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[Lindyruns]

Hello,
I'm new to this forum and I'm wondering if anyone has found there's an optimum time of day to take this pill. Insomnia is a major issue for me, no sleep at all some nights, around 3 -4 hours is norm and if I sleep 5 hours I consider it to be a good night, main problem is I just don't fall asleep and after 2/3 hours get restless and up and down for loo. Hoping HRT will help as I'm out of options after 4 years and feel depressed and exhausted. I'm also plagued by a list of other 'issues' I can see on this site are related to menopause. I'm really hoping HRT will work as well for me as Mirena coil has for out of control bleeding.
Thank you,
Linda

[Dana]

I took premarin for a while and I normally took it in the morning, only because that was the most convenient time for me. I would be more likely to forget to take it later.

My worst meno symptom was also insomnia and I found taking it in the morning was fine.

I remember reading about dosing times for premarin versus estradiol tablets, and apparently estradiol tablets are most effective for the first 12 hours so taking it at night would be better for sleep issues. However premarin had a longer effective time (closer to 24 hours) so dosing time didn't matter as much.

However, maybe a better option for you would be to consider patches. Estradot is a good estrogen only patch. I'm not someone who demonises "synthetic" HRT, which is what premarin is, because I believe women should use what works best for them, but patches do give a much more consistent dose, and because they're absorbed through the skin and don't have to be digested, the overall dose can be much lower than tablets.

[Lindyruns]

Thanks Dana, I've been taking in the evening for 3 weeks now and it's not working yet, still having sleep problems and night time sweats. I'm beginning to think I need a stronger dose.

[Anna67]

Hi lyndyruns, iv been on Premarin for 6 weeks now and also have the marina coil, I take mine first thing in the morning, I was suffering really bad with insomnia and anxiety would cry over stupid things and get really angry over nothing, I was off work for 6 weeks because I just couldn't cope it was dreadful, but the past 2 weeks things got a lot better for me I'm sleeping a lot better and the anxiety isn't so bad either, I also returned to work which I was dreading but you know what I feel so much better for doing it and going back, it can take 3-4 months to get yourself right with hrt so stick with it and it'll get better, the ladies on this forum are brilliant with advice and I listened to them all, I felt like giving up at one point with the hrt because I didn't think it was working but they take time and patience isn't my strong form, so hang on there and things will improve for you.. take care 

[Dana]

Thanks Dana, I've been taking in the evening for 3 weeks now and it's not working yet, still having sleep problems and night time sweats. I'm beginning to think I need a stronger dose.

It's usually recommended to stay on one type of hrt for at least a couple of months before deciding if you need to change, but I think that's more for the tougher symptoms like anxiety etc. For me, I always found that hrt worked fairly quickly for insomnia, so 3 weeks does seem a long time to not see any change at all. That would seem to indicate that you do need a higher dose, or maybe a change to a different delivery system, like a patch or gel.

After taking premarin I switched to an estradiol tablet, but had to eventually stop that because I found I wasn't absorbing enough of the estrogen. My GP told me my liver was working "too well"..lol..  I've now been on patches for ages and they work really well.

[Hurdity]

Hi Lindyruns

A bit late but still wanted to say  !

Just to ask also how old you are, and if you know whereabouts in menopause you are? I realise you may not have been having periods as you have the Mirena but were they regular up until starting with it or had you started skipping them or perhpas coming closer together?

Also as Dana says Premarin is not the same as our own oestrogen - it is a mix of horse oestrogens - and although stronger than our own oestrogen (estradiol) some women just don't get on with it. It does come in two doses (maybe 3) but the higher dose 1.25 mg is very strong.

I agree with Dana that it sounds like you need to take a different type of HRT and specifically go for a transdermal method ie patches or gel oestrogen. Medium dose patches worked within a few days for me (I was late peri-menopause when I started) and I have been on them for almost 10 years - now in my 60's. All the different types are listed here:

http://www.menopausematters.co.uk/treatafter.php

Hope this helps

Hurdity x

[Lindyruns]

I'm nearly 55 and not had periods for some time now although I did have bleeding when coil started to fail a few months ago but a new one stopped it. No idea why doc gave this type of HRT, there was no discussion of different types and I had no idea until joining this site that there were so many options. I'm not getting any bad effects from it, on plus side Im getting fewer night time sweats and it does seem to have stopped the adrenaline surges that I was getting with those. Just wish I could sleep more. Some nights I don't sleep at all and a complete zombie the next day.
I accept that no drug is natural and is something made from a plant more natural than from a mammal, who knows. I'll discuss other options when I go back for review in 3 weeks time. I decided the risk to me from driving, crossing roads etc when I'm so tired was greater than from HRT, seriously!

[dazned]

It's still early days yet,hopefully you will see some more positive improvements.

[Dana]

I actually don't agree that it's early days. If it was going to help your insomnia you should have noticed some improvement by now. Insomnia is one of the worst meno symptoms, but it's also one of the easier ones to get on top of if you are on the right dose.

Three weeks is a long time to wait to see your doctor when you aren't sleeping well. What dose of premarin are you on? How about trying a little experiment to see if you need a higher dose? Take an extra half a tablet for a week and see if that makes any difference.

If it does then you have some evidence for your doctor. If it doesn't then you may need to consider gel or patches. I know I certainly sleep much better with patches than I do with an equivalent tablet dose.

[Lindyruns]

Hi Dana, I'm on the lowest dose, the next step up is to double it. I could do that just by taking an extra tablet a day but I'm not confident to do that without speaking to GP first. I wonder if it's progesterone I'm missing more as when I had a new Mirena coil fitted the unexpected bonus was that for 3 months I slept fine and I don't think it was coincidental.
I think I just need to go back for a chat about options. Do the patches stay on well, I swim and run so not sure if they would stay on.

[Dana]

You'll find that sometimes your own experiments with hrt will give you more information than your doctor will. There is no harm in trying a higher dose for a little while. Most of us on MM have done it at some point. If you just try it for a week, and it doesn't help then there's no need to tell your doctor, but if it does help then it's definitely something you can be confident about suggesting to your doctor. However it's your call.

If you are on the lowest dose I personally think it is more likely to be that you need more estrogen to help you sleep than more progesterone because most meno symptoms are because of estrogen depletion. You are post meno and it is quite normal to be on a medium dose at that stage, which is more than you are currently on. It's also quite normal for doctors to start on the lowest dose and work up, so it's quite likely your doctor is going to increase your dose anyway.

I use estradot patches and they stick really well. I don't swim, but I do exercise and I also live in Australia and I've never had any problems with them coming off in summer.