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[Tass1960]

Just introducing myself though have been browsing for a while. 

Am 56 with no period for 3 years so definitely post menopause.  Decided this year to start HRT because of lots of issues - Joint pain, insomnia, extreme fatigue but my main issue was my zero libido and vaginal atrophy.  After a bit of a false start whereby I had liver tests and having to get BP under control I finally started with Evoril Conti patches.  I didn't have much success with this wrt libido and atrophy but certainly some of the other problems improved.  After around 6 weeks it became clear that the negative effects were outweighing the postives - I was so snappy and tearful and added to the this the feelings of anxiety were overwhelming.

Fast forward a few more weeks and I started using Femseven patches.  Just a couple of weeks in and with still no improvement with libido I was having full blown anxiety attacks.  It's not clear whether the HRT is causing this or outside agencies ie work is a bit stressy at the moment but I have stopped the Femseven and the doc had prescribed diazepam to try and help with the anxiety.  She also prescribed Prempak-C as an alternative HRT.

I am really scared to start this.  I also really want my libido back and for the vaginal dryness to disappear.  My GP doesn't seem to be too clued up though I do have an appointment at a menopause clinic for February.  I don't know whether to leave the HRT for now and re-start through the clinic or get started and see how it goes.  I'm seeing mixed reviews for Prempak (mostly not great). 

[CLKD]

If your GP has diagnosed atrophy then that's the 'easiest' part to treat!  Ask for vagainal atrophy treatment, i.e. Vagifem or Ovestin1mg, both localised creams inserted initially for 2 weeks at night then every few days for ever.  Some ladies find that they require additional creams in the outer vaginal area to keep things moist.  Have a browse for 'vaginal atrophy' by using the search button.

Use the Valium wisely.  I took a tablet in order to see how I would feel then as necessary for many years.  Now my GP has given me beta-blockas to ease anxiety surges and an AD which enables me.  I have an emergency pill for when the anxiety floors me.  I have used Bachs Rescue Remedy with some success.

Exercise: pilates; yoga; brisk walking, swimming, cycling can all ease anxiety surges.  We have threads on those too 

   browse round!

[babyjane]

Hello and welcome, CLKD is quite right.  Vaginal atrophy is easy to treat and needs treating as it doesn't come right by itself.  I have used Vagifem pessaries, which are very tiny, for 6 years now successfully and now also use estriol cream externally.

I also use a beta blocker and an antidepressant, both low dose, to keep the anxiety under control as it is the pits.  Careful with the Valium as it can be habit forming.

I have read many thread from ladies who use Oestrogel successfully and I expect someone will soon be along to tell you of their experiences with it.

 

[Tass1960]

Thanks for responses - I don't plan to use the diazepam unless I absolutely have to.  I know it can become addictive.  The anxiety has floored me - I've never felt like this before, ever, despite coming through some very stressful family bereavements. I will get some Reacue Remedy though and try that meantime.  Hopefully that will help manage the anxiety.

[vickypk]

Hi Tass1960
Hope you are feeling better soon.  I had a lot of problems over the past couple of years with anxiety.  I use the Evorel conti patches.  I couldn't get on with them at first and then cut the patches to a third and slowly  built them up.  They have worked fine for me and I have been using them for over a year now.  The anxiety is much better for me.
Hope this helps.
xx

[Hurdity]

Hi Tass1960

  from me too.

So sorry to hear about your menopausal symptoms. I totally agree with the others re treating vaginal atrophy with local oestrogen so that's the first thing to sort out. Ditto re the diazepam - your doc should not be prescribing these because your HRT does not suit you!

One of the reasons you may be experiencing problems with HRT is because you have been given continuous combined HRT which is correct for someone who is post-menopausal and to prevent a bleed. However both of those types contain synthetic protgestogens and if you are sensitive to these, they can give rise to low grade side effects ( irritability, headaches tiredness, depressions) which as you have found can outweigh ( by interfering with) the beneficial effects of oestrogen.

Personally I would not try the Prempak - I mean this is also a continuous combined HRT, In your position I would want to know if adding a medium dose oestrogen helped with sleep, and joint pain - and therefore would start with oestrogen only and then add in the progestogen. This would mean putting up with a bleed every month - but at least you would know which progestogen you could tolerate and if none, then you could ask for a referral to a menopause clinic and perhaps go for a shorter course per month, or a longer cycle, under supervision.

If you decided to go down this route then there are cyclical versions of the same patches ie Femseven sequi and Evorel sequi to try, or do what many of us do and take oestrogen separately from the progesterone ( tablet, patch or gel) along with the bio-identcial progesterone ( micronised progesterone) ie the same type that our bodies make and so less likely to cayse sdie effects - especially if used vaginally.

The other option is having a Mirena coil which slowly releases progestogen to the uterus where it helps to keep it thin - which means you can just add oestrogen at the level that helps you and apart from some initial bleeding and spotting eventually stops any bleeding altogether.

Finally there is a product Livial (Tibolone) available only to post-menopausal women  which is not like other HRT but is also no-bleed and is very helpful for libido as well as giving other positive effects. Some women love this!! There are some threads going on at the moment.

I would resist taking any form of AD, betablocker ( which is a heart medication) without first trying to get the HRT right - if your low mood etc is hormonal rather than something you have experienced throughout your life. Low oestrogen can cause low mood and anxiety on a long term basis - you just lose that zest for life.

All the HRT types are listed above top tabs - treatments/HRT preparations.

Hope this helps and do ask if there is anything else we can help with - hope I haven't confused you

Hurdity x

[Dancinggirl]

Hurdity has made a good suggestion regarding Tibolone.  It is great for libido and often works well for insomnia and flushes etc. I tried it for 6 months and felt great - unfortunately I suffer from acne (even now at 60 I still get spots) and Tibolone can make this worse and for me it really did, so I had to stop. Most women don't get the problems with spots.
Tass1960 - Tibolone could be well worth trying. Dg x

[CLKD]

Hurdity : " is a bit stressy at the moment but I have stopped the Femseven and the doc had prescribed diazepam to try and help with the anxiety.  She also prescribed Prempak-C as an alternative HRT" .

Also: whilst MM Members know that you wouldn't try ADs, depression and anxiety need to be addressed regardless of what is the cause. 

Regular Members of MM know that GPs have been advised by NICE not offer Anti-depressant medication as a 'first line' treatment if HRT is appropriate.  However, if a patient presents with anxiety or depression, it is important to treat those initially as a separate illness.  Once mood is lifted and once anxiety symptoms eased, then the patient can 'see the wood for the trees' and therefore, is able to be more rational in discussing the benefits of HRT.

ADs can take 4-5 months B4 a patient notices good benefit, also, it can take months to find an AD which suits: pretty much the same as with HRT.  If depression is under control, the patient is like likely to go along and ask which HRT might be helpful.  If the patient is not treated for depression, she may never return because she isn't well enough - been there etc. etc. etc.!

Acne can be controlled with anti-biotics if necessary, however, ABs have been over-used and we/animals are now building up resistance 

Browse round.  Make notes 

[Hurdity]

Not sure what you are saying CLKD.  Not sure if you are taking issue with what I've said in my post ??

The NICE Guidelines imply the other way round (hormones before ADs) and Tass1960 is a new member and may not be aware of the Guidelines.  That is who my post was addressed to not MM members in general  . You don't just start ADs if you are "feeling a bit stressy". Everything Tass1960 has said points to a hormonal cause to her symptoms.

Tass1960 - you sound as though you understand what's going on and that you recognise it is unusual for you to have such extreme feelings despite having experienced life events that are far more stressful. That is the nature of menopause and if you can cope in other ways while trying to sort out the right HRT then I would urge you to do so. Besides remedies you mention there are lots of thinking therapies and techniques you can try rather than drugs - and there are lots of books and websites which can help - like nomorepanic.  others can help better with this if needed eg re Mindfulness etc

Re the "stressy" work - is it particular meetings or things coming up with deadlines etc that care worrying you more than they otherwise would? I used to (and still do when I am worried about work related events or things with deadlines) imagine myself in the time following the event or commitment - and think somehow the time will pass and I will have done this thing that is worrying me and it will all be over, and this seemed to help me focus or put things in perspective.

Hope this is helpful and wishing you all the best in sorting out the right treatment for you to feel better and function properly.

Hurdity x

[CLKD]

Hurdity wrote: "Ditto re the diazepam - your doc should not be prescribing these because your HRT does not suit you!  …"

: so Hurdity, what do you suggest to counter any anxiety this new Member suffers with until HRT 'kicks 'in? Have you ever suffered depression or anxiety?

Regular Members R aware that you appear anti-support for anxiety or depression but HRT is NOT the quick fix!  Proven methods to ease anxiety and/or depression MUST be offered.  We are not privy to the Consultation between GP and various Members who post on here; so to say you would 'resist' - well that is your choice.  UK GPs do NOT have to bide by the Guidelines so what is a patient to do ….. some GPs as we are aware are anti-HRT …….. and when feeling already low, for whatever clinical reason, it is difficult to return to the Surgery when one feels fobbed off!

"Stressy" can cover a multitude of feelings  ……… so if Valium helps then go for it Tass1960.  I used it successfully for over 10 years 'as necessary'.  I wouldn't be sitting here without that support.

[Hurdity]

CLKD -  I am not sure why are you trying to have an argument with me?
Tass1960 asked for advice about HRT and a particular product as well which I gave to her as I am trying to help her in the way that I can as I am sure you are.
You are free to have your own opinion as we all are so please address anything you want to say to Tass1960 - if you want to offer different advice - who must now be wishing she hadn't spoken!!!
You've done this before on my posts and it is not helpful as it causes arguments and stress!!!

Hurdity x

[CLKD]

Does it  ……. you haven't answered my question about what you suggest instead to ease anxiety and/or depression  .  Civil question I thought?

[babyjane]

whoa, ladies, this doesn't need to be personal at all. Hurdity you do seem to have a tendency to be oversensitive if another member comments a different opinion to the one you are offering. You are very knowledgeable but none of us are the fount of all knowledge and there is often an alternate view; it is not an attack on you personally but you seem to think it is.

I am staying out of it but as someone who has had successful treatment for anxiety and depression this year I want to say that my GP made the right choice giving me an AD and a beta blocker. 

In my opinion the doctor has been sensible in giving the original poster, Tass1960, something to help with anxiety whilst she decides what to do about HRT.  Anxiety robs you of your powers of reason and makes it very difficult to see the wood for the trees and you over react to everything, I have been there.

[Tass1960]

Thanks for all of your replies.  I haven't had to use the Diazepam ... Although I wouldn't have hesitated had I felt the need.  I really do think the HRT was causing the anxiety and this was being exacerbated by a stressy time at work.   

The problem at work is that there 2 of us who do the same job but for different teams.  The other person has been off with stress (not related to work) for the last 12 weeks.  The people she supports have been under pressure with cases coming into court that require major input from their support staff.  There is a temp but she isn't up to speed and this means that they are all getting ratty stomping around, slamming folders down and generally  causing the atmosphere to be horrible.  This is what is causing me to be stressed - I can actually manage my workload (and theirs where necessary to be honest) - what I find hard to cope with is being sniped at almost constantly.  I was very tempted to take the offer of the sick line offered by my GP but felt it wasn't really the answer.  Anyway last week my line manager spoke to the main culprit and things are more relaxed - adding to this that I have had no HRT for the best part of a week - I am feeling much more relaxed with no anxiety at all.  (sorry that was a bit long winded) !!

I think it's really hard to know if my low mood is because I am depressed (I don't think I am) and the questionnaire result was "not clear".  My.mood has been better the last few days but then I hadn't been at work since Thursday and today everything was nice with no stomping or nastiness.  This just makes me even more confused. 

Am undecided about starting the Prempak but will definitely give it another week or so before I do and hopefully the PV bleeding will stop soon   am going to be anaemic at this rate ...

[Hurdity]

Hi Tass1960

Your work situation sounds very stressful indeed but glad it seems to be a bit better now! I know just how that feels having encountered difficult situations in the workplace and especially while peri-menopausal – in fact that is when I rejoined the world of work after being self-employed for several years following children. Workplace politics take some getting used to!

The thing about menopause and low oestrogen ( or the wrong HRT!) is that it makes one less able to deal with situations which you would normally find a solution to or take in your stride and that is where HRT does really help (if you haven't been previously depressed of course) once you have the right one. I certainly found that when I was in your position. I cried so much during this time but I certainly was not depressed despite the work situations – I was hormonal!!

Do give our suggestions some thought re trying the different types of HRT but whatever else you do or do not do, please do go and get some vaginal oestrogen to help with VA. If we can help in any way do ask.

Wishing you all the best and  do let us know how what you decide and how you get on .

Hurdity x