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[Aubrey]

Hi, I've dipped into this forum so many times and have found it so useful in guiding my HRT decisions.

However, there is one issue I can't seem to get hold of no matter what, and that's insomnia.

I'm currently taking 2.5 mg of Sandrena gel daily, it seems a lot but anything less and I may as well take none, and 10 days of 100 mg Progesterone, up my flu. 

I've tried testosterone a few times and it makes me fat and spotty. I think it causes insulin resistance, and higher glucose concentrations in my body.

All other symptoms are under control on this regime, except the insomnia, which is worse during the progesterone phase of the cycle.

Any ideas?

X

[joziel]

Usually low estrogen. Especially if any less is taken and you 'may as well take none'.

The dose is irrelevant, it depends how much you are absorbing. Have you done a blood test during your period to see what you're able to absorb from HRT? (Your own E should be at its lowest then.)

[Aubrey]

Thanks. I've tried increasing the Sandrena but it doesn't change anything. I had an estrogen blood test while I was using 2 mg and it was 292 nmol or pmol, so quite low, so I increased dose to 2.5 mg.

I'll try that camomile tea. However, I've been prescribed and tried, Zopiclone, Daridorexant, diazepam, Circadin,(pure melatonin), valerian with melatonin, propranalol, and Sertraline,(SSri). Nothing touches the sides. It's so frustrating!

X

[Wrensong]

Another insomniac here & I feel your pain.

insomnia, which is worse during the progesterone phase of the cycle.

Despite progesterone's sedative reputation, quite a few women on here report Utrogestan considerably worsens their sleep.  It certainly did mine.  If you feel increasing your estrogen dose further won't help & you don't want to change progesterone for a trial of a progestogen, it might be worth trying Mirtazapine at low dose as this can be very helpful for sleep.  Be aware though that it's said it can affect glucose status.  I mention that because of what you say here about having trialled T . . .

I think it causes insulin resistance, and higher glucose concentrations in my body.

Wx

[Charliehorse1]

Do you take your Sandrena at one time of day or split the dose?

I had a lot of trouble sleeping whilst taking my 1.5 dose in the morning, I know it's supposed to last for 24 hours but didn't in my case, so I do one sachet in the morning and half a sachet at about 9PM and it seems to make a difference for me.

[Wrensong]

Good point Charliehorse.  Well worth trying if Aubrey hasn't already.

[Gnatty]

Agreed, I split my Sandrena dose and find it much better that way.

[Aubrey]

Thanks for the advice.

As you say, Wren, I do not tolerate Utrogestan. I used to take it orally and the effects were ugly and completely negated the benefits of the estrogen gel.

Yes, I've split the dose, I've been trying different things for over a year, including Mirtazapine. 

I'm  therapist, so I've tried that on myself too...

[Minusminnie]

Lorazepam? Which is a PRN & might work better than diazepam.

[Wrensong]

Oh, sorry Aubrey    Mirtazapine seemed worth a mention as not on your list of failed meds.  I expect you know this but just in case you trialled a higher dose - with Mirtazapine it's at low dose that it's said to be most effective for insomnia.  Some people find it stimulating at higher doses.  I found 7.5mg sedating, but unfortunately had to discontinue it for other reasons.  Insomnia can be a very stubborn problem for some of us at this stage of life & sorry to say I haven't cracked it yet.

[joziel]

Aubrey, you might need quite a lot more estrogen before concluding that it's not estrogen related...

" I've tried increasing the Sandrena but it doesn't change anything. I had an estrogen blood test while I was using 2 mg and it was 292 nmol or pmol, so quite low, so I increased dose to 2.5 mg."

So, firstly I have it from 3 different Newson Health doctors I've seen over the past 3 years, that many women need estrogen between 450-650pmol to fix symptoms, especially during peri-menopause when often higher E is needed than post-meno. (To over-ride fluctuations.) This goes especially for insomnia and neuro symptoms. 292pmol is very low, only just over the 270pmol you need for bone protection.

Whilst you've added another 0.5mg, you haven't tested and there's no guarantee you have actually absorbed anything additional with that increase. (In my case, I had the same serum estradiol on 6 pumps of Oestrogel as I did on 12 pumps of Oestrogel.) A dose increase does not always = a serum estradiol increase. And even if it did, you only added 0.5, which isn't going to bump you up 200pmol...

Secondly, our own estrogen is all over the place during peri and your own ovaries can contribute more and affect test results. You might only be getting (say) 50 from HRT and the rest might be from yourself - which cuts out down to 50 when your ovaries cut out. (As happens during peri.)

So I really don't think you've explored the whole estrogen side of things thoroughly. It might not be the answer, but really it needs to be tried to be ruled out and there is no reason not to trial getting the serum estradiol higher into 450-650 range.

I say this as someone who is trying to do the same thing, for the same reason. For me it is hard because I don't absorb well transdermally so I need high doses. On 6 pumps of Oestrogel (and on 12!) I had about 325pmol. I am now on 100mcg Estradot patch as well as 12 pumps of gel, but I'll be coming down on the gel as I go up on the patches.

[Aubrey]

Thank you everyone for your advice.

I will increase my estrogen gel significantly, and see if that helps. In the UK, we're pretty much on our own in this, unless we can afford a private consult, which I have done once, at the Newson clinic. Maybe I should cough up for a blood test again and see where I'm at. The blood test I had was with the NHS, there was no follow up so I've had to try to work out the results myself.

I didn't know that about lower dose Mirtazipine. Thanks for that Wrensong.

X

[joziel]

I get bloods done with Medichecks usually. I don't want to ask my NHS GP for them as frequently as I want to do them. It's about £40...

[Aubrey]

Thanks Joziel, that's good to know and affordable.