Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Tempest on December 02, 2016, 10:59:53 PM
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Hello everyone!
Wow, I have some catching up to do here! I see quite a few new members so hello to you all, and I also see a lot of news from some of the lovely ladies using Tibolone (so pleased to read good things about this, in the main)!
I have been hunkering down and plodding away building up my levels again after being transferred initially onto the Estradot 25 (nightmare), working through a couple of week's of 37.5 (next to useless) and now on 50 (very, very slow improvement - slower than when I was using Estrogel. Damn that rash, or else I would probably switch back to it despite all of my swearing about it)!
Anywho, I'm still seeing my Psychiatrist. In the new year, he wants to start Venlafaxine as he feels I have severe anxiety and depression, but has just written for input about this to my Menopause Consultant. I'm seeing him again for my pre-Christmas appointment this Friday. I'm still in two minds about whether I want to go down this road, but things are very shakey here so I need to think about this seriously as this year has seen me almost on the verge of mental collapse. It's been very scarey at times, with real periods of crisis including brief hospitalisation, crisis intervention on a couple of occasions and rescue medication to keep me somewhat stable. All I know is I was never like this before menopause!
The second week in January, I'm back again seeing my Menopause Consultant and I hear from my GP that she is now somewhat nervous about doing an estrogen implant as she is worried that if I don't adjust to it well, it could add to my mental instability. I will discuss this with her further as I'm just getting this second hand from my GP and this was following a phone conversation my GP had with her - I find this rather odd as I received a letter fairly recently from her stating that the plan was to go ahead and attempt an implant in January.
I AM very nervous myself about implants, but I am journalling my HRT experiences and symptoms and have noticed that my problem is fluctuations and that implants would lessen the frequency of these considerably. I just don't know what to do if this option is still on the table!
My other thoughts are that if this is no longer on offer, that I may ask for Tibolone as I'm chasing rainbows here constantly with trying to get my estrogen levels up and the transdermal route just doesn't seem to be a great success for me. I really don't think I'm absorbing as well as I should via this route, and my Consultant thought that the levels I achieved on Estrogel reflected this. It is relatively early days on the Estradot 50, but it is barely doing anything compared even to the equivalent 2 pumps of Estrogel. I have no breast fullness (in fact, they are very sad and floppy), I have almost total insomnia, skin is dry, mood very low and anxiety is still present (but this could very well now be an added extra issue as well as related to hormones). I never really had hot flushes anyway (except when we hit silly temperatures here in Scotland). And I'm exhausted and achy all the time.
I spoke to the GP about this, and it was agreed that I should just stick to the Estradot 50 until my Menopause Consultant appointment and persevere so, yeah - Merry Christmas! And she gave me a prescription for Diazepam to tide me over....
I have to get a plan together somehow to move ahead in 2017 - this year has been very frustrating and very, very tiring at the very least.
Should I take the AD's? I probably DO need them now but it feels like 'giving in' somehow. Do I try an implant if it's still on offer? Is Tibolone viable for me as an alternative at my age and can I take it relatively long term (I.e. at least 5 - 10 years)?
Any words of wisdom and advice would be gratefully received. Thank you all so much for listening!
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I'm so sorry to hear of what you've been going through. All I can do is empathise - was also hospitalised due to what I call a mental crisis, was just unable to cope with all the symptoms, and lack of care too.
I can give you one bit of advice re:Estradot - place it on your butt cheek instead of belly, and alternate butt cheeks each time you change the patch. According to manufacturer, uptake of estrogen with patch on the butt is 17-25% more effective than belly, due to butt being a muscle with greater blood flow. Although the patch is changed twice a week, I'm pretty sure it starts to run out around 2.5-3 days. I don't wait 4 days to change it, technically I change it twice every 6 days rather than 7. Like you I found the 37.5 useless, don't think 50 did much for me. Now on the 100 and waiting...!
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Perhaps B4 you agree to the implant have a chat with the Medic and ask about any reservations. What many people don't realise is that they do chat with each other and share experiences when faced with un-usual cases.
I didn't want to take ADs because I wanted to know what was causing my depression but eventually, after several stops and starts until one suited me - about 8 months :-\ - I realised that I had a Life again. What's to lose? Why is taking medication 'giving in' - to what exactly? I don't tell anyone about my medication regime any more than I would tell them when I spend time on the loo ;) - the people on the Need to Know List are my GP and Husband.
Physical oestrogen rather than an implant is probably 'easier' to adjust rather than a measured amount as I think that the implant would be?
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Goodness me, when I saw the title I thought you were considering a breast augmentation!
I wouldn't be afraid to try the ADs as you may need the serotonin support as well as the oestrogen as they're all hormones after all. They shouldn't be a first line if it's oestrogen women need but you may need more of a cocktail to balance everything out.
Can the implants be removed if you don't respond well?
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Tamoxifen is oral?
I read 'implants' and thought of teeth ;D
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I had Tibolone after ovarian failure 2 years after my hysterectomy at age 39.
It got rid of all my anxiety/depression and gave me great energy etc. The only problem I had was headaches so now trying oestrogel and Testogel. It's been a much slower progress with this routine but no headaches. The change with the Tibolone was much quicker, if it hadn't of been for the annoying headaches I would never of stopped it.....I felt amazing!
It would be worth a go? The good thing is if you don't like it you can just stop and revert back to the patches?
X
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Hi Tempest
Our symptoms are so similar. I get the overwhelming anxiety and dread, but no hot flushes.
I would recommend at least trying an AD. I also felt it was akin to giving in. But then I started to feel so bad that I stopped caring, and I was prepared to do anything to feel better.
I started taking Sertraline back in July and felt a difference with days. I started on 50mg, then slowly increased to 100mg. I was very pleased with it, and had to keep pinching myself because I couldn't believe I was actually starting to feel better. It made me feel slightly dreamy, and pretty tired most of the time, but I didn't mind.
But, I still had a return of my symptoms every month, just after ovulation, but I could cope with it better, and the dip only lasted a few days.
But this month, something has changed again, and it feels like the tablets have stopped working all of a sudden. Rationally I know this won't be the case, but it's 'something' my body/hormones are doing differently? I don't know what?
I have broken down in tears to my poor husband several times this last week, and feel so low and desperate again.
But, you could at least give them a try?
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GRL
I've just had a thought, my friend has been given tablets to stop her ovulating, would that help you ? Xx
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Hi Annie
I have heard of Zoladex injections which stop you ovulating. I know some women have them to cure severe PMS. I don't know how effective they are?
What does your friend have them.for?
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I can't remember GRL, she briefed over it as I dropped the dogs off for our holiday in September. I think because she was bleeding too heavily and frequently , she said they'd given her something to stop ovulation and it's working
I'd search all the avenues, there may be an answer for you out there. It's too nasty for you to carry on suffering xx
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GRL - I know of some women (think it might be mainly in Australia) where docs prescribe SSRIs for a few days or half the month for meno symptoms. If it is a desensitisation that you're having this might give you a break to avoid this and then you could just take them for the middle part of cycle when symptoms are worse and the stronger effect may come back. Check with your GP if they do that here.
If you were at max dose of Sertraline you would feel very tired in the mornings (as in too tired not just relaxed and sleepy) as this happens to people who no longer need the Sertraline because the stress cause has lowered.
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It's interesting what you say about the tiredness DM. Since starting on Sertraline I have certainly felt much more tired overall, and especially in the mornings when I really don't want to get out of bed. But it's actually a really nice sleepiness, and infinitely better than waking in.panic at 4am.
But for the last few days that sleepiness & tiredness have gone, and I have started walking earlier and earlier, feeling anxious again. It's horrible.
I have been on 100mg for the last 8 weeks, and felt it was really working. But after the dip last month, and then this worse dip this month, I increased to 125mg a few days ago.
I don't know if I have just got myself into a vicious circle now. And I'm panicking myself because this dip is the worst yet, and so I'm making myself so anxious which is making me wake early again. But then I would have thought Sertraline should stop that vicious circle from starting?
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If the problem is hormonal then the dips will be a specific 'time', they can also over-ride the AD. How are you today?
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Yes I think thats probably it too, the lift in tiredness is a sign the Sertraline is being overridden. It will possibly calm down when in the calmer part of your cycle so the higher dose is a good idea or look into the cyclical dosing.
Peri hormone surges can go much higher than other times in your life so you may need to fight back with the stronger doses or targeted time frames.
Getting anxious about it is a natural reaction, especially with your fear of things getting worse again, but at least you know the level of relaxation you're striving for rather than just feeling around in the dark.
Also when you're feeling overwhelmed tell yourself (shout it to yourself if necessary!) that EVERYTHING WILL BE OK! Because that is the truth.
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I haven't read all this thread - but all contraceptive pills - both the combined ones and the progestogen only mini-pill - prevent ovulation - which is why women are often given them in peri-menopause as they prevent mood swings, and especially the newer ones with estradiol in. Both contain high doses of progestogen though so you need to be able to tolerate this for them to work. However - would be an alternative to anti-depressants for those who would rather. I'm not sure if there are other tablets too as well as injections?
Sorry that's off topic to the implants and the OP - but just picking up on what Annie0710 said!
Hurdity x
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Hi CLKD, thanks for asking after me. Yesterday was quite a good day. Woke up feeling jittery and anxious, but as soon as I was up I felt something 'lift' inside, and went on to enjoy the day.
But today I woke up anxious, and it hasn't really lifted all day.
I'm wondering if my AD is somehow being over ridden too? My period is due in the next couple of days, so that might be why?
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Thanks DM, you're always so positive and supportive.
Yes, that very slightly dreamy/sleepy sensation that I associate with Sertraline has definitely gone. I don't think it can be a coincidence that it 'went' on Day 12 of my cycle - especially when looking back in my diary, I have had a similar dip on Day 11/12 for the last 4 months. But, the dips only lasted a few days, whereas this month it hasn't really lifted and my period is now due in the next couple of days.
I'm wondering if it's because I have been on unopposed oestrogen for the last 3 months, and haven't taken any Utrogestan? But I must have my own progesterone still working, because I've had a period every month, still.
I didn't realise that hormone surges in peri can be stronger than at any other time? Does this mean that I could be having really strong surges of my own progesterone?
I WISH there was a test which could show how much longer my peri is going to last. I know being menopausal isn't always a walk in the park, but at least these huge surges will stop, won't they?
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Ive only read about oestrogen surges going higher than any time in a woman's life but I suspect either hormone can surge and crash as one can have an effect on the other. What it does always say for sure is that it does all calm down in the end.
Hormone supplementation is very complicated as the progesterone I am taking initially causes a rebalance that the brain isn't used to, so the oestrogen receptors, which had become desensitised by the high oestrogen, reawaken and so you feel worse initially, so I have to lower the dose when this happens. The same can happen with supplemental oestrogen if the opposite is the case but this only lasts a cycle or two apparently so probably doesn't apply to you.
This explains why my friend (who is in 30s and also feels awful post period onwards) felt great on Studd's regime for the first 6 weeks or so but then felt dreadful and higher amounts made her worse and worse. I suspect she needed prog too instead of oestrogen.
Yes if only there was a really reliable blood test or a way to measure over the course of a cycle.
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Hi DM
Can I ask how you know that the Sertraline 'sleepiness' disappearing means it's being over ridden? I'm just really shocked that my own hormones could actually over ride an AD!
It's interesting what you say about becoming de sensitised. I wonder if that is happening to me?
How is your friend doing now?
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I didn't realise that hormone surges in peri can be stronger than at any other time? Does this mean that I could be having really strong surges of my own progesterone?
As dangermouse says it is the oestrogen which tends to surge and fall dramatically during peri-menopause. I am not quite sure why because the pre-ovulatory peak is produced by the one dominant follice so the higher levels ( I have read about) must mean that that particular follice produces more oestrogen - not sure about this. I do know that leading up to peri-menopause more follicles begin to be stimulated, each of which are producing oestrogen - but not sure how much these contribute to the peak :-\
I have tried to find out about the amount of progesterone produced by the corpus luteum and whether it increases as we near to menopause but have been unable to ( don't have the time to spend hours at it!). However I would imagine that progesterone levels are probably more consistent than oestrogen - as this is produced by the one empty egg sac whereas oestrogen is produced from developing follices and the dominant one?
Hope that doesn't sound confusing and just thinking aloud really?
Hurdity x
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I don't mean that your hormones are overriding the Sertraline but that it's to do with desensitisation overriding it.
When you first have a drug you feel the full effects but the brain is very clever at retaining homeostasis (balance) so it down regulates the receptors to try to stop the effects, as it thinks it's a bad thing as it's irregular, and suddenly it becomes much weaker. This also happens with pain killers, heart meds, etc.
If you then stop a drug you can get withdrawal effects where the receptors go back to full effect and whilst the drug is still active for a few days you feel much worse.
I have not taken Sertraline but many of my clients (and my mum) have and they report the drowsy feeling on the mornings either if they have too much or if they no longer need it because the anxiety cause has ceased or another drug has rebalanced you. If the opposite is happening and you feel less drowsy it's either more anxiety in your life and/or the desensitisation.
It's a common problem with some anti anxiety drugs and you can either have more of it to see if you can beat the desensitisation or have breaks so that you keep reacting like when you first took it.
My friend is not great as not on anything at the moment but she isn't having suicidal urges like she was with the high Oestrogel.
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If I get more than 3 mornings when my brain feels low I up my dosage of AD for 3-5 days. Nowt to do with hormones, but depression has ups and downs too >:(
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Thanks DM. It's a horrible thought that I might becoming de sensitised to Sertraline, and it was really helping me. But, having said that my symptoms still resurfaced every month, since I've been taking it, so not 100% effective.
My mood has been so up and down this last week. But even on the 'better' days, I haven't felt nearly as good or stable as I have been used to feeling on Sertraline.
I increased Sertraline from 100mg to 125mg 9 days ago, but it hasn't brought back that very slightly sleepiness/contentment that I've been used to. Not sure if my mood yo-yo-ing so much this last week is due to increasing?
Feeling very flat and down today, but period is due tomorrow so I'm really hoping my mood will lift.
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An interesting post, as always Hurdity.
I genuinely do not know what my hormones are doing. This last month I felt great the week before my period was due, and continued to feel great during my period and for the 2 weeks after. So nearly 3 weeks of lovely normality.
Then it all crashed on Day 12 (yet again). My own oestrogen wouldn't have been high in the week before my period, and it would have been very low during my period, so why did I feel so good?
I am so confused.
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GRL I'm sorry to see you're not doing so well.
All I know is that for me, it's not the levels of hormones that cause certain mood related symptoms, it's the fact that they're fluctuating wildly. I always had some form of PMT when my normal cycle did its thing. When the postnatal and peri stage hit, those fluctuations really affected me.
It was confirmed to me by the second gynae I saw recently that some women are simply really badly affected mentally by fluctuations. Guess we're both in that gang.
It explains why I felt desperate when my oestrogen was low, AND when it was high!
I had a rough time on SSRIs (both sertraline and escitalopram) and unfortunately neither worked when that severe PMT hit. For me, I needed a mood stabiliser which did work for those awful black moods, anxiety and insomnia.
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Hi Flufferam
I have felt better since starting Sertraline, but the awful anxiety and low mood has resurfaced every month. I am like you, in that I can't seem to stand any fluctuations in hormone levels.
Did you ever try Zoladex injections to totally shut down your ovaries?
Can I ask which mood stabiliser you take, and what dose?
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No I haven't tried shutting down my ovaries because the drugs work!
After tinkering with Evorel patches and lots of blood tests I came to the conclusion that hormones alone can't fix what's going on with me at the moment.
I suffered (badly, really badly!) for three months before I gave up the ghost, had a mini breakdown and asked my doc for Olanzapine. I'm taking 2.5mgs, a tiny dose, at bedtime. At first it knocks the hell out of you but that sedation wears off after a couple of weeks.
Now I just sleep properly and the crushing anxiety is gone. I'm back at work, looking forward to Christmas and am booking a holiday! Two months ago I was having continuous adrenaline rushes, not sleeping, unable to leave the house and thinking I would never get better.
I'm still using the Evorel 50 just for the week or so leading up to my period. I saw a second gynae recently and after reading my long medical notes and my history, agreed that for now I need the two pronged approach of meds and oestrogen premenstrually. She is keen for me to repeat bloods within the year, at the moment my FSH/LH is fine and dandy but if I develop any physical symptoms she wants to know ASAP.
I had an internal scan and all looks good physically.
Olanzapine is an expensive drug, and from what I've heard it's not prescribed much in the UK because it costs the NHS too much.
That's a real pity because SSRIs and SNRIs do not suit lots of people and in some cases don't work at all.
It's often prescribed for bipolar and a schizophrenia which scared me when I read that but I'm neither bipolar nor schizophrenic! I guess I'm an "off label" case.
In short, much as I tried hormones alone, it wasn't fixing me and I wasn't functioning. I'd had a battery of blood tests, four visits to my GP, and three appointments with two private gynaes.
Down the line I hope that when these fluctuations stop I'll be fine on HRT but at this weird point in peri I need the drugs!
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I can categorically confirm as a lady with no ovaries or uterus that it IS fluctuations that make you bonkers!!! If my estrogen fluctuates due to poor absorption in general (which I think is very likely happening on transdermals for me) or drops due to the method 'pooping out' (these blessed patches only last 2 days on me, and the Estrogel only 12 - 14 hours) then I feel HORRIFIC. And I do mean horrific! :o :'( :o
When I was on NOTHING for a year, my mood was stable. A bit depressed, but not the absolute crazy I have experienced on both the estrogel and the patches. Prior to my surgery, I was in peri and felt exactly the same. Totally a hostage to the wild swings! The feelings I'm getting now due to fluctuations in HRT are exactly the same, so I think this may help to clarify what you're experiencing.