous light to medium bleeding from the coil (which I am finding a bit trying tbh but am prepared to ride that one out) but I am not happy that the insomnia and night sweats are getting worse again. Should I increase the Estrogel dose, and if so by how much?

I have made an appointment with my GP to discuss things, but it is not for another 5 weeks and I am not sure I can wait that long!

Liz

[Gilla999]

A couple of thoughts -

- I was part of a group zoom call with a handful of ladies who asked a menopause specialist questions. One lady described exactly the same situation as yours and the menopause doctor advised her that it was likely the removal of Utrogestan that caused the return of symptoms (insomnia and sweating). She advised that it's perfectly safe to take Utrogestan and have the Mirena coil at the same time and advised the lady to try this and see if it addresses the problem.

- I read recently that an increase in Progesterone can cause you to be symptomatic of low estrogen, because of the fine dance these two do with each other. It may well be that you need to increase your estrogen to balance out the new amount of Prog you're getting. My personal opinion is that this is more likely (especially with the night sweats) but it's really your choice with what direction you want to try going in 

[Winter]

Hi Liz,

You poor thing. If you'd stopped the utro and moved to the coil, and still having the symptoms, then I guess at least it wasn't the utrogestan itself that was causing the issue.

As Gilla says - it may be an increase in oestrogen is needed - in all the time I've been reading forums etc, it seems to be when people increase oestrogen that they are able to tolerate the progesterone part. See how you go on the coil (I wouldn't touch one with a barge pole, but they work for millions of women).

Gilla - that's so interesting what you said about progesterone - where did you read that? I took utro by itself once on the advice of a meno specialist who though I was oestrogen dominant - it was awful - I'm now on gel too, and completely different experience so there is definitely something in the balance, as you say.

[Terri]

Hi Liz,

As a rule I’d say It’s usually best to check with your GP before increasing, although many are happy for you to make small tweaks at your own judgement. That said, a minimum of 8 weeks was recommended to me after a change to allow for the body to adjust. I also have the mirena and it takes time to settle. I highly recommend it although it doesn’t suit all women. I’m on my 2nd one and has made the whole HRT regime easier me.

Agree with the other ladies comments It sounds like you need more estrogen from my experience. My first  indicator for low estrogen is usually insomnia and night sweats returning, and I’ve had to up my dose after 7 weeks when I started (12 weeks ago). Within a couple of days those symptoms resolved. I went up from 1 to 2 pumps and I did this by increasing gradually - half a pump for a couple of days initially. I’m sensitive to small hormone changes.

Given it’s been 4 months for you, I’d say you definitely need an increase. 5 weeks is a long time to wait with symptoms in my view, I’d be inclined to increase by half / one pump and see how you feel. You can always revert back to 2 pumps. X

[Perinowpost]

My friend had to go from a 50 patch to a 75 when she had her coil fitted, to balance out the oestrogen with the progesterone from the mirena x

[Gilla999]

Hi Winter - I came across it while researching about estrogen / progesterone ratios, as in my own experience that is equally as important as the level of any one particular hormone ie. you can still be symptomatic even if each looks ok on paper if the ratio is off.

Here is the thing I read that I was referring to:

https://healthmatters.io/understand-blood-test-results/pge2-ratio

WHAT DOES IT MEAN IF YOUR PG/E2 RATIO RESULT IS TOO HIGH?
A high ratio occurs when Pg is high relative to E2. This is most common with supplementation and describes progesterone dominance. When this occurs, a patient may complain of symptoms of estrogen deficiency resuming after previous successful treatment, as estrogen receptors are down-regulated by excessive progesterone. In general, either increasing estradiol and/or decreasing progesterone are appropriate.

[Winter]

Thanks Gilla - so useful and explains why I'm fine and can tolerate utrogestan now and couldn't before!

[Mrs Spoon]

Thanks for all your advice 

The insomnia started about 10 days ago and the night sweats have only been going on for a few days, but they are gradually getting worse.

I will try 3 pumps of estrogel for now and see if that helps.

[Spiderley13]

Just wondered if your issues resolved with the increased oestrogen ? I’m in a similar situation after recently having the coil fitted and have found that my night sweats have become much worse…….

[Nas]

Personally I think that that coil works best with a slightly higher dose of oestrogen.

I am on the 75 patch with a mirena, which seems to work okay ( ish) Anything lower than a 75 and I don’t feel great.

It’s all about fine tuning unfortunately and that can take time and patience.

[Spiderley13]

Personally I think that that coil works best with a slightly higher dose of oestrogen.

I am on the 75 patch with a mirena, which seems to work okay ( ish) Anything lower than a 75 and I don’t feel great.

It’s all about fine tuning unfortunately and that can take time and patience.

Thanks so much for your reply , it’s so hard knowing what to do for the best ! I think I will continue as I am for a bit giving the coil chance to settle down and then make some tweeks if things don’t improve