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No period, on HRT, unable to fall asleep. What is causing the severe fatigue again?

I am 49 and have not had a period since last April. I am on HRT (e gel, progesterone tablet) since then for extreme fatigue and night sweats . Have been doing well until about 6 weeks ago, regular doctor noticed my thyroid went lower and increased my synthroid from 88 to 100 mcg. Just tested last week that thyroid is now normal level but I am having severe fatigue again. I have the insomnia too, so I am on the zoloft/trazadone combo at night. Without the night meds, I am unable to fall asleep. What is causing the severe fatigue again? Estrogen dropping again? I feel terrible - shaky, weak, pale, exhausted. Feels like flu fatigue or dehydration fatigue but is not either of those. Contacted my GYN for blood test. Suggestions?
Asked On : Fri, 29 Mar 2013
Answers:  1 Views:  32
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Psychiatrist 's  Response
Hi there, thanks for asking. If you have tender points on your sternum, your elbow (on the lateral sides) and some other parts of your body, you probably have chronic fatigue syndrome. Sleep problem in chronic fatigue syndrome is manageable with treatment of the mood in majority of the people.
As you mentioned, it could be related to your estrogen level drop as well, specially if you do not have any tender point in your body. The process of decreasing the hormones takes several years and many people need to take hormone replacement therapy or some medications from the class of alpha 2 agonists (like clonidine, guanfacine,...) to control these symptoms. Best wishes.
Answered: Sat, 30 Mar 2013
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