HRT for sleep-stop or carry on?

[Retrievemysanity]

Just wondering if anyone has any advice. I’m 45 and for the past two years have struggled with sleep/insomnia which have gradually got worse, mainly waking several times in the night and finally around 3am not being able to get back to sleep. Friends recommended HRT. My GP was reluctant because I don’t have other symptoms and she thought the sleep issues were more likely due to stress. Anyway, she did prescribe the gel and progesterone tablets but she was quite negative about it and if I’m honest, did scare me a bit. I’ve been taking it for a month now and seen no change in my sleep and I’ve been waking up very hot in the night every night which I wasn’t doing before. Has anyone been in this situation/got any advice? I don’t want to take HRT if it’s not really necessary but likewise I’m not sure if I need to give it longer.

I would look instead at working on your nervous system and stress levels. Start a good quality magnesium glycinate supplement a hour before bed.
you may have too much oestrogen as progesterone levels drop first in perimenopause. Loads of advice about detoxing oestrogen and balancing hormones on Pippa Campbell’s instagram page.

I'm peri and was waking up at 3 am, staying awake for hours, finally falling asleep again at 5.30/6.

The straw for me was when it started happening at 1 am. I now take magnesium at night and I dont wake at all. It doesn't make me fall asleep, I still need to be tired to fall asleep.

Thanks both. I did try magnesium last year but it didn’t seem to make a difference. I’m a bit at my wits end really as I feel I’ve tried everything and HRT was my last resort 😞Generally I fall asleep ok but then wake an hour or so later, manage to get back but then wake around 3 and then it’s game over.

@Retrievemysanity I started HRT later than you (early 50s) with a private consultant (been seeing them already for other things) and sleep was my main reason for HRT, along with hourly hot flushes.

The change in my sleep pattern was that I couldn't get to sleep which was unusual for me. My consultant emphasised that lack of sleep is very bad for health and should be sorted.

What you're describing is very common. I expect you may find your cycle changes soon too- either longer or shorter.

Can you say what dose of estrogen you're on and how much progesterone you're using?

Often, women as young as you need a higher dose of estrogen (which is what you'd have normally at 45) so the average 2 pumps may need increasing.

I'd say you need to keep going and consider adjusting your dose.

@Londonlou2 Peri symptoms are because of loss of estrogen, not progesterone. Women who are post menopause have no progesterone at all (it's only produced after ovulation) and many women have symptoms for years after their periods have stopped. Unfortunately there is misinformation online. 'Estrogen dominance and balancing hormones' is not something that the most open-minded menopause gynaecologists would endorse and the whole estrogen dominance doesn't exist, even though many private naturopaths like to say it does.

I started HRT at 45 (now 46) & while it has improved my general happiness & I feel a lot calmer, sadly it has done nothing to address my disrupted sleep. I also have night sweats, really bad brain fog & night sweats. Hasn’t helped any of these either but I’m staying on it for the improvement in mood alone.

Started HRT a week ago - it's made my sleep much, much worse.

@Hallywally Have you had a review of your HRT?
There seem to be a lot of women who aren't finding it helpful but the advice from Nice is to review it, tweak the dose or tweak the type.

I have the impression GPs aren't always proactive in offering different types, higher doses, etc.

I know from my own experience with a specialist that anything that wasn't working would be addressed and options offered/ tried etc.

I take trazadone - I can't take HRT so was prescribed this to help with the awful insomnia and anxiety, and it's been a game changer.

I didn't find hrt helped my sleep. The most useful things I have found to help are getting outside for 15 minutes before 9am, taking 3mg glycene at bedtime (magnesium glycenate did nothing for me) and nsdr for 5 min before bed to lower resting heart rate.

HRT helped me with almost everything except sleep. I recommend phenergen - it's available OTC and I find 1 25mg is plenty for those nights when you really need to sleep eg big work meeting, deadline etc

Hrt has totally changed my sleep - it’s so improved. I’m no longer taking zopiclone x2 a week only now sporadically when I have something big on the next day

Give HRT five months. I had side effects I didn’t like when I started and almost gave up but so glad I didn’t.

It sounds a bit like you've not adjusted to it yet if you're waking hot in the night? it takes me 6 weeks to settle properly after I change a dose and I get some really odd fluctuating symptoms before I settle. It took much longer than 6 weeks to adjust when I first started HRT.

I'm on a high dose now, I'm (relatively!) young. I went up gradually on estrogen and sleep was the last symptom to improve, even though it was the first symptom to start.

I honestly thought it just wasn't going to work for sleep - but I just wasn't on a high enough dose.

I still wake up early but only during my period now, so I know it is hormonal. They only last 3 days so I can live with it.

After 4 years, it's honestly a bit confusing to be woken by my alarm !

What dose do you take please? X

HRT sorted my insomnia

Do you have ongoing stress or was your gp just presuming? Obviously easier said than done but try and address that too, did your gp suggest talking therapies or anything?

I always bang on about self care on these threads, obviously carry on HRT and see if it helps but ime once we get to peri we really need to focus on the basics to aid sleep. For example drinking coffee all day and wine on a night is something we get away with in our younger years but in peri our bodies object.

So yes HRT if Dr advises but also address stress with whatever is available online or whatever, avoid or limit caffeine and booze, make sure you are physically active. If no time for actual exercise just walk as much as poss. Aim for 10k steps a day so you are naturally tired and obviously usual stuff avoid screens etc and go to bed/get up reasonable times so in a good routine.

@JinglingSpringbells i am on the two pumps of gel and the 12 days on/off progesterone.

@socks1107 @WhaleEye how long did it take to improve? I suppose that’s really the main point of my post-do I need to give it longer?

@Janiie well my doctor didn’t advise HRT, that’s part of the problem, she thinks my issues are stress not hormone related. But yes, I do all the recommended stuff, I run,weight train, yoga, don’t drink caffeine after midday, rarely drink alcohol, do a meditation app etc That’s, what I was saying to the GP, I can’t make any more lifestyle changes because I think I pretty much do all the things people suggest to help.

@Theeyeballsinthesky yes phenergan is good and I’ve used it before but I struggle every night and you’re not supposed to take this a lot are you because it’s addictive.

@Retrievemysanity yes I only take it when I 'need' it - the insomnia thing is just so crap isn't it

@Theeyeballsinthesky it really is, it’s destroying me 😔A different GP prescribed me the phenergan last year and said only take it when you really need it and I thought ‘ well I need it every night!’

Im so sorry :( insomnia is the bane of so many women's lives and yet research into still feels so limited

I use HRT patches and have increased those max 100mg. Sleep is a bit better since then

One month in is early days OP - it can take up to 12 weeks for the effects to really kick in. I started feeling much better about 8 weeks in, and my sleep has been so much better since being on HRT.

I agree with the advice about magnesium glycinate - really helped my insomnia and restless limbs at night

Your GP had no business scaring you - you're taking bioidentical HRT and the risks are absolutely minimal

It's brilliant that you have considered lifestyle too and are doing loads of positive things. HRT is wonderful but it's not a magic bullet, and you absolutely do need a holistic approach to managing perimenopause

You should consider increasing your estrogen first and foremost.

Antihistamines taken regularly long term are being linked to other conditions later in life (eg dementia and movement disorders) and are not advised for long term use.

2 pumps of gel is sometimes not enough. I was using that in my 60s so for someone your age you're likely to need more. The licensed dose goes up to 4 pumps.

If your GP isn't helping it's worth finding a private menopause specialist to help.