I have been using estradiol gel for almost a year and it has really helped reduce the frequency of my night sweats, 3 a.m. wake-ups, and anxiety. I went on vacation last week and had night sweats every night and 3 a.m. wake-ups. Could this be diet-related? Is it time to remove my Mirena IUD and try a birth control pill instead? Could estrogen be the wrong hormone for me?
—Anonymous
My first piece of advice would be not to make any changes based on symptoms you have experienced only while on vacation. If estrogen and a progestin-eluting IUD were managing your symptoms before you left on vacation, I would see if things get back on track once you get home.

It could be that you missed doses of your estrogen gel — vacation is a common time for people to miss doses of medications, because they are out of their usual routine. And, as you suggest, diet could be having an effect on your nighttime symptoms, though maybe not in the way you would expect.
You may have had a glass of wine or a cocktail at dinner. Alcohol can disrupt sleep, as its sedative effects wear off overnight. It can also cause blood sugars to rise and then plummet. Dropping blood sugars can cause night sweats and sleep disruption.
Similarly, you may have eaten differently on vacation. We often do. Perhaps you were having dessert after dinner, and you don’t usually do that at home. You may eat more simply at home; most of us aren’t making multiple courses with elaborate side dishes. Again, blood sugar could be the culprit here. Blood sugar that drops quickly overnight can leave you wide-awake and sweaty.
It could also be the environment. I always find the air-conditioning systems in hotel rooms difficult to adjust. I am always too hot or too cold. Plus, you are in an unfamiliar bed, and if you are like my family, you may not be sharing that bed with your spouse. You might be sharing that hotel room bed with a kid who gets really warm when they sleep. All these differences in your environment could account for the symptoms you have been experiencing.
The upshot: Many aspects of vacation life could be triggering your night sweats and sleep disruption, including alcohol consumption, vacation food, and your physical environment. Get back into your usual routine at home and reassess your symptoms there before changing your hormone therapy regimen.
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