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[Kathleen]

Hello ladies.

I thought I'd update you on my GP appointment. I am fortunate that my doctor is very supportive and helpful plus he is interested in the menopause and all it has to offer (!). I am using 3 pumps of Oestrogel and Utrogestan vaginally and still have some flushing and anxiety symptoms.  I have tried reducing the Utrogestan dose but the resulting spotting worries me.

During our chat he wondered if I have achieved as much as I can using HRT and perhaps my anxiety requires a different approach. He has recommended CBT  and given me a number to call to arrange an appointment. He has also scheduled a blood test to measure Calcium as low levels can induce anxiety and depression which was a surprise to me.

I will follow his recommendation and try CBT.  Coincidentally my friend had her first session today and from what she tells me and I'm not sure I have a lot of confidence in the process but time will tell.

So there you have it ladies, a brief update and if I learn anything of interest I will let you all know.

Wishing you all well.

K.

[CLKD]

What does your GP expect CBT to do for you?   Why aren't we all measured for low calcium, I've had anxiety since the age of 3 .........

[SueLW]

Have you tried 4 pumps of Estrogel a day Kathleen?  I've been told it is OK to do so and to split them into 2 in the morning and 2 in the evening if I want to (which I did because I could feel I was running low in the evening with palps returning.  So far I'm using 2 in the morning and 1 in the evening but know I have the option to move up to 4.  For that I've been told 100 Utro vaginally every other night is fine (push it right up as far as possible).  I am getting a bit of spotting but I had a scan in the summer and my lining was fine so I don't worry about the spotting.  Back in the day when I had a Mirena I spotted almost daily for about 4 months and then never again, so I know it takes time.  I also have some testosterone, but I have to say the 3 pumps of gel and the every other night Utro are making me feel the calmest I have felt in ages and this (I now realise) is because my oestrogen levels are finally going up.  What I was doing before wasn't making enough difference. 

The way the Utro was explained to me was that taking 100 every other night vaginally was equivalent to swallowing 100 every night.  I did try using vaginally every night but I turned into a zombie.  I wish I'd carried on really, as I think I would probably have got used to that and the effect would have worn off.  I felt zombied when I had that Mirena fitted years ago, but it did wear off.

The doctor I saw for this new regime was Louise Newson in her new women's health clinic.  She was very nice, and her treatment is making a difference.  She said with the Oestrogen gel some of us just need to experiment with the dose a bit and up to 4 pumps a day was fine.  I will be reviewed in early December, but for the first time I am feeling some hope.  I also have to balance an under active thyroid so that makes things harder, but everything is starting to feel less difficult.  Never give up.  There is a regime out there.  Your doctor is giving up too fast.

[racjen]

Hmmmm, yes I confess I also question what your doctor thinks CBT is going to do for you in this situation. If it's acknowledged that the anxiety is caused by hormones then any amount of talking therapy isn't going to make any difference. Of course, it may be that you have a more complicated situation going on ie you have a combination of psychologically-based anxiety, which would respond to CBT, and hormonally based, which wouldn't; but if you've never suffered from anxiety until the approach of menopause, the likelihood is that it's the result of hormones and your well-meaning GP is clutching at straws.

[Kathleen]

Hello ladies and thank you so much for your responses.

SueLW - Thank you so much for your passing on the advice given to you by Louise Newson. I will think about using four pumps even though my consultant seemed to think three would be enough ( though  of course she didn't say why or what I should do if it wasn't enough).

 racjen -   I have had anxious times in the past due to difficult circumstances and life events but surely that is true for everyone! The sudden feelings of dread and irrational panic are completely new to me however and seem physical and hormonal in origin. I can feel anxious or calm about exactly the same situation and  there is even a paragraph in my trusty meno book that describes my situation perfectly.  Many women continue to have problems even when using HRT but I think lots of doctors don't believe that.  Having said all of that I am open to learning techniques that can reduce anxiety as that would be a helpful skill to have for the future.

Many thanks again ladies, I truly value your comments and appreciate you taking the time to post.

Take care all.

K.

[Conolly]

Hello Kathleen,


I'm glad you are being taking care of. CBT may not stop hormonal anxiety but it certainly helps us to cope better with stressful events so in general it is going to be very helpful.


Regarding calcium, I'm very interested in the subject because my blood tests showed hypercalcaemia and a kidney stone which is probably of calcium oxalate. Interestingly, my anxiety has gone awol this year.


Conolly X

[AgathaC]

I think I agree with Connolly. I have hormonal anxiety and therefore CBT cannot cure it in any sense. But it can help some people deal with the anxiety as it arises. Even if it helps take the anxiety down just one notch it has to be worth it. I don't take any meds so I have to mitigate my anxiety by keeping busy, getting outside, that kind of thing. Gosh it's a daily struggle and I'm quite exhausted by it. Waking up each day feeling like something awful is about to happen is very upsetting and draining. It's a sick feeling in my stomach. Ugh.
I'm also very interested in various posts about vitamins. I've been pumping myself full of all sorts and have laid off them for the last week or so. Comments about kidney and liver issues from other members have made me wonder.
Final thing to say, Kathleen, is that even if CBT is helpful, I found it quite offputting when my GP pointed me in that direction, as if it was just in my head without any acknowledgement of how bad the anxiety as a physical issue. I think racjen feels strongly about this, as she rightly should.

[racjen]

Yes AgathaC, you've put your finger on it - I'm fed up with being fobbed off with this idea that it's mainly in our heads. It really isn't, and I say that as someone with years of psychotherapy behind me and a year of training as a psychotherapist before my cancer diagnosis. Since this all started for me a year ago I've had crisis after crisis, and at first the mental health team just saw it as another case of anxiety and depression needing antidepressants and CBT. But the longer it's gone on and the more they've got to know me the more they've all become convinced it's a hormonal, and  therefore medical, problem, not a mental health one. So now I've got the Mental Health Crisis Team and Community Mental Health Team putting pressure on my GP to refer me to a hormonal specialist. On my to-do list tomorrow is to write to my MP insisting on my right to be referred to a specialist of my choice. And all this is after the extreme menopause brought about by breast cancer treatment, and yet the medical people just don't seem to want to know. What's the point on spending all this money on cancer research if you then just abandon survivors with a quality of life so terrible they'd rather have died?

[Ladybt28]

SueL.W  - I was really interested in your post - I have just started the gel/urtrogestan regime and am exactly 1 month in on a cycle.  Were you on a different regime before this or are you just starting out?  If you have had previous go's at getting it right can I ask what regimes they were and what problems did you experience?

[SueLW]

SueL.W  - I was really interested in your post - I have just started the gel/urtrogestan regime and am exactly 1 month in on a cycle.  Were you on a different regime before this or are you just starting out?  If you have had previous go's at getting it right can I ask what regimes they were and what problems did you experience?

Hello

I have been on HRT for 3 years.  My GP told me he didn't know anything much about it and when I asked for bioidentical hormones he just looked blank.  As a result I went privately to a menopause clinic in London where I used various kinds of bioidentical hormone preparations.  Some compounded creams, a lozenge, and I also tried a patch and gel.  But nothing much worked.  I was very up and down.  Never recovered my energy and suffered a lot of anxiety, stress and expense.

Looking back on that period, I blame the too rapid changing from one preparation to another, but also the doses being kept too low.  This particular doctor wanted the lowest dose of oestrogen possible and it just kept me in an anxious, miserable state.  I did have some testosterone in with these preparations but all of a sudden I lost my muscle strength.

What I will never know is if the issues were simply because I was early in the process of peri/menopause or if it were because the doses were too low or too messed about.  I tried swallowing Utrogestan.  It only took 3 capsules to make me feel suicidal.  As a result I never would touch it again.  Until, on here I began to see people talking about taking it vaginally and I plucked up the courage to give it a go again.  I told the London doctor that I wanted to go back to it and to add in Estrogel.  She was OK with that and with my idea to use it vaginally every other day.  But again wanted that oestrogen really low.  Telling me to use 1 pump a day.  I stated off like that and immediately, the first morning, I was paining my toe nails within an hour of applying the cream (something I usually do all summer long but hadn't been bothered with at all this year up to that point).  No issue at all from the vaginal progesterone but I felt angst and low moods and poor focus on the 1 pump.  As the leaflet said 2 pumps is the dose I moved up to that and felt better right away. 

Then, having been on the waiting list for the new Newson Women's Health Clinic in Stratford for quite some time (I registered as soon as I found out about it because I want to stop having to keep going to London) I suddenly got a call to say a cancellation appointment had arisen for 2 days hence and I jumped at it. 

Dr Louise was so much more reassuring and kind than the London doctor!  She said I was on the right regime now, but would need more gel and she was happy for me to use up to 4 pumps a day and alternate day Utrogestan vaginally until I have a review in December.  My blood test results came back very low in everything, despite already using 2 pumps of gel a day so I immediately switched up to 3 pumps a day, where I am now.  I think I could do with going up to 4 pumps, but I want to let this settle a bit first because I have a 3 day event this week and I've been very poorly with a horrible cold/chest/coughing bug for the past week.  I've been on the 3 pumps for 2.5 weeks now and in that time I have had one very down and miserable day, a week last Sunday.  But by Monday I was struck down with the bug so I don't know if that horrible day was hormonal or sickness.  I will see if it happens again.

I would love to use the Utrogestan every night because I feel calm and more fleshed out somehow on the days I do use it.  But I tried it and it made me low/slow and sad very fast.  If I move up to 4 pumps of gel I will look at having another go at daily and perhaps force myself to stick it out for longer because I suspect I would get used to it and it might not be an issue then.  Just have to pick a quite time to try it.

I hope some of my story helps you in some way.  Let us know what you decide to do and how you get on.

[Ladybt28]

Oh yes your story helps enormously - the more detailed the better I find because then it puts everything in context.  Thanks so much for taking the time SueLW.  I know what you mean about changing to often and not letting things settle but my reactions can be so wild that you just can't deal with it.  The other thing is that I have realised through all this my hormone problems go right back to teenage years  Now I know what needs to be done to kill the crushing depression for which I was given anti-d and counselling off and on (more on than off) for 40 years (none of it worked at all, it just made me numb and life a total non-event and beyond a struggle every day - so it most definitely wasn't in my head) -  I don't really have much patience to waste another minute of my life feeling rotten, 40 years is enough to waste!!
I am under the meno clinic on the NHS but my first appointment didn't go at all as expected  Consultant just wrote down 4 types of HRT to try and left me too it!  No tests or checking levels etc.  I am 57 and pretty much post meno so it should be easier for them to check me.  I did think about going private but the consultant at the NHS clinic is the same on who sees people privately.  I did book a provisional appointment but it was a 2.5 month waiting list and which kind of gave me the impression that she gave useless consults on the NHS driving her patients to see her privately....I'm such a cynic and probably being very mean but it didn't look good.  There is only one consultant for HRT in NI!

I am going to stick out a full 3 months of gel and utrogestan this time (I know I cant take the utr continuously so I will have to bleed - but that is something I know I can cope with, it is the head stuff that's crippling).  I will use what I learn here to tweak the regime like you have said when you have answered my other posts.  Upping the gel, splitting doses and writing a diary.
I don't even know if the meno clinic are likely to be calling me back in December when I have done 3 months? 
Does anyone know where I can buy a bucket load of patience 

[racjen]

Well I've endured a year of this crap without any progress whatsoever - don't think my patience is going to hold out much longer so if you discover a source please let me know. Here in Devon we have precisely zero specialist menopause clinics, I've been referred to a gynaecologist who doesn't seem to be aware that anxiety can be a symptom of the menopause......I simply don't know where else to go from here 

[AgathaC]

Coil tomorrow, Racjen? Hope all goes well.

[Taz2]

Well I've endured a year of this crap without any progress whatsoever - don't think my patience is going to hold out much longer so if you discover a source please let me know. Here in Devon we have precisely zero specialist menopause clinics, I've been referred to a gynaecologist who doesn't seem to be aware that anxiety can be a symptom of the menopause......I simply don't know where else to go from here 

It's difficult when there are no specialists in your area. Are you able to travel?

Taz x 

[racjen]

Yes, happy to travel but my GP just won't refer me  . The Mental Health Crisis Team have told me to write to my MP...