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[Postmeno3]

Hi there,
I'm looking for advice from very postmenopausal ladies over 60 on systemic HRT who might help me understand why I'm experiencing very heavy sweats on waking, whether during the night to occasionally need to wee or first thing on surfacing? I don't sweat at any other time. I started on Evorel25 in May and was upped to Estradot37.5 three months later. I noticed almost no changes at all in symptoms on the first dosage, but symptoms seem worse on this increased one, particularly these sweats, but also with fatigue, concentration, mood, energy, vaginal sensitivity/bladder urgency plus mild panic/flusteredness with any deadline or scheduled timings. With my next review looming, I'm puzzled to know what to request as, essentially, all these symptoms I had before have worsened. The sweats are new and concerning as they affect the quality of my sleep or how my day goes if with the morning wakening. To me, it sounds like quite marked fluctuations due to an ongoing or heightened imbalance which I need to know what it's indicating and how to address it? I think testosterone could help, but with the oestrogen deficiency symptoms seemingly all over the place, that's an unlikely outcome. Has anyone any experience of this sense of going backwards, even with a new symptom, in my case sweats and what helped you?
Feeling a bit despondent.
Many thanks in advance.
💚

[Dierdre]

Sorry cant help with the HRT and related symptoms as im not on full HRT just local but the sweats have been a problem for me too. I never suffered with them before (65 and 11 years post meno) until i had the AZ vaccine in March then again in June, they have only recently stopped this last couple of weeks. There's alot of threads regarding this and disruption caused to HRT regimes that were previously fine. Also younger women have reported changes to their menstruation after the vaccine. Assuning you have had the vaccine, have you considered this?

[Gnatty]

Just to add, that is still a very low dose of oestrogen so you have plenty of room to increase the dose further/ try a different delivery method eg gel.

[Postmeno3]

Hi Deirdre. I had the Pfizer and the second one was a long time ago. I think it's insufficient systemic oestrogen and no idea what is being absorbed. Thanks again.

[Postmeno3]

Thanks, Gnatty. Yes, I think still plenty scope and earlyish days after many, many years depleted.

[Wrensong]

Almost 60 & 9+ years postmenopause.  The horrible, intense night sweat package has been my most resistant symptom since very start of peri in mid 40s & one that continues to wreck sleep whatever I try.  Currently on same brand & dose of oestradiol patch as you.  When I add in the progestogen cyclically the night symptoms get markedly worse & I reason this could perhaps be the opposing effect on oestrogen, or the fact that prog raises body temp.  Oestrogen is said to increase the stress/waking hormone cortisol though, so perhaps something for both of us to bear in mind.

I am on testosterone, this does seem to have helped with sleep & has definitely helped other symptoms, so may be worth trying when you can.  It's not stopped my night sweats but my first menopause specialist told me years ago that it should improve sleep.  Still fine tuning my HRT but it's complicated by other conditions. 

My feeling is it may be that you need more oestrogen (some of your other symptoms suggest this, don't they), but equally that your body could well be struggling to adapt to the relatively new influx of hormones & especially now at a higher dose.  I think you've posted in the past that you had a long break from HRT & are very sensitive to medication.  Mine throws a hissy fit at every change, whether up or down.   

I also sense that the deeper sleep I get as my oestrogen dose increases, together with the mildly sedative effect of some progestogens, means I sleep further into overheating episodes, so that by the time I wake suddenly with them they are very intense.  What I mean is that my sleep is unsatisfactorily lighter on lower oestrogen but that means I wake more easily as I begin to overheat, so can remove covers before the heat becomes truly infernal.  So the accompanying shock to the system is less.  Either way, sleep is far from adequate!  Have you noticed that when you are actually asleep your sleep has deepened on the increased dose - could the intensity of overheating scenario with associated stress response be the same for you?

If you can manage to get your oestradiol level tested to see what absorption you're getting, this may help you work out next step.  You mention your instinct that fluctuations may be behind the night symptoms, so you could maybe discuss with your prescriber trying a different method - gel/spray?

Sorry Postmeno3, this can be such a bumpy ride when in later years we could really do with it being sorted pdq.
Wx

[Postmeno3]

Thanks. Sleep is of a very good quality on the higher dose. My understanding is pumping out a lot of cortisol depletes oestrogen and so there could be a case for increasing the oestrogen to have sufficient to manage or deplete the cortisol output. Maybe someone with the "chemical interaction" expertise will come along to inform us more! 🤞

[Wrensong]

This is interesting (small study), but perhaps explains why some women feel better on a form of progesterone:-

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663529/

"Conclusions
Estrogen administration elevated cortisol levels, but this effect may be moderated by progestins."
Wx

[Mary G]

I'm 60 now and over the past year, I have noticed that I need a lower dose of oestrogen and if I go too high, I get loose bowels and it triggers my silent migraines.  It's a definite change and my migraine specialist said that in my case, if I take more oestrogen than my body needs, it will set off gastric migraines. 

Fortunately I can take a lower dose of oestrogen (1 pump of gel) and be symptom free but it's certainly a physiological change around the age of 60. 

Could you be the complete opposite and need a higher dose of oestrogen to be symptom free?

What type of progesterone don't you use?

[Postmeno3]

Without bloods, it's very difficult to assess what's what. If I understand the study correctly, (thanks!) patches have little or no effect on cortisol even reducing it as opposed to tablets which increase it. It also seems to imply, if I'm right, that longer use reduces the cortisol scenario even further. I also see this is a hugely underinvestigated area! That's poor. It makes one wonder about increased anxiety, reactive sensitivities etc etc etc! However, I am guessing I need a shed load of oestrogen (progesterone off the table due to hysterectomy). Calling Taz, Hurdity, Elkwarning?? Hmmmmmm.....plenty food for thought meantime!

[Mary G]

It's important to have blood tests fairly regularly to check your hormone levels post menopause, it's the only way to know how well you are absorbing your HRT.  You could try to get them on the NHS.

[Postmeno3]

If only, Mary G. Sadly, they refuse point blank, even at the specialist clinic (NHS). I've posted before about not understanding this dictate for postmenopausal women, where, presumably, the confusing fluctuations of peri and meno which could lead to misleading information, are much less prevalent if at all. Absorption issues are clearly key. Is there a magic wand to be waved for the relevance of this to be given more attention? Surely it can only be beneficial all round for this group, not to mention cost-effective, less time-consuming, less harrowing and just plain common sense? Unless I'm missing something......

[Wrensong]

Sorry Postmeno3, I hadn't re-read this study in detail before posting the link this morning - had simply bookmarked it some time ago & just scanned it today.  Yes, confusingly it cites other studies that gave mixed results as to the effect of oestrogen administration on cortisol levels  (inc one that found transdermal had no effect), but it also mentions that transdermal has some, if lesser effect:-

"This may help explain why oral ERT more consistently elevates total cortisol levels compared to transdermal ERT."

I've done a quick trawl this afternoon & there is mention that cortisol levels are higher in postmenopausal women than pre, but I haven't had time to look into it further.

I suspect a dysfunctional cortisol response is involved in my repeated early awakenings (hence suggesting you might be the same), so I'd really like to get to the bottom of this.  Although I'm much better in other ways for oestrogen & testosterone replacement the night sweats are frustratingly still very disruptive & eliminating them would make a massive difference to my life.  So I really sympathise with your situation.

There are quite a few women on here who report feeling calmer for progesterone (I'm not one of them) & while I understand your point that this is not usually thought necessary after hysterectomy, perhaps you could discuss it with your menopause specialist if, as your earlier thread on the topic suggested, you still feel you may benefit from it.

If you feel you do need a shedload of oestrogen though, does that mean your night sweats were even worse before resuming HRT?  If they were less problematic on 25mcg than 37.5 (as I thought you meant in your original post) it certainly confuses the picture!

I hope you get some helpful advice from other members.
Wx

[Postmeno3]

The "sweats", I feel, are different to "night sweats" in that they only happen if and when I wake, once awake. They do not wake me. During the night, they start after I wake if I need to go to the loo or immediately after waking naturally for the day. They are much worse on the higher dose, indeed was not aware of them at all on the lower dose. I have nothing during the day at all, even on waking from a nap. There must be something about hormonal "rhythms", I'm guessing, perhaps more active at certain times? I know about cortisol firing us up for the day, technically and there may be something worth investigating more fully there in relation to "sex hormone" levels? This doesn't account, though, for the loo call sweat much earlier. Hmmmmm.....🤔

[Mary G]

I have noticed that the NHS say certain procedures are not necessary ie hormone blood tests and uterine scans because they can't afford to offer them to women.   

Far too many women are taking far more progesterone than they need and having dreadful side effects because of the lack of uterine scans and far too many post menopause women are on the wrong type/dose of oestrogen because they have no idea what they levels are.   It's vital to known your levels post menopause, particularly if you need oestrogen for bone protection.

Why not be honest and admit it's because of financial constraints?