Estrogel and tiredness

[ohthegoats]

I started estrogel combined with a progesterons coil about 3 weeks ago. I want the coil for contraception reasons, and have had non-hormonal ones for the last 20 years, so it seemed the obvious choice.

Before I started all this, I was a walking text book list of menopause symptoms. After only 3 weeks I've definitely seen an improvement in mood, no more hot flushes, libido slightly better, sleep is massively improved (due to no hot flushes I expect), and the initial boob pain has subsided a little. I felt nauseous for the first couple of weeks, usually first thing in the morning, but it affected me all day.

BUT, I still absolutely hit a tiredness wall about 4 hours after using the gel. I've changed from night to morning application (1 pump only at the moment) to see whether I could avoid the nausea, which seems to have worked (or maybe it's just everything settling down), so now at 11am I'm BAM, knackered.

Trying to avoid caffeine to try and reduce boob pain, so don't want to start drinking coffee to wake up.

Don't have a review until 20th Feb, and have been told to tweak to 2 pumps after a month if it feels like I 'need' it - since it's reduced my major issue of hot flushes, I'm pretty happy to leave it at one pump, unless 2 pumps might help out with the tiredness.

Background - 44, been definitely menopausal for 2 years, mum had early menopause, I've had DVTs in the past, so it's being managed through a consultant.

Any ideas?

I doubt very much that it's a side effect of estrogen because its effect is the opposite- energising!

The best guess is that the dose is too low. At 44 and post meno (and with mirena) you are using less estrogen than me, and I'm in my 60s.

Try 2 pumps at bedtime or one am and one pm. Younger women need far more than us oldies- I started HRT 10 years older than you are now and have always needed 2 pumps.

You might even need 3 or 4. 2 is the starting dose, so not sure why you were told to use 1.

You might also be reacting to the Mirena. Although it is supposed to act locally only in the uterus, some of the progestogen does get into the blood stream, and some women find they have side effects like loss of energy, weight gain and even acne.

so...

1 Increase the gel, split the dose to avoid feeling sick
2 If this doesn't work, go up to 3 pumps
2 If that doesn't work you might be someone who the Mirena doesn't suit so will need something else to go with the estrogen- perhaps Utrogestan or a combined patch.

Ha, yes to acne! Last week was all about a spotty face and boob ache. Then I've had tiny period going on for the last two days, so boob ache and spots would fit with that.. I'll give it another few months with the coil before I start thinking about other options.

I'm a bit scared of the two pumps - when I started the first one and had boob pain I almost stopped taking it. Will try anyway, it makes sense that I would need more I guess. Will split it though to avoid the sick, but also to avoid being covered in sticky goo.

So yesterday I did one pump before going to bed as well as in the morning, then did normal pump this morning... 5 hours later I've not had the tiredness wall yet. Maybe that's the answer.