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[Fosse]

Hello, I've been reading this site for some time. Thank you so much to everyone who has posted on the forum – your advice, comments and feedback have helped me so much!

I am posting myself in desperation now. A brief history – I am 54 now. I started peri about aged 50 and tried different HRTs to help hot flushes for about a year before settling on Femseven Sequi patches. I started with other health problems 2 years ago, eventually having my gall bladder removed in June 2014 – but have continued to feel ill including intermittent, but growing anxiety. I stopped HRT a year ago in the hope I was through meno and to see if it was causing my other symptoms. Unfortunately, the hot flushes were back within a few weeks

The general anxiety has got considerably worse in the last few months and I am struggling to cope at work now (inner trembling, palps, mild breathlessness, on the edge, feeling strange, headache, brain fog, dizziness, poor sleep). I went back on HRT in December (Femseven Conti patches because I hadn't had a bleed for a year) to see if it would help the anxiety (full patch made me ill so I use half a patch). The hot flushes have gone (hurrah) but it hasn't cleared the anxiety which is so bad now I am off work. 

I saw my GP yesterday and tried to discuss if the oestrogen or continuous progestogen could be causing the anxiety or if we should adjust the HRT - and I asked for a referral to a menopausal specialist. However she doesn't think menopause is the cause since HRT has helped the hot flushes but not the anxiety. She has suggested BBs and AD's (Sertraine). I'm not convinced this is the right treatment and am so worried about how long it takes to settle on the right AD / dose. I need to get back to work, not have 2 weeks of feeling even worse!

How do I know if the menopause is the cause of my anxiety? How do I convince my GP to refer me to a menopause specialist? Would a change of HRT help my anxiety? How does everyone with bad anxiety symptoms cope at work??! If I do go on AD's how do I cope at work with 2 weeks of potentially feeling worse? I wish I didn't feel so reluctant to discuss my menopause issues/anxiety with my male boss 

Many thanks for any advice!

[CLKD]

There are medications which can ease anxiety.  Some are anti-depressants - if you feel better on the HRT regime and although GPs are advised not to use ADs as a first line in meno-treatment, maybe 6-8 months of ADs to see if the anxiety symptoms are helped?  That way you and your GP will know if this regime helps. 

I began ADs in 1989 for depression.  I have to take a low-maintenance dose for Life.  I have betablockas to ease anxiety and when panic attacks take over, my GP has prescribed an emergency medication for short-term use.

When you had periods, did you get anxiety and/or other symptoms prior to a bleed?  I would cry the night before a bleed started, even if a period wasn't due. 

[Taz2]

Hi Fosse. Welcome to this site which will give you lots of advice and support.

I have never found HRT to help with my anxiety to be honest. It does help with the flushes and other meno symptoms but anxiety has always remained. I used to blame the progesterone part of my HRT for it but after a hysterectomy I am on oestrogen only HRT and still feel as anxious. When I stop the HRT for a while the anxiety lessens.

I think that you may need to try an anti depressant which lessens anxiety although I do understand your reluctance to try to cope with work while starting the medication. You say that you are off work at the moment so wouldn't this be an ideal time to start?

Taz x 

[Kate50]

Doctors are annoying
Best thing I ever did for anxiety was have therapy.  Have used NLP EFT and analytical hypnotherapy. Costs around £50 an hour I don't bring an income in but my health is my priority and in my experience it's the head that causes the anxiety the body just let's you know it's there.

[dazned]

Hi I like Taz think that hrt is great for physical symptoms like flushes etc but moods,emotions are definitely the hardest to combat ,after all you get pmt,pms etc whilst we have our own hormones whilst not peri or meno ! 

I and a few others on here use both hrt and AD,although latterly Ive stopped hrt. Hope find an answer that suits you soon.

[Fosse]

Thank you so much for the feedback and advice. Sounds like I will have to try the AD's. I've never had anxiety prior to meno and didn't really suffer much from PMT so struggling to cope with these sort of symptoms. Guess I will have to speak to work so they understand what is going on when I start trying the Sertraline. Maybe I'll be lucky and not suffer bad side effects! 

[jedigirl]

Hi ,
 I found that HRT did nothing for my anxiety but helped flushes, aches  and nausea. It wasn't till I went on Citalopram  that my anxiety was under control.
I work four days a week and found i needed support from management to help me. Do you have anyone else at work who you could chat comfortably to? Your boss may surprise you and you don't have to mention menopause just that you are struggling with your health.
I was off sick for three months then had a phased return. Now if i have bad day I take half a 5mg diazepam and ease up on my workload.
You are presuming you will feel bad the first two weeks but that may not be the case. I had a few headaches but it was manageable then truly a relief to feel something other than fear.
Good luck xx

[SooTee]

Hi Fosse

I took a mild AD for my anxiety although admittedly at the time I wasn't sure if this was menopause related or not, but it took the edge off and I felt tons better although I was against taking it at first.  I felt so anxious and jittery inside and my confidence disappeared almost over night and the AD did help.  You need to decide what's best for you and give it  a try, if things don'r improve you can always stop taking it again.

Sue
xx

[babyjane]

I agree with these ladies. I am on a low dose of medication which keeps me on an even keel and I also have psychotherapy as my anxiety has been there for decades but only became a physical problem in the last year.

[Hurdity]

Hi Fosse

 

Sorry to hear about your persistent anxiety.

I am going to disagree with everyone re the ADs! Did you get on well with the Femseven sequi before you stopped the HRT?

Also I would beg to differ with your doc about the anxiety. Firstly, notwithstanding the experience of other women on here who take HRT and are still anxious and are taking ADs (and I am happy you all feel better even though I am not in favour of ADs for menopause!),  you are on a continuous combined patch and therefore getting a continuous low dose of a synthetic progestogen which can cause persistent low-grade negative side effects - this is well known, and written about in the medical literature. This may well by why you felt ill on a whole patch - and also increasing oestrogen too quickly can cause temporary side effects in some women. In addition you are on a very low dose ie half a patch so your oestrogen dose is simply not high enough to induce any feelling of well being. I would say that the doc is wrong - by saying that just because the oestrogen dose (of 25 mcg) is sufficient to eliminate hot flushes, this means that lack of oestrogen/menopause cannot be the cause of anxiety. It is well known that the physical sympotoms of flushes and sweats are the first to diminish, but much higher doses of oestrogen are needed for most women to feel at their best. I suspect a lot of us simply don't have enough oestrogen!

Therefore in your position, I would definitely either change the HRT type, or (maybe) temporarily go back to having a cycle - in order to find an HRT combo that suits you.  OK you would have to have a bleed but this is a small price to pay for feeling good.

I would definitely not try ADs and betablockers at this point (well I wouldn't take the latter anyway if I didn't have a heart problem) - heavens we will all by dosed up the eyeballs if we accept all of this - and hooked on happy/calming pills! I was prescribed amytyptiline when I went to the doc about a suspected urine infection. They are still sitting in my cupboard!!

If you have no particular reason for your anxiety eg psychological or mental problems due to events now or in the past as some women have, then please look to the HRT first before taking these! Remember also to give each type 3 months before deciding it's not for you because side effects do settle.

So - if you felt OK with Femseven sequi I would start with these, although my preferred type is oestrogen patches with separate progesterone (Utrogestan) which is "natural" and bio-identical with our own. Although a few women are severely intolerant to this, most of us have relatively minor side effects from it ( the usual pms ones) and manage to cope with it. Some of us ( such as myself) are on a longer cycle to minimise the frequency of progesterone.

I hope this helps and please do ask if you have any more questions. Wishing you all the best and hope this helps

Hurdity x

[dazned]

With all due respect Hurdity its great that you dont  suffer the terrible debilitating anxiety,palpitations and panic attacks that some of us do ,and it s fine that you dont wish to choose ADs but for some of us this allows us to continue to work and function each day. Each of us finds our own way through this time and what works/helps us after making informed decisions,surely this is a personal choice . 

[Fosse]

Thanks so much for your replies. From reading the comments it is clear AD's are right for some people and I had got my head into the right place to go on them – but I also complete relate to Hurdity's logic and this was what I expected my GP to say to me!  So, after much thought….I am seeing my GP again tomorrow and will ask to come off conti patches and take more oestrogen. I will try that for a month and if I still don't feel better I will go on the AD's.
 
I can't decide whether to go back on the FemSeven Sequi patches which I tolerated OK before – or if I should try a 50mcg FemSeven oestrogen only patch with Utrogestan progesterone. However I am reluctant to try Utrogestan because I don't want to take tablets that could upset my stomach/liver after all the gallbladder problems I had.

If I do opt for Utrogestan should I take ‘2 x 100mg daily at bedtime for 12 days per 28 days (days 15-26 inclusive)' as if I am peri or ‘100mg at bedtime from day 1 to 25 of each 28 day cycle' as if I am post! I assume the latter since I am 54 and did go about 1 year without a period?

Out of interest, what are the differences between the manufacturers (apart from price)? i.e. is a 50mcg estradiol patch from FemSeven the same as a 50 mcg patch from Estradot?

I mailed my boss last night and told him I probably need another week off. I know he will be understanding but I worry so much about my work stacking up and the problems it will cause. Might try and do some from home if I can get through the brain fog. Just want to get back to normal!

[Hurdity]

Hi there

dazned - you will see from my post that I acknowledged exactly what you were saying and particuarly in the light of my subsequent comments to Fosse, but the NICE Guidelines do not recommend ADs as the first line of treatment for menopause and if you look at Fosse's original post she was asking questions about the HRT, and the oestrogen and progestogen, and herself expressed doubt about the ADs and BB's. I answered this with what seemed like a possible cause for her continued feelings (the continuous progestogen and too low a dose of oestrogen) and made suggestions accordingly. This would be the first thing to try rather than giving what may well be additional medication to deal with symptoms caused by the HRT (or lack of it) in the first place! As you say informed decisions are what are needed.

Fosse - Estradot patches are tiny - much smaller than Femseven so many of us prefer them as not so much to stick - but if you want to stay with what you are used to in the first instance then maybe stay with Femseven initially? Re the Utrogestan - I can understand your reticence re oral use - I have had a nil-by-mouth approach to all HRT from the start. Also I suggested you went back to a cycle ( if you can cope with a bleed) at first because then you can tell if the oestrogen dose is right for you, and whether you feel differently on the progesterone phase. There is nothing wrong with having a cycle when you are post-menopause - it's just that most women would choose not to (I mean who wants to have a bleed?!). There is a substantial minority of us though who choose to have a cycle to minimise the progesterone. I wonder how many women in post-menopause give up HRT because they feel bad on it - due to the continuous progestogen?

Therefore I would go for the 12 days of utrogestan. If you are using it vaginally you may well be able to have either a lower dose ( eg 100 mg) or a shorter duration but the exact amount varies from woman to woman and depends on other factors eg how much oestrogen you absorb and whether you have small fibroids etc. Best to start with the licensed dose and then take it from there.

However if you tolerated the sequi patches then why not go back to these first of all until your body gets used to it all again and see how you feel?

You may not get it right in a month but you should definitely be able to find a dose/HRT type that makes you feel better for most of the time as you are post-menopausal and don't have to deal with the huge hormonal surges that cause such problems during peri-menopause.

Good luck and keep us posted

Hurdity x

[Taz2]

I still don't understand why oestrogen-only HRT makes me feel more anxious. I originally wanted the GP to up the dose of oestrogen but now that I've felt better without any HRT at all I'm not sure whether to use a lower oestrogen plus an anti-anxiety drug as suggested by StellaJane on another thread. I always thought that lack of oestrogen caused anxiety in many women but I suppose it depends on the individual. For years I've blamed the progesterone!

Taz x

[GypsyRoseLee]

Hello Fosse

My main peri symptoms are debilitating anxiety, mood swings and depression. Physically, I have barely noticed any changes except for periods getting much lighter.

My symptoms come and go, all the time, but generally speaking I feel perfectly well for about 12-14 days per month, and feel wretched, anxious and despairing for the rest of the month.

My consultant at the Meno Clinic was totally dismissive of the benefits of a 25mg patch to alleviate my symptoms. She wanted me on 'at least' a 50mg patch, if not higher.

Last summer I tried 50mg patches with separate Utro for 12 days per month. Looking back I didn't stick with this regime for long enough mainly because I was too desperate to feel better, and I expected it to work like a magic wand. It might have been that I needed to up to a higher patch? But I do know that I had extended stints (of 2-3 weeks) of feeling REALLY good on this regime.

But because I was still getting my symptoms returning I swapped to trying BCPs instead. I tried them for over 4 months, with very mixed results. Felt fantastic some of the time, but was still very up and down. Eventually I think I had too much build up of synthetic progesterone and I had a dreadful weekend, feeling almost suicidal with extreme anxiety. So I stopped.

Since Boxing Day I have been on Femoston 1/10 then 2/10. But I only seem 'good' for about 10 days, on the oestrogen only tabs in the middle of the pack (this time last week I was feeling on top of the world).

But then, when I have started the combi oestrogen and progesterone tabs my mood has slumped and the anxiety has come back. I feel jittery, upset, tearful and hopeless inside.

This has happened twice now, and I don't think it is a coincidence? I really think I am very progesterone intolerant. If you Google 'progesterone intolerance' you will see it cites increased anxiety, low mood etc.

I hope my experience might be useful information for you? It might be worth trying sequi HRT (a decent dose of oestrogen) and that way you can see if you feel well on it all the time, or just the oestrogen only tabs?

During these last 2 years I have also tried ADs, with not a lot of success. I also took them for 2 years when I had PND. They stopped the anxiety and depression, but in doing so they seemed to switch off all my emotion, I was like a robot.

I have no proof for this, but I think if your anxiety/depression is purely hormonal & cyclical then ADs might not quite work properly. The reason being that for much of the time your brain doesn't 'need' the ADs, and so something goes wrong, resulting in the robotic sensations I had.