One week is really too soon, I'd give it another couple of weeks. If you feel worse than you did before hrt it's probably the mirena. They say you shpuld give it 6 months to settle but some people feel so bad the remove it before then. Do you have flushes? If they do and they aren't controlled in a fortnight then increase the gel. With other symptoms it's harder to tell as they take longer to go (my insomnia and anxiety took 3 months). You do need to increase slowly though, too much oestrogen can be as bad a too little. 2 pumps is the normal starting dose in peri and seems to be suitable for most, but not all, women.
