Hi jadenatalie123
So sorry to hear about your premature peri-menopause, but good that you are having HRT. At your age I would want to be on the highest dose of oestrogen possible and I would agree that gradual increases are what's important. The oestrogen will not be responsible for lethargy or brain fog - quite the opposite. Depending on how long you have had the Mirena, or when it was changed - the progestogens can causer these symptoms, and contrary to popular belief, the progestogens in the Mirena are absorbed systemically (ie into the body). However it is synthetic so unless you are needing it for contracaption, perhpas swap to Utrogestan instead which is bio-identical, (so more natural for your body) though of course will give you a withdrawal bleed every month. Alternatively there are contraceptive pills which use the bio-identical estradiol - QLAIRA and ZOELY, though the progestogens here are synthetic.
Hurdity x