HRT and sleep

[VanCleefArpels]

Lack of sleep was one of my (many) symptoms which led to me being prescribed HRT 8 years ago or so. However I still don’t sleep well - only in 2-3 hour sessions with wakefulness up to an hour in between. I recently went away for a few days and forgot to pack my HRT and slept like a baby. I’m now wondering if the drugs are actually impacting my sleep. Anyone else found this?

No i look forward to my progesterone two weeks for the lovely sleeps! Maybe it was the whole setting and being away from your home stresses that helped.

I dont know. Ive been an insomniac for years and Ive been on HRT for 20 years they could be related.
I recently started taking nytol out of desperation and slept very well.
A quick look on AI shows people have mixed reactions to HRT.
Some sleep better, some worse but poor sleeping is usually temporary...6 weeks or so.
Could it be stress? I know I sleep badly as I live alone and Im hypervigilant at night.

That's a really useful clue that your sleep changes without the HRT. It might be worth keeping a simple log for a couple of weeks — note how you slept, any hot flushes or night sweats, your mood and energy, and whether you were on your HRT or off it that night. Take it to your GP and ask what options there are for tweaking your regimen or ruling out other causes, since a written diary usually makes it much easier for them to spot patterns and decide what to try next.

I’ve heard (on here) that if you use oestrogen gel later in the day it can impact your sleep.

I started taking my HRT first thing in the morning as I found it was impacting my sleep when I took it later in the day. I sleep a lot better now.

Any long walks outdoors? Those put me out like a light for a good eight hours.

I take utrogestan every day so not that!

Thank you! I take HRT every day - I’m toying with the idea of stopping for a month to see if there’s any difference to my general well being. I’m post menopause so wondering if my need is less anyway

Every day either walk several miles or do some kind of exercise so not that!

I’ve always put my estrogen gel on first thing and progesterone at bedtime as recommended

I take estrogen patches twice a week and one progesterone tablet every night. From the day I started taking them I sleep through the night.

It sounds like you may need to up your dose. I sleep so much better since my dose was optimised.

I have heard that sleep doesn’t improve for some on the continuous dose. I’m on 3 a night for two weeks on/off

@VanCleefArpels It may be a total coincidence- perhaps when you were away you had a different routine, more relaxed, etc.

Post menopause you can need more or less.
I am still on 2 pumps of gel almost 20 years post menopause.

I've stopped twice to see how I feel - insomnia came back in 4 weeks and 2 weeks.

You might want to try upping the estrogen and seeing if that helps.

Thank you - I will try this!

I ran out of my patches and had a gap of about a week before I could get more and also slept amazingly well! I actually heard my alarm clock rather than waking 3 hours before it!
I’m back on them and back to waking at 4.

You need to keep taking it for the heart and bone health benefits just to name some.. not sure why women want to stop taking it.

Well this is interesting!!!

It's important to recognise that if someone is using a combined patch or daily progesterone, it can be the progesterone that is the culprit for lack of sleep, not necessarily estrogen (or the combination of both at the same time.)

'Patches' can mean an estrogen only patch or a patch with Norethisterone or different progestin.

Quick one on the heart-and-bone claim in this thread. NICE guideline 23 is blunt: do not offer hormone replacement for preventing cardiovascular disease. Bone protection is real while you're on it. That still isn't a reason every woman has to stay on for life.

Sleeping better when you forgot the pack for a few days? I've seen that reported. You're on morning gel plus Utrogestan at bedtime. Oral micronised progesterone at night knocks some people out and leaves others feeling more wired or foggy, so a short gap can change how sleep feels without meaning your oestrogen dose is too low.

I'd be careful about upping the gel for insomnia alone. 8 years in, night waking has plenty of other causes: returning flushes, mood, sleep apnoea, caffeine timing. The same NICE guideline also lists menopause-specific Cognitive Behavioural Therapy for night-time awakening linked to flushes, either alongside other treatment or instead. Worth a GP or menopause-clinic chat before any DIY dose bump.

Quick one on the heart-and-bone claim in this thread. NICE guideline 23 is blunt: do not offer hormone replacement for preventing cardiovascular disease. Bone protection is real while you're on it. That still isn't a reason every woman has to stay on for life.

Has anyone here said that HRT is prescribed for heart protection?

Because as you rightly point out, it's not, although the evidence is unequivocal that is helps.

If women need HRT for menopause symptoms, they need an individual assessment. If they are 'on the fence' about benefits, their family history is sometimes relevant. So a strong history of heart disease or osteoporosis is worth bearing in mind.

HRT can be used indefinitely as a treatment for osteoporosis. It's a recognised treatment by endocrinologists.