Hi Wrensong!
Yes, I'm now taking oral estradiol 2mg and Prometrium/Utro 200 mg x 12 days per month. Symptoms improving rapidly. It will take me a few months to stabilize and I expect that will bring an end to the night sweats. My vasomotor symptoms are definitely associated with cortisol level, so they're at their worst in the morning, starting with night sweats in the early hours and continuing with occasional hot flashes and everything that comes with elevated cortisol. As the day progresses and my cortisol level falls, my symptoms dissipate. I don't have hot flashes once the sun goes down and I feel better as the evening progresses. I'm a true night owl. I feel my best late in the evening. It's a very productive time for me. My body cools down in the evening and I often curl up with a book and a heating pad at bedtime.
I know you don't sweat. I sweat profusely so it cools me down and hot flashes pass quickly. It's not distressing, only inconvenient, and less inconvenient now that I have a sweat-proof wardrobe. I feel the physical symptoms of morning anxiety but I know it's elevated cortisol so I don't experience it as anxiety. That helps, I think.
I've read that hot flash bother tended to be associated with higher overall cortisol levels and higher baseline levels of plasma norepinephrine. Night sweat bother, on the other hand, was associated with higher overall cortisol levels and tended to be associated with higher interleukin-6.
I mention that because "IL6 has substantial impact on thyroid function, particularly in patients with autoimmune thyroid disease." In a study to investigate the potential association between serum inflammatory cytokine levels and thyroxine replacement dose in patients with Hashimoto disease, thyroxine replacement dose showed significant positive linear correlation with serum IL-6. Dose per kilogram of body weight was also positively correlated with serum IL-6. You may be aware of this already, but thought it worth mentioning.
https://www.sciencedirect.com/science/article/abs/pii/S1043466606002262 https://academic.oup.com/endo/article/149/6/3062/2455199I don't have thyroid issues and stumbled on the association while reading about IL-6. I wonder if that's playing a role in your VMS. With the stressful year you've had, it's not surprising that your cortisol has gone up and impacted your estrogen levels. Lisa Mosconi puts it this way: "Stress can literally steal your estrogens. And that's because cortisol, which is the main stress hormone, works in balance with our estrogens. So if cortisol goes up, your estrogens go down; your cortisol goes down, your estrogens go back up."
Exercise is the one thing that works for me consistently to improve VMS and quality of sleep. I need to exercise daily. If that isn't possible, I notice the impact right away. It might not work for everyone, but it works for me. Even when my estrogen is rock bottom (undetectable on blood test), it helps. For me, taiji is the best medicine for high morning cortisol. It brings immediate relief. It's a great stress reliever. For me, it combines the benefits of meditation and exercise. I aim for 30 min of cardio per day. On a bad day, when I'm struggling with hot flashes, working up a good sweat will reset my thermostat. When the day comes that I can no longer take estrogen, I'll still have taiji.
My doctor doesn't think we'll have to wait too long for estetrol to be approved for menopause treatment, since it was approved for use as an oral contraceptive in 2021. No idea whether it will be offered as a combined tablet or on its own.
