Should I increase oestrogel, or ask for more progesterone?

[Allthegoodusernamesareused]

Hello, I'm hope someone here may have experienced similar, and be able to advise me!

I'm 48, and started Oestrogel in October after a few years (yes, years...) of symptoms like sleeplessness, anxiety, overheating, brain fog etc etc.

I already had a Mirena coil and had had one for years although it was no longer stopping my periods. I had a hysteroscopy last year to remove a small fibroid that was believed to be causing the bleeding but surgeon couldn't find it!

At first, Oestrogel was amazing. I'm on 2 pumps daily, and I felt an improvement in my anxiety and brain fog within a few weeks. Sleep still variable and I still feel like my internal thermostat is broken, but better than it was.

However - I'm having a 21 day at most cycle, not bleeding heavily but still.. and in the few days before, during and after my period, my anxiety and tearfulness is ramping up again. I'm in a demanding professional role, and it is starting to cause me some issues and embarrassing moments again.

I'm not sure if I need to increase the Oestrogel, or ask for additional progesterone? Or both?? It's a minimum 6 weeks wait to speak to the menopause specialist GP at my surgery.

Sorry this is so long.. but any help gratefully received!

You might need more oestrogen - two pumps is quite a low dose. I use patches but after a few weeks moved up from 50mg (equivalent of 2 pumps of gel) to 75s and then 100s which has been great for me.

I’m not clear what you are doing for progesterone - if your mirena is a few years old it is likely not releasing progesterone so you’d need to address this as a priority, either with a new mirena or with progesterone tablets.

@Allthegoodusernamesareused
That sounds really frustrating, but you’re not alone—many women experience similar fluctuations while fine-tuning their HRT. It’s great that Oestrogel has helped with anxiety and brain fog, but the short cycles and mood swings suggest your hormone balance might need a tweak.

A few possibilities to consider while you wait for your GP appointment:

1. *Could It Be Low Progesterone?*

• Your Mirena coil should provide enough progesterone for womb protection, but it’s possible that as it ages, the dose it releases has decreased.
• Some women find that adding *oral progesterone (like Utrogestan) or vaginal progesterone* helps smooth out mood swings and anxiety.

2. *Would a Higher Oestrogel Dose Help?*

• You’re on 2 pumps daily, which is a standard starting dose, but some women need *3-4 pumps* to fully control symptoms.
• Your broken thermostat feeling and worsening pre-period symptoms could indicate oestrogen is still fluctuating too much.
• Increasing the dose gradually (e.g., adding half a pump and seeing how you feel after 2 weeks) might help.

3. *Tracking Symptoms*

• Keeping a *symptom diary* can help identify patterns and make it easier to discuss with your GP.
• If the anxiety, tearfulness, and cycle changes are linked to hormone fluctuations, adjusting your HRT could help stabilise things. ❤️

Can I ask do you do anything for yourself ? Selfcare wise? I don’t mean for anyone else I mean just for you? With you saying you have a stressful job.

Since it’s a long wait for your menopause specialist GP, you might also check if your surgery has another GP with menopause experience who can review your case sooner.

You're definitely not alone in this though it can feel so isolating, and with a bit of tweaking, you’ll hopefully find the right balance soon! Remember it takes time for your body to adjust to its new normal. X

Thank you - my Mirena has only been in since May. The one before that was only 2 years, and only changed because I had a hysteroscopy. Mirena stopped my periods completely for years, but they have gradually returned, with a much shorter cycle!

@Menoglow, thank you for all your suggestions. Yes, I have a Mirena, and no, it's not old. So maybe that's not the issue - I just wondered if it could be, as I had no periods for years after I first got one. Bleeding for 10 days out of every 21 isn't great.

No other GP I can speak to. It's a small rural practice, I either wait or go private which sadly is not an option at the moment.

I do take good care of myself. I'm lucky that my DH is really understanding and pulls his weight at home!

I think I'm going to try slowly increasing my oestrogel as you suggest.