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[Wrensong]

Ah yes, that's the thing Postmeno3 - sometimes I'm already way too hot when I wake suddenly in the small hours, but what also often happens is that I find I'm suddenly awake, initially relaxed & wondering why I'm awake & then the intense overheating follows within a minute or so.  Often the worst is the latest: the 5am.  On only 25mcg oestrogen I only usually manage to sleep on & off until around 3-3:30am & then I'm too alert to get back to sleep (same as without HRT).  I also don't feel as though I'm on oestrogen at only 25mcg - I don't feel the obvious benefits at that dose that I get on 37.5.  But on 37.5, despite the horrible sweats persisting, I can more often get back to sleep in between as I'm generally drowsier.  I think the intensity of sweats may be worse for me on 37.5mcg than on 25mcg, but cumulatively I tend to get more sleep on the higher dose as the quality when I am actually asleep is better.  Not a consideration for you as you don't take prog, but progestogens really ramp up the heat & the stress response that comes with it, further disrupting my sleep so that I absolutely dread that phase of the cycle.  Not sure whether any of that gels with your experience.

[Postmeno3]

Yes, I suppose I'm trying to differentiate between sweating (as in drenched in perspiration) and overheating. I'd love to find out more about how different delivery methods work and even "brands" for the sensitive as Evorel50 might be the upgrade I need given there was at least no setback on Evorel25. Perhaps there are some ladies with more experience than me in this regard. There might also be a place for better stress and nutrition management. I'm just confused and curious about the worsening on a higher dose and needing to have a clearer idea of absorption and levels so that I might know better what I'm dealing with so that I can work with it as best I can.

[Wrensong]

Yes, we all absorb differently so if you feel the brand may be wrong for you, then returning to Evorel could be next step.  Personally I get better absorption by far from Estradot than Evorel (4 x more bloods have shown), but it may be quite different for you.

I prefer to say "overheating" in relation to my getting so hot at night as I don't produce sweat, simply get intensely hot & that seems to badly stress the body.  Not sweating means it takes longer to cool down so it plays merry hell with sleep!

I absolutely share your frustration re the NHS position on testing of sex hormone levels postmenopause & have messaged you with links to the private hospital group I use for mine, just in case this is an option for you.  I completely understand it may not be though, & sympathise if that's the case.  We are not well off but can just about afford to do this by foregoing other things.
Wx

[Postmeno3]

Thanks. That's really interesting about the absorption. Without testing, of course, hard to tell as you say. Does anyone else, postmenopausally, feel they absorb better on Estradot, or, vice versa, on Evorel? It would be useful to get a concensus, though, of course, we're all so different and absorption maybe depends on having/reaching a certain level first? 🤔

[Ana21]

Hi Postmeno3,

You said, "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."

Another cause for the sweating could be low blood sugar in the morning (nocturnal hypoglycemia).  While sleeping at night, your blood glucose level may be falling too low.  Adrenaline is produced in response to the declining blood sugar level which causes sweating. 

Depending on the severity, other symptoms include nightmares or sleep disturbances, headache, lightheadedness or dizziness, anxiety, pounding heart, dry mouth, tingling or numbness of the mouth, shaking, hunger, blurred vision.

[Postmeno3]

Wow! Thanks for this. So where does the HRT come into it? I have only had it since upping to Estradot37.5 in the past few weeks, nothing on the Evorel25 in previous weeks. I understand Estradot may be faster absorbed and more strongly than Evorel. Is it nothing to do with this, or something causing more rapid fluctuations affecting or linked to blood sugar reactions?

[Ana21]

Changes in your hormone levels, as well as age-related changes, affect how your body responds to insulin and can trigger fluctuations in your blood sugar level, up or down.

[Wrensong]

Good point Ana21.  Blood sugar probs are said to become more likely at menopause.  But didn't you post elsewhere Postmeno3 that you'd recently had blood sugar issues ruled out, or am I thinking of someone else?  I had the impression you were already nutritionally clued up, but I agree with Ana21, definitely worth looking into if you haven't?  If you want to have a discerning Google, there are lots of articles on how sex hormones affect blood sugar & it's been discussed on many threads on here too.

I've long suspected nocturnal hypoglycaemia could be a factor in my own sleep probs & have spent a lot of time researching it, but my Endocrinologist doesn't think it likely & all attempts to safeguard against it with habitually careful attention to diet haven't really improved things.  Doesn't help us that inadequate sleep also makes us prone to destabilised sugar control - catch 22!
Wx

P.S. Ana21 - you've posted again while I was writing this!

[Postmeno3]

Yeah, so my blood sugars are fine and nothing in my nutrition has changed. The only thing that's changed is the introduction of Estradot which may just be too much of a "hit" to my very sensitive systems. You seem to be experiencing overheating as part of your hormonal fluctuations, on Estradot also, Wrensong? Something is awry somewhere for us both, it seems. So, is it a case of too immediate an influx? Do we need a trickle rather than a deluge?

[Wrensong]

Yes, Postmeno3, currently on same dose of oestradiol from Estradot as you, but symptoms are not exclusive to Estradot, I've also had them on other types of HRT.  Worse on the progestogen phase of my cycle & onset was with perimenopase, starting in my mid-40s, years before HRT.  The most resistant symptom for me & one of the hardest to live with.  I don't know what the answer is, but I'm sure working on it!

[Ana21]

Hello Postmeno3 and Wrensong!

Good to hear you've ruled out blood sugar issues.  I'm low-carb but my father had Type 2 diabetes, so I'm mindful of the symptoms.  Earlier in the year, I experienced night sweats and HFs with heavy sweating while on Estradot 50 + Prometrium/Utro 100 mg.  I had never experienced such profuse full body sweating.  I was wearing a dress with no stockings and sweat was literally running down my legs.  It looked like I had wet myself.  It wasn't the summer heat.  I had been in an air-conditioned building all day.  My symptoms had to become quite extreme before my doctor ordered a blood test to check my estrogen level, which confirmed I wasn't absorbing the patch.  I wish they would routinely test postmeno women to ensure they are absorbing transdermal estro.  I wasn't warned that absorption could be an issue, so I wasn't looking for the signs.  In retrospect, I had symptoms indicating I wasn't absorbing the patch well or consistently since I started HRT at the end of Feb 2020.  Many women do well on it, but I'm not one of them.  I hesitated to post because I don't want to increase your anxiety.   Hopefully, Postmeno3, your morning sweats will disappear as you adjust to the new patch.

[Postmeno3]

Thanks! Yes, it's all a bit of a mystery without knowing about absorption and levels. So, did you find out why the sweating was related to poor absorption? I've been on retreat this week and should, if anything, have had less that had the potential to be challenging instead of things getting worse. I've been on the Estradot37.5 for two months now so I think it's safe to say it's not agreeing with me, but hard to understand why.

[Wrensong]

Hello Ana21, that degree of sweating sounds extremely uncomfortable.  Have you found a regimen that suits you better since then?  The testing issue can be so frustrating - when I first started HRT some years ago I was nearly 2 years on Evorel Conti before we found when it was finally agreed to test my oestradiol, that I was absorbing very poorly, explaining inadequately controlled symptoms.  Being a 50mcg patch my then doctor thought it should be sufficient, but turns out I was getting less than half the expected absorption.  My HRT is now overseen privately & I arrange bloods myself.

[Ana21]

Postmeno3,

I think I can answer your question as to why my sweating was related to poor absorption.  Broken thermostat.  The hypothalamus, located deep in the brain, is the body's thermostat.  That's one of its many jobs.  Estrogen plays a role in temperature regulation and messaging.

Hot flushes are complicated and a bit ridiculous.  From what I've read, it's not our estrogen level that matters as much as the drop.  For example, we don't experience hot flushes before puberty.   A hot flush only occurs when a brain that has had estrogen has it taken away.  It's all about the drop. The faster the drop, the more severe the symptoms.  That's why surgical menopause causes more HFs and more severe symptoms in general. Normally, menopause is a gradual process. 

Another oversimplification, but here goes.  When our estrogen drops, our thermoregulatory system becomes extremely sensitive to minor changes in temperature and it responds in an exaggerated manner. We develop a wonky thermostat. It thinks our temperature is higher than it actually is. 

A hot flush is the body's attempt to cool itself.  Women may experience a wave of heat and redness in the face and chest.  This occurs because the blood vessels dilate and blood is shunted to the surface of the skin in an attempt to dissipate some of the non-existent heat.  There's reduced blood flow to the brain, the heart rate goes up which can feel like anxiety, and we sweat.  After all this, body temperature drops and some women experience chills.  It can be an exhausting roller-coaster ride.

To my demented thermostat, the house was on fire.


***

Wrensong,

You also had to wait a long time to get confirmation that you weren't absorbing well.  I've only been on tablets for a few days and my doctor plans to reduce my current dose once my estrogen level is up, as well as switch tablets.  Changes ahead.  It will be many more months before I can tell whether I've found a regimen that suits me.  I hope I can find a transdermal that works for me in the future.  That would be ideal.  I'm also hoping my doctor will be less reluctant to order blood tests in the future. 

Have you found a regimen that works for you?  How often do you have blood tests and do you test for estrogen only or other hormones as well?  My estradiol level was <40.

[Postmeno3]

Thanks. So, yeah, I have been thought to have M.E. and broken thermostat/hypothalamus is very much related to that, too, but I feel I may have been misdiagnosed or not entirely accurately potentially because of circumstances, diagnostic process etc at the time eighteen years ago. If it is M.E., I believe it was hormonally (not virally) triggered and would have needed a very different treatment plan, probably endocrinologically. Diagnosis came at the perhaps significant number of age 51.  So, the journey has been long and complex since. I am now 69. However, I just read that, in rare cases, Estradot can cause carb intolerance!!!!!! These sweats, only on waking at those two times, could be linked to that rare side effect. Blimey, this is fascinating but a zillion piece jigsaw puzzle!