Try increasing your estrogen, if you're not at the max licensed dose yet. If you are at the max dose, ask for bloods to check you're absorbing okay - and get them run when you think your own estrogen is lowest (if you still cycle), which would be during your period.
Even if they say you are absorbing ok, you might need a higher dose. My bloods on 4 pumps of gel were 284pmol, which my GP told me was "high enough to protect you and is fine". Luckily I'm with Newson who said "if you're still symptomatic, go higher". I'm now on 8 pumps and since getting to 8 pumps, I feel like I am finally getting better sleep. Not perfect or great yet, but a manageable amount of sleep. I was at 334pmol on 6 pumps, so reckon I'm probably around 400pmol on 8 pumps. Newson said many women need to be around 400-600pmol for best symptom control. I didn't know if going higher was going to help, but figured I'd give it a go and could always come down again if it didn't make things any better...
I don't get morning anxiety, but I do get evening/going to bed anxiety, which can make it incredibly hard to sleep. I found that I have high cortisol at night on a 4-point saliva test and I'm now taking lots of cortisol lowering supplements too - holy basil, ashwaganda, phosphatydeserine and Relora and zinc... along with magnesium. I think that is really helping, since high cortisol at night causes insomnia. But - some people have high cortisol in the AM or all the time, so you might want to get a 4 point saliva test done too. Your GP won't understand that (although they can do a fasted 8am blood cortisol for you), the 4 point saliva you'd need to get privately.
Hope that helps x
