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[JoannFran]

Hi

Wonder if anyone can help?  I posted on here before by brief history, I'm 49 and peri.  Have had a terrible few years.  was on evorel 100 and utro and testosterone until last october.  I was also on beta blockers because my worse symptom when this all started was horrific anxiety and racing heart.  EVerything was 'ok' on the HRT and propranolol which I started at the same time. It settled the racing heart but I never ever felt great tho and soon got to a place where I felt I was being poisoned and anxiety was back, insomnia and the most awful frequent ectopic beats which were coming one after the other.  Went to Drs and she said stop everything.  Stopped the HRT and tapered off the beta blockers and the ectopic beats went away.  I honestly felt pretty ok (better than I have in ages) in November and December.   Over the past week or so I've been waking up with the racing/banging heart and have had all day anxiety with a fast heart rate.  I feel like my body is pumping out adrenaline and I can't stop it.

Dr has suggested I either try HRT again or has given me Mirtazapine ADs.  Really don't know what to do.  Not really keen on the ADs as I've read they can cause weight gain and be very difficult to get off of.   Thinking my best option is to try the HRT again first and I would take it very very slow.   

Can anyone tell me what helped their anxiety the most, HRT or ADs?  I just don't know why I've started to feel like this again when I was ok for 2 months off of everything.  My life has become very small and I'm scared to do anything because I feel so uncomfortable when I have this anxiety and my heart constantly races.  My resting heart rate can be in the 80s and sometimes 90s and go over 100 when I get up from sitting. When I'm feeling calm (not very often) my resting heart rate is naturally around 70 BPM.

Any advice very much appreciated.  Thank you!

[CLKD]

Personally I certainly wouldn't go back to HRT at this moment in time, because your body may not require it.

From the mid-1980s Cortisol surges would wake me anytime from 3.00 a.m. - I would be absolutely terrified  , had to get out of bed immediately and get dressed.  Sat; hardly daring to move.  My GP gave me Propranolol to take every morning which really did ease those surges.  Initially 80mg 3 times a day, then 40mg twice a day followed by 40mg in the evening. After several years I dropped to 20mg at night which did me well until we went into lockdown.  I had no ill effects by stopping.

4 me getting the anxiety under control then considering HRT would be my choice.  I've never required the latter other than for VA. 

A friend was prescribed Mirtazapine when we had a tragedy do deal with, she had no problems stopping it after 3 years.  It did her well. 

Can U remember why U went onto HRT?  Which symptom did U want to ease first?

Adrenaline for me is like hot water coursing through my veins 

[bombsh3ll]

I would certainly be inclined restart the hormone therapy including testosterone as there is virtually no situation, physical or psychological, that is made better by the loss of ovarian hormones.

However sometimes expectations regarding the resolution of complex issues such as anxiety are not always met.

I would recommend trying to access non drug psychological therapy in the first instance - even if this has to be self funded it can be really helpful in developing long term strategies to deal with anxiety.

If drug treatment is indicated, there is nothing more effective than benzodiazepines, however concerns about addiction (often overstated) limit their availability although they can be prescribed by a psychiatrist.

Beta blockers can be used for physical symptoms like a racing heart or palpitations but are often poorly tolerated. There are multiple different beta blockers and sometimes it is worth trying a different one.

Mirtazapine is really really useful for anorexic cats. That's what vets use it for.

It can be useful in humans for nausea, poor appetite and insomnia. I have used it personally for these indications.

I can't speak to it's effectiveness for anxiety or depression but significant weight gain is almost universal.

[JoannFran]

Thank you for your replies.

CLKD - Yeah I get the feeling like the hot water coursing through my veins, it's horrible.  I went on the HRT primarily for the anxiety but I was having some other symptoms too. 

If i can help it I won't ever take beta blockers again.  Almost caused me to go insane.  I've tried 2 different ones now and felt the same on both.

bombsh3ll - I agree with you about trying therapy.  I did have CBT a few years ago and it did help.  Probably something I need to go back to.  I've got some diazepam but won't take it unless I'm really really bad.  I have a fear of medication now because of the horrible time I had on the beta blockers and it concerns me that I might be back to square one when I want to stop the ADs. Also taking medication makes me think there's something wrong with me and this then fuels my health anxiety. Never had anxiety until perimenopause.  Literally woke up with it one morning. I've been researching the mind/body connection and I know that I'm fuelling this anxiety and keeping myself in the fear-anxiety-fear loop.  So I'm going to work on trying to change my responses to the symptoms.

Thank you both for your help.  It's nice to have different perspectives to think about.

[CLKD]

Another friend has a bad reaction to Betablockas, they make him hyperactive. 

Was the anxiety the main reason that you were prescribed HRT?  MayB think back to your regular menstruating years: when any anxiety hit, was it cyclical for example?  Did it disappear once the bleed began?

Talking therapy about my family history helped a lot, venting.  However, cognitive behaviour therapy didn't do anything because my problems began within 3 hours of being born so heavily engrained.

Let us know what you decide and how you get on.

[joziel]

JoannFrann, those are identical to my symptoms. I didn't get relief until I really increased the HRT beyond the maximum licensed dose and got my serum levels up to around 850pmol. (Waiting to test again to see if that was a spike or if they are consistently up there. I suspect a spike as I was getting EW cervical mucous etc as well then and I'm not now(!)... so it will be interesting to see. Testing next week...

My dosage to get there is 200mcg patches plus 4 pumps of gel, well that test was on plus 6 pumps of gel - I reduced slightly. I actually think I need to go up a bit as I still have light symptoms.

Interestingly, I got all these symptoms back again 2 nights ago and couldn't figure out why. Lying in bed with heart beating hard, light sleep and insomnia. Next morning I checked my patches and it turned out I'd forgotten to peal the plastic backing off half of one of the patches. So I was really on 150mcg patches plus 4 pumps of gel. Which confirms to me that I really need this dose: If I drop even 50mcg from where I am, I get it all back. That was a 'double blind' trial, as it were!!

I stuck new patches on and had a great night the next night....

These neurological symptoms can need high doses of E to fix. If your GP does not support going above the max licensed dose, I highly recommend you try a private clinic like the Newson Clinic. It is much safer to be on E than antidepressants and SSRIs and psych meds. Before this, my NHS GPs have wanted to prescribe pregabalin and gabapentin - which I refused, because I knew this was hormones. It's such bollocks, when are GPs going to know anywhere near as much as their patients do, about a condition which 51% of the entire population will experience.

[JoannFran]

Thank you Joziel.

Makes sense what you are saying. What I can’t understand is that I feel like this wherever my hormone levels are. Had a few blood tests recently and I feel the same whether my estrogen is 100 or 200. Is it just that I haven’t got my levels high enough? I was on 100 evorel and my maximum estrogen was 349.
My last blood test without any HRT and estrogen was 175.  I don’t even know if this is low because is says within range but the range is so vast!
I’m so scared and confused. I can’t feel like this for the rest of my life. I just walked up the stairs and my heart rate shot up and now I feel panicky.
Just had a long chat with my husband and he’s trying to be understanding but said that he’s not sure how much more he stand seeing me like this and feels like our future doesn’t look great because I never want to do anything or go anywhere 
I have no appetite and can’t eat.
Any advice would be so so appreciated. What should I do? Am considering seeing an endocrinologist. Could they help me?
I even had a text for adrenal tumors a few years ago because this is how I felt when this all started.
Thanks again xx

[bombsh3ll]

Whilst everyone is slightly different around the estrogen level they need to feel well, assuming your blood results are in pmol/L which is typically used in the UK, then they are low at 100 or 200.

Even the NHS accepts that 250pmol/L is required to be reasonably confident of bone protection.

Mental health symptoms often require higher levels eg 450 -600 pmol/L.

Personally I wouldn't let myself get below 400pmol/L as that's where I feel well.

Certainly if you have never really achieved a therapeutic level it would be worth seeing someone like Louise Newson or the late Professor Studd's clinic which is still being run by those he trained.

Also I know it's hard but are you exercising at all? Increasing your level of physical fitness can also naturally result in a significantly lower heart rate both at rest and after exertion such as running up the stairs, which could make you more comfortable over time.

[JoannFran]

Thank you bombsh3ll

I think that’s made my mind up that I need to give HRT another go (without the beta blockers so I’ll know if it’s the HRT causing my problems).

I’ve taken half a diazepam today and that’s calmed me down a bit.

I am fit and up till Oct when I came off the HRT and BBs I was exercising everyday. Could run 5k no problem. Thats why this is so concerning to me as I’ve been quite fit and never raised my heart rate by going up stairs. I’m too scared at the moment to exercise incase it puts more strain on my heart when I feel like it’s already over stimulated.

The GP I see is private and specialises in meno and she was happy for me to go above 100. Trouble is at the time I didn’t know what was causing my ectopic beats but it seems after going research that it was the propranolol causing it.

Thanks again for taking the time to give me advice. X

[Jjumper]

Hi JoannFran,

I just wanted to say you poor thing! And I think I can relate to a lot of what you’re going through. I’ve had problems for years and have been experimenting with HRT for the last three. Whilst it has helped with some things it has never fully helped with the anxiety/mood stuff so two weeks ago I started on Sertraline (I did take this 5 years ago and it helped to get me out of a horrendous hole at that time). I weaned off it successfully 3 years ago before starting HRT. I’m now hoping the combination of HRT and SSRIs will prove better for me as I believe they can be more successful together.

Things had got very bad for me recently, with anxiety and depression, hence this step. I totally hear you on the no appetite and I also have a fear of swallowing and slow swallow reflex which adds to the misery. It is all very frightening and sad.

Anyway, I also wanted to say to trust your gut. You can listen to what worked for other people and read research etc but I do believe we are all different. My good friend is a pharmacologist and she says that medicine is far more of an art than a science and our physiologies are so different from each other. She says medical trials are fascinating because of this. One good thing about being in menopause is that we are older and wiser and have years of experience of our own bodies behind us. I am trying to listen to what mine is saying and to trust myself more.

And also, I’m having therapy, which is very helpful. One of the things my therapy is encouraging me to do is to accept these mid-life changes and find a new way of going forward. My husband is very supportive, but yes, I hear you on how difficult it is not being able to do things we used to, because of my limitations. It adds to the anxiety and sadness. Trying to find new ways to enjoy life together is the challenge now.

I hope my thoughts help a little. I don’t post very often but I was drawn to your message. I really hope you (and I!) can find some solace soon.

[JoannFran]

Thank you for your reply Jjumper. So nice to have some support and encouragement. I’m glad you’re taking steps to feel better and hope the SSRI works for you. I tried an SSRI a couple of years ago and it really didn’t work for me. I was in a state of total panic for 3 weeks and GO said stop.

You’re right about trusting your gut! I feel like I’m going to start the HRT again and see how I go with that. I do want to take it for the cardio and bone health benefits.  And I’m going to start therapy again.
I’ve developed an anxiety about eating as I have a hiatus hernia and when I feel full it feels too close to my heart and I start to panic. Homely don’t recognise myself anymore!
Here’s hope we find something to help! This surely can’t be it!!
Thanks for your kind words xx

[JoannFran]

Joziel, can I also ask about thyroid? I’m sure I read a post a while ago and you seemed to have a good knowledge of them? Was that you?

I’ve only ever had TSH and free thyroxine checked. But there is a more comprehensive test? I had lots of the symptoms of an over active thyroid!
My last blood test in October my TSH was 1.17 (which although normal seems to be on the low end). And free thyroxine was 18.9.  I’m think about having the more in depth test.
Thank you x

[CLKD]

Eating little and often may alleviate those fears JoannFran.  It may also ease some of the anxiety surges.  Do U keep a mood/food/symptom diary to chart progress?

   Jjumper. 

[Seasidegirl]

I was just going to raise thyroid issues.

I have felt fatigued since 2019, TSH 0.3 ish but "in range" according to the NHS.  Thyroid goitre that was benign

Long story,  but started HRT last May as the fatigue,  overwhelm and anxiety, racing heartrate were unbearable.   Felt fantastic for 6 weeks then the fatigue & racing heartrate returned. 

TSH still 0.27/0.36 etc. so right at bottom of range and Thyroid goitre back.   NHS say all fine despite symptoms.

I saw an endocrine specialist privately yesterday who said that we don't all fit into boxes, that my symptoms match sub clinical hyperactive thyroid and my TSH is right at the bottom of the range.   Hallelujah!!  He's started me on an anti thyroid med to see if it helps.   

A long way of saying that thyroid symptoms and peri/ meno symptoms can be very similar.

[CLKD]

Seaside Girl - tnx.  It is known that the NHS won't do extra tests for T3/4 believing that results 'within normal limits' are that.  Despite patients retiring many times stating that symptoms continue.   

Let us know how you get on?