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[Nik2502]

Hi

Sorry I just need to vent.
I’m feeling so terrible at the moment and feel so alone.
I just can’t get my HRT right. I’ve gone from 175 patches to 75. I was having terrible internal tremors, crying, anxiety and panic attacks. Plus awful palpitations.  They stopped on 75 but are back again with vengeance.
I couldn’t stand the way I’ve felt so cut the patch down to 50 today.
In the past I’ve always needed more oestrogen but I now think I’m post menopause at nearly 55 and I don’t know what’s going on.
Are blood tests worth it at this age? I was previously a Newson patient but I just can’t afford it currently as I’ve taken so much time off work.

Thanks
Nicola

[CLKD]

   U may not require HRT now.  The way to tell if you are through peri is to stop all HRT.  Menopause literally means last period but when taking HRT one can't know.

Can U remember which symptom you wanted to ease when U opted for replacement? 

Anxiety and panic attacks can be eased with appropriate medication.  I have an anti-depressant which gives depression at bay; many years ago I was prescribed Valium to help with the dreadful anxiety - initially 10mg 3 times a day followed by 5mg twice a day, then as necessary. Useful for the night B4 events that I was unable to get out of knowing that I could take an extra 5mg if necessary.  Never required.

My GP has also prescribed Propranolol at night to ease early morning anxiety attacks.  That worked well for several years.  Now I have an emergency go-to pill when anxiety floors me which either enables me or knocks me out.  When I wake the anxiety has gone.

Could 75 be too much all at once, would U need 75 a couple of times a week with 50 to back it up? 

[Nik2502]

Hi

 Thank you.

I’m terrified to stop it all. I was suicidal before I started HRT and it changed my life for the better.
I’m also on venlafaxine as I can’t get off it due to awful withdrawal. I don’t think it ever did much as my mental health problems are definitely hormonal.
My GP won’t prescribe diazepam. I do take propranolol though.
I’m haven’t been sleeping well and I don’t think that’s helping either. I have ordered some melatonin to see if that helps.
I think it’s just going to be trial and error trying to get the right dose.

X

[bombsh3ll]

I am not sure what a blood test would add at this point, as it is primarily about getting you well. Generating a number in pmol/L that you are happy with is futile if you feel like crap.

What it does sound like you need is some menopause literate clinical oversight rather than chopping and changing your estrogen dose by yourself, rapidly reducing in steep drops.

I would be far more inclined to suspect the noradrenergic antidepressant that you are taking as the cause of tremors and palpitations etc rather than estradiol.

Do you have a supportive GP that you could work with to stabilise your treatment?

If not, I would save up for a further specialist consultation, even if that takes a while, and I wouldn't drop below 50mcg without a medical review because the long term health benefits such as bone protection, cardiometabolic health etc have not been reliably evidenced below this.

[CLKD]

If your GP has told U that he/she won't prescribe diazepam then ask for a referral to a psychiatric clinic for support, they may also have access to a wider choice of anti-anxiety medications. 

Try not to worry at this stage about stopping the Venlafaxine because that will increase any anxiety surges.  When I withdrew from one - can't remember which - it took 9 weeks under supervision.  My brain kept "What if I continue to feel ill and have to go back on it?" however: once I realised that bounce back symptoms lasted no more than 12 hours and didn't become worse in that time, I coped.  It wasn't easy !

Could U ring 2 query what a phone appt with Newson Health might cost, if U are already on their books it might be an option. 

I have used 'bachs' rescue remedy mouth spray with success. 

[Nik2502]

I am not sure what a blood test would add at this point, as it is primarily about getting you well. Generating a number in pmol/L that you are happy with is futile if you feel like crap.

What it does sound like you need is some menopause literate clinical oversight rather than chopping and changing your estrogen dose by yourself, rapidly reducing in steep drops.

I would be far more inclined to suspect the noradrenergic antidepressant that you are taking as the cause of tremors and palpitations etc rather than estradiol.

Do you have a supportive GP that you could work with to stabilise your treatment?

If not, I would save up for a further specialist consultation, even if that takes a while, and I wouldn't drop below 50mcg without a medical review because the long term health benefits such as bone protection, cardiometabolic health etc have not been reliably evidenced below this.

Thanks for your reply. I’ve dropped the dose over a year in small increments apart from going from 75 to 50.
I’ve been on venlafaxine for 20 years now with no problems so I doubt it will be that.
My GP doesn’t have a clue. She’s supportive in other ways but doesn’t have any menopause knowledge.
Ive spent thousands on private healthcare and I just can’t justify it at the moment. And, although they helped initially, I now feel that they’re more interested in money than healthcare.

If your GP has told U that he/she won't prescribe diazepam then ask for a referral to a psychiatric clinic for support, they may also have access to a wider choice of anti-anxiety medications. 

Try not to worry at this stage about stopping the Venlafaxine because that will increase any anxiety surges.  When I withdrew from one - can't remember which - it took 9 weeks under supervision.  My brain kept "What if I continue to feel ill and have to go back on it?" however: once I realised that bounce back symptoms lasted no more than 12 hours and didn't become worse in that time, I coped.  It wasn't easy !

Could U ring 2 query what a phone appt with Newson Health might cost, if U are already on their books it might be an option. 

I have used 'bachs' rescue remedy mouth spray with success. 

[Nik2502]

If your GP has told U that he/she won't prescribe diazepam then ask for a referral to a psychiatric clinic for support, they may also have access to a wider choice of anti-anxiety medications. 

Try not to worry at this stage about stopping the Venlafaxine because that will increase any anxiety surges.  When I withdrew from one - can't remember which - it took 9 weeks under supervision.  My brain kept "What if I continue to feel ill and have to go back on it?" however: once I realised that bounce back symptoms lasted no more than 12 hours and didn't become worse in that time, I coped.  It wasn't easy !

Could U ring 2 query what a phone appt with Newson Health might cost, if U are already on their books it might be an option. 

I have used 'bachs' rescue remedy mouth spray with success.

I’ve been on venlafaxine now for 20 years. Even the tiniest reduction causes major withdrawal eg brain zaps, vomiting etc. psychiatrist told me it would take five years to come off safely!

[CLKD]

I remember the brain zaps, try explaining those to anyone!

Do u feel that there is a rush to stop it?

I think that because private menopause clinics are become popular, ladies are seen quickly then left to their own devices with little chance of follow ups.

[Nik2502]

To be honest I’m not even bothered about stopping it. It’s never caused me any problems other than withdrawal.
You’re right. You can get a new patient appointment quickly but they aren’t so keen to see you again that quickly!

[CLKD]

Let us know how you get on and perhaps see a different Doctor in the practice.  Mine had no problem diagnosis Valium and kept an eye on how I was feeling with weekly appts.. 

Hopefully U will feel a little better tomorrow having shared with us. 

[CLKD]

How R U this morning?

[Nik2502]

Hi
I was a little better thank you.
I just want to feel back to myself but I don’t think it’s going to happen overnight.
Nik x

[CLKD]

Little steps. 

[ElkWarning]

Hi there

You seem to be describing symptoms that render you unable to function - lots of time off work. You're also describing features of a medical emergency - suicidal.

Your GP, as gatekeeper to other services, needs to do better. I suspect what's happening is that they're hearing 'I can't go on like this' and kind of ignoring what that means. Have you tried saying 'This illness is preventing me from going to work. It's completely disabling. Can you note this down in my medical records and give me a fit note?'

^^ Essentially, it sounds as if you need to force your GP into the position of being responsible for your healthcare and outcomes. Unfortunately, it would appear that you've already discovered private clinics are able to bail and leave you unsupported when their treatments fail and consequently the money runs out, hence why I believe your best bet is your GP.

[Nik2502]

Hi there

You seem to be describing symptoms that render you unable to function - lots of time off work. You're also describing features of a medical emergency - suicidal.

Your GP, as gatekeeper to other services, needs to do better. I suspect what's happening is that they're hearing 'I can't go on like this' and kind of ignoring what that means. Have you tried saying 'This illness is preventing me from going to work. It's completely disabling. Can you note this down in my medical records and give me a fit note?'

^^ Essentially, it sounds as if you need to force your GP into the position of being responsible for your healthcare and outcomes. Unfortunately, it would appear that you've already discovered private clinics are able to bail and leave you unsupported when their treatments fail and consequently the money runs out, hence why I believe your best bet is your GP.

I don’t know why you’ve assumed I’m suicidal. Yes I’m depressed but I’m not that unwell. That comment could be triggering to someone.