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[jorainbow]

Morning all - I am 47 and in perimenopause (chin hairs/skin changes/aching joints pre period/dryness here there and everywhere) but still have regular periods.  One thing I have noticed and mentioned previously is post period mood swings.  I have had some external stressors recently so aware mood etc is slightly lower than usual but this last episode was absolutely dreadful.  Anxiety off the scale, tears, intrusive thoughts you name it.  Heart rate on waking from a nana nap yesterday was 112 so ended up at GP.  Prescribed beta blockers if needed and am being tested for thyroid issues (sister had hers removed years ago) but when I mentioned hormone testing thats when the assistance stopped. Is it possible to do tests when periods still regular or would they not show much? TIA

[Hurdity]

Hi jorainbow

Sorry to hear about your problems. It's a good thing they are testing your thyroid because some of these symptoms can be due to this and sometimes this gland goes a bit wonky in women as they head for middle years!

Re testing for sex hormones (as opposed to thyroid ones): from what I've read, on average during the late reproductive stage - when periods are still regular, FSH begins to vary as the ovaries being to pack up and ovulation becomes less frequent - and at this time pms often becomes more pronounced. Some women also begin to experience peri-menopausal symptoms at this point even though not "officially" at peri-menopause (according to the medical definition). Some of these women do in fact benefit from a low dose HRT at this stage, and others find that controlling the cycle with the birth control pill ( there a couple that are a bit like HRT rather than the stronger synthetic types). You are the right age for this.

However current guidelines are that women should be diagnosed as peri-menopausal on the basis of cycle changes  and symptoms alone - so if your cycle has not changed then presumably that's why they do not see the need. In the meantime - if your thyroid turns out to be OK - where does that leave you with symptoms?

I suggest you wait until the results of the thyroid tests - and then decide what to do depending on the outcome. Either ask for a blood tests, or for something to control your cycle/prevent mood swings.

From what I understand palpitations are also common in peri-menopause - has the doc said you have a heart problem or that it is dangerous to have a temporary high heart rate like that?

Hurdity x

[jorainbow]

Hi Hurdity and thank you for the information. It does make sense and if they dont show anything then no reason - what is the medical definition of peri?  I get confused with that!!!!

He attributed the heart rate to anxiety alone - blood pressure was fine.  As I have felt calmer today my heart rate is as it usually is around 86-90.  I slept better last night and have eaten better too  all of this has contributed to how I was I think.  I went for my bloods done this morning so hopefully they'll be back beginning of the week and I'll know what I am dealing with.  I have also registered with the local IAPT and am having a course of CBT. Most importantly I am going to keep a diary of symptoms and confirm the patterns.  Overall I need to look at my stress levels, diet and anything else which may have a negative impact on mood and hormones.

[jorainbow]

Just spoken to a lady GP from the practice.  Her words were (please dont shoot the messenger!!!) the menopause can cause a little increase in anxiety and depression but not to a great degree like you are experiencing. 

She has suggested fluoxetine or a systemic hrt tablet which may help. What is the latter? Any thoughts? ?

[Hurdity]

Hi jorainbow

How I understand it is that if you haven't experienced depression or anxiety in your life then if you suddenly start experiencing these feelings for the first time heading towards menopause - or they become more extreme, and especially if they are cyclical and there are no life events likely to have caused them – then these are most likely due to hormones. As I said from what I've read pms worsens in late reproductive stage – due to the fact hormone begin to surge and fall to a greater degree and this gets worse as peri-menopause starts and oestrogen levels also crash in between cycles. I think from a medical point of view this change is more difficult – because if you are having regular periods, then officially peri-menopause has not begun when the NICE Guidelines state that anti-depressants should not be prescribed in the first instance for menopausal symptoms.

The NICE Guidelines use this definition : Perimenopause The time in which a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period. The perimenopause is also known as the menopausal transition or climacteric.

Early peri-menopause is more precisely defined in the STRAW  papers (linked to on here at various times – can provide it if you want)  but these provide a model for a large proportion of women – of course by no means all will follow the model pattern!

I think this is the point many women are given ADs and are then on this slippery road – to needing them long term and in higher doses. Personally I would go for the systemic HRT tablet – this is just HRT. Systemic means it is absorbed into the system as opposed to local oestrogen ( vaginal).

A while back someone posted a link to a paper by ?Panay maybe – about treatments for pms at this point – ooh I've just found it – sorry haven't read it but may be something useful there:
http://www.nickpanay.com/Papers%20pdf/Royal%20College%20of%20Obstetrians%20%20Gynaecologists%20PMS%20Guidelines.pdf
You could also think of trying the CCP – one of the milder types which is like HRT – maybe this has already been said on another thread? This would control your cycle and eliminate the mood swings.

Rather these than beta blockers and ADs - if a hormone solution will work!

Hope this helps

Hurdity x

[jorainbow]

Thank you! Im going to use the record of symptoms sheet in that pdf it's great. I'm not really sure what I'm dealing with but feel like my body and mind are having a battle with me.  I know I've had emotional upsets plus the accident and I know my hormones have always made my moods very up and down.  I'm now finding I have horrendous dips two or three times a day often before or just after food where I go into a complete fog which just increases my anxiety so I'm looking at my eating and sugar levels. But despite all this I am still trying to be positive 😯

[CLKD]

In the late 1980s NAPS advised me to eat every 3 hours, 24/7 to stop that awful 'dip' when the body requires sustenance!  It worked then and I have kept to the 3 hourly regime almost every day since!  I spread out my diet rather than eating extra, adding a good carbohydrate mix as well as slow release foods, i.e. bananas; snacks are dried fruits and nuts, RedyBrek, Dextrose tablets when necessary.  As for using BBs as necessary  ........ they aren't an anti-anxiety medication but are used to lower heart rate.

Having had bad PMT in the 1980s/90s I was lucky in that all those symptoms went at peri-menopause : PHEW!

Browse round. Make notes.  Keep a mood/food/symptom diary will help you chart on a daily basis.

Your symptoms sound hormonal, therefore HRT should be discussed - is there a Dr in your Practice who is lady-savvy or a Practice Nurse?

[jorainbow]

Thanks CKLD! Ready oats, oat biscuits and bananas bought today! Also making sure I have something on my bedside table as im early morning waking at 3am. I haven't taken any more beta blockers as my heart rate is 70-80 now. I'm seeing a lady gp Friday to discuss and hopefully my bloods will be back by then. 😊

[CLKD]

I use gels occasionally that the Pro-cyclist drink whilst racing but that is a sharp sugar burst.  Exercising is supposed to help symptoms too 

[jorainbow]

Thanks again CKLD! Bloods came back all fine so I'm assuming this is partly hormonal and partly stress. The main thing I find difficult is this spaced out feeling. It's damned annoying!!

[CLKD]

Could it be that you aren't eating enough or maybe sleeping too deeply, I get a weird, like my head is elsewhere, feeling when I've had a good night's sleep  - bugga ........

[jorainbow]

Probably on both counts due to stress. It's improving as my appetite is. Had a dip an hour ago felt awful foggy weepy - ate two slices of brown toast and marmite and I'm back to ok and off to aqua aerobics. Not 100% but such a difference.

[CLKD]

Eat when you get out of that pool  - I feel worn out thinking about undressing, swimming, dressing 

[jorainbow]

Ate a banana whilst drying off. Really enjoyed it though! Had lunch (toasties and chips) no dip so far.... awful period pain for 10 mins though 😡😡😡

[jorainbow]

Has a fantastic lesson today from a psychologist about food, digestion rates, glycogen and the affect on anxiety. Interesting stuff and certainly makes sense. Didn't realise the the food from the tea you eat isn't available energy wise until mid morning the next day! Explains the early morning anxiety issue as well as the brain fog which can be caused by lack of glycogen. He also thinks I have mild depression caused by the stressors I've experienced which I would agree with. So for now it's concentrate on my diet, try get better sleep, meditate and exercise.  Being back at work tomorrow will help too. I am of course worrying I'll have a huge dip around period time but will just have to see x