HRT- no sleep & no bleeding!

[Mirandasbestmate]

Hello. Have been impressed by the support & advice on here so am hoping someone has some to spare please!

Have been on HRt - elleste duet 1mg - since October & am 50. To start with it was brilliant & I was sleeping like a baby again. However this last week I have woken at 5 am every single morning & am starting to feel like a zombie. I don't know how much if anything is HRT related, & if so what to say to Dr.

Also I have only had 1 bleed since starting it. My Dr says this is fine but I feel very uneasy about it. ( I haven't had a period since I was 47 anyway) in my mind it just means my womb lining must be building up & up & 1 day I'll just explode!!
Any advice welcome, thank you.

when was the last bleed? it may be that the dose you are on 1mg- is just too low to give you a bleed. You could try asking the dr to arrange a scan to check the thickness of the lining but my guess is due to NHS funds they won't be willing. You were clearly very post meno when you started HRT (some of us only start taking it in our 50s when we are still having periods or at least irregular ones) so you'd probably have low levels of oestrogen by now.

With the sleep, what time do you go to bed and how many hours sleep are you getting? I find I wake earlier in summer - birds tweeting, sun shining- and a 5.30-6am wake is not unusual. Have you tried going to bed earlier maybe - or conversely- later, so you re-set your body clock?

Your other option is to go up to a 2mg dose which you may well need now.

Thanks Pinkfrocks. I think the bleed was about January time. I started taking it as the insomnia & anxiety were getting unbearable, as well as the night sweats. The last 2 have thankfully pretty much vanished but the return of the insomnia is hard to bear.....
I went to bed at 1130 last night, having been up since 5am & done a 5k run, stole the blackout blinds....... Still up at 5 again today. Think I may resort to vodka tonight! Thanks again. If it continues will ask for next dosage when I go back for my 3 monthly review. Thanks

Re the lining and no bleed. If you aren't having any sort of bleed and you are on cyclical HRT then it can't be building up. As pinkfrocks says the oestrogen dose is probably too low.

How it works is that oestrogen builds up the lining, progesterone changes it structurally to prepare for fertilisation, and then if no embryo implants, the progesterone falls and the lining is shed. With HRT the progesterone falls when you go back onto the oestrogen only tabs so even if the progesterone dose was insufficient to sheh all the lining - some of it would come away. The progestogen in Elleste is a powerful one anyway (called norethisterone) and is good at thinning the lining.

A small proportion of women do not have a withdrawal bleed on cyclical HRT anyway.

I feel for you. I started HRT in the form of Estradiol gel 6 weeks ago. At first it was as if someone had sprinkled sleep dust on me. Now however, for reasons I don't understand, I'm waking 5am and the sleep I do have is only light. I'm wondering if you increase the dose will that help.. or just for a short period of time?

HormonalHeap Lack of sleep in menopause is usually due to repeated wakening from night sweats. Has the gel eliminated these (as well as flushes) and you don't wake throughout the night feeling hot? If so it is doubtful whether a higher dose would help.

Are you taking progesterone too to protect your womb - if you still have one?

Many people sleep less in the summer anyway as it gets light early!

Thanks Bellaciao, I'm not waking up in a sweat anymore just poor quality light sleep, leaving me exhausted, and waking 4.30/5am. I do think it's linked to hormones because I had the same thing early on in both my pregnancies.

I have a Minera coil for progesterone. My doctor is telling me to split my gel into 2 doses daily, so will see if that helps, though not sure how...

This last week I have realised that my waking is tied into night sweats - usually about 4am. I have discovered sleep aid tablets - in the aisle at Sainsbo's which help a bit. I have also covered all windows etc in the bedroom with silver tinfoil........ It's the most effective blackout I've found & I don't care that it makes my house look like a crack den!

HormonalHeap - you should get less fluctuation in estradiol concentration in your blood by applying it in two doses. Perhaps you are sensitive to the temporary high level or the decrease, obtained from once daily application? Do you usually apply night or morning? (I'm not a gel user!).

I've been waking at 5ish for ages now since the blasted birds starting singing and it's got so light in the mornings. I do have a black-out but it doesn't seem to make that much difference. I doze until about 6-7 thankfully. Don't think it's anything to do with meno as my HRT is stable and in winter I am fine.

You might try splitting your dose- I do and have done for years because using it all at once gave me nausea like morning sickness.

Bellaciao thanks, I apply it just before I go to sleep so could that be a reason for early waking? I'm not convinced as very poor sleep quality all night. Pink frocks before my peri I slept like a log. I have started splitting the dose and will give it a week then back to my specialist if no good and she will have to wave her manic wand!