It's a bit unintuitive to me, but since bottom surgery, on-and-off, I've been getting night sweats. I've complained about that here before, but now it has been pretty well established that my sleep has become ...perimenopausal in experience.

It's just unintuitive to me because I haven't changed the HRT regimen I'm on (although adding weeks of post-surgical care to my routine has sort of made my dosing less consistent) and, I'm not certain what losing my body's main producer of a hormone I didn't want would have to do with plummeting estradiol. A quick search of the usual places shows that I'm hardly the only one who has experienced this, with many reporting that it goes away ...eventually.

Still, I think that my time with sublingual administration of estradiol (2mg, 3x daily, for 6mg overall) has come to an end and that it is time for me to request a switch to injections.

I have two main reasons for this:

1. Stability. Sublingual administration is quick to increase levels and they then trail off. Most of my blood tests have been in my waking trough: that is, the nearest trough when I am awake, usually somewhere around 11:30am, or 5½ hours following my morning dose. My last reading was 455pmol, which is satisfactory (between 350pmol and 500pmol would be considered to reflect a general premenopausal cisgender average). Of course, my real trough would be when I wake up. My last dose is at 8pm, first is at 6am, so that is a 10-hour gap. No accessible blood lab is available to me at 5am to measure that trough, which would most definitely be low. My night sweats would be an indicator suggestive of that.
2. Convenience. Having to remember to administer on a weekly-or-near-weekly cycle may be preferable to multiple times daily. From what I understand from how others put it, the greatest satisfaction is with a 5-day injection cycle and this is what I am going to ask for. The 7-day is most common from what I understand, but I've heard far too many complaints about those last two days of the cycle to believe that a 7-day is ideal. It's not just remembering: my mid-day dose is at 1pm, right when I do often have work meetings to be on.

While I have to admit that I'm a little nervous to begin using needles - I really am a little afraid of them and while I don't find them anywhere near as painful as other things I do regularly (electrolysis) or have done recently (surgery), it's still not pleasant - I know, though, that it will quickly become second nature.

I had thought about requesting an increase to 8mg (2mg, 4x daily), but that would not solve the fairly violent bottoming-out of my estradiol levels while I'm sleeping and just keep me at a higher daytime peak. Instead of sweats at 1:30am or 2:30am, I'd probably just get them at 3:30am or something. It also wouldn't solve melting a tablet while I'm supposed to be being fully present for meetings and not stiffly smiling, quickly an introduction ("HiImCharlottejustananalystonthefile")

August 5, 2026