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[Emmia49]

Hello beautiful ladies!

The forum has been a comfort to me many times and I am grateful to be able to contact you and ask you for your opinion, suggestions and experiences.
I apologize for the grammar mistakes as I am from Germany and English is my second language. I also apologize for the long post.

I am 49 years old, I have a wonderful family and I can say that there is absolutely no situation in my life that could make me feel as bad as I have been feeling for the last 6 months.

I am in perimenopause, my periods are every 22 days, they are very short and light. I live a very healthy life, I don't have any diseases, I run regularly 5 times a week. I take no medication.

2 years ago I noticed changes, I knew that one day menopause would hit me too, but I was in no way prepared for what is happening to me now.
First I noticed changes in my periods, sometimes they were late, sometimes I had 2 per month.

Before that I never had any problems during my periods, no PMS, no nervousness. I gave birth twice without problems, I never had mental problems.

So, I experienced night sweats a couple of times a month, sometimes I had a sleepless night, but it was not that bad. Then came the tinnitus, a ringing in the head not so much in the ears. I took natural supplements and vitamins.

But then it hit me like a bolt out of the blue. Terrible night sweats started, regularly waking me up at 2am and lasting for 10 minutes until morning . This continued week after week. After 4 weeks I was so anxious that I couldn't even leave the house…and depression came.

I went to my gynecologist and explained to her that I was probably going through menopause. I barely convinced her to check the blood, the results showed very low estrogen, almost no progesterone and FSH 75. I asked her for HRT, but she dismissed me with the explanation that one ovary is still working and that I still have regular periods.

I was very hurt and disappointed. After a week my condition got so bad that I couldn't get out of bed.I went back and was prescribed HRT, lanzetto spray 2 pumps and utrogestan 200mg for 14 days.

Unfortunately, after 1 month of this therapy, my condition did not improve, got even worse although estrogen and progesterone levels rose to normal. I had really bad side effects.

I found that after the lanzetto spray I was very anxious all day, could not function at all and the utrogestan made me depressed. I tried it orally and vaginally and there was no difference: vertigo, nausea and depression. I helped myself with the experiences from this forum.

Then I tried trisequence pills, which made me completely suicidal….I was really thinking about suicide, so I stopped HRT completely and went to GP and asked for an antidepressant, because I wasn't sleeping at all. Was prescribed mirtazapine 15mg at the beginning, then 30mg after 2 weeks.

After 4 weeks relief finally came. I no longer had night sweats, I slept through the night. Then after 4 weeks in mood swings started to appear in relation to the menstrual cycle. I was ok for 2 weeks, and for 2 weeks I was completely down: depressed and anxious.
 
I am currently taking 30mg mirtazapine for 11 weeks and my sleep is normal and I have no night sweats. But the moment I wake up in the morning, I am immediately taken over by anxiety that lasts the whole day.  This has been happening for the 9 days now and I'm desperate, feeling so low and very sad!

I'm afraid of HRT because unfortunately I had a bad experience and I honestly won't be able to try a new HRT because it takes 3 months to see the effects and I won't be able to handle all the side effects. In addition, I recently paid for a blood test at a private clinic and my estrogen and progesterone levels are normal now. Testosterone is in normal range too.

So I'm afraid the fluctuation of my hormones and HRT together will cause me even more problems.

My intention was to cross the bridge to menopause with the help of AD and then try HRT when the hormonal chaos calms down at least a little.

So within 3 months my life was completely destroyed. I'm not able to work and I can't do sports either, which I loved very much.

I don't know what to do, should I increase the dose of the antidepressant or switch to another one? Should I wait a little longer? I can't handle these side effects either, because I'm tired of everything. I have an appointment with my GP next week.

Please give me some advice or reassurance that things will get better one day. I am desperate.

Thank you

[Sb1974]

Dear Emma,

I am so sorry this has happened to you. I can feel the desperation in your tone as I read the email. First of all in my experience things can deff get better. I have had a slightly different experience to you as I have suffered with anxiety all my life and this increased with perimenopause - however I had never had depression before in my life but fell into a deep suicidal depression with perimenopause. I am 49 as well, work full time, single mum to two teenage boys. This all lasted about a year for me before I  recently managed to put in place support/medications which seem to be helping a lot. I am now on an AD called Venlafaxine which I take in the am and pm at quite a high dose and I am on HRT (gel and pill) I take 4 pumps of gel which again is a high dose. I have only recently upped my gel and it helped the depression tremendously. I am sorry I have never taken mirtazapine so I cannot advise - but I do know that you need to give AD's a number of weeks to work. With regards to the anxiety I have found that using mindfulness has helped significantly - letting the worries pass by instead of engaging with them - have a look at the work of Dr Claire Weekes she is a godsend. Also CBT therapy works really well for anxiety - I am having a refresher course through the NHS for free through https://www.iesohealth.com/ so have a look and see if it is available in your area. Please know that there is help - keep looking on this website and the free menopause app called Balance is also really good for help, advice and information. I am here on-line if you want to chat I know how lonely it can be --- good luck Sam.

[Emmia49]

Dear Sam!

Thank you very much for your reply. This means a lot to me because I feel completely alone.

I know I have to wait a little longer for the anti-depressant to start working, but when you've been sick for so long it sometimes seems like I'll never be okay.

I miss my life, I feel completely detached from my family, I feel completely helpless and empty.

Sometimes I feel like I don't exist anymore, that only my body is somehow working.

I sought the help of a psychotherapist and when I explained to her how I felt she was immediately ready to help and that also means a lot to me, but it doesn't help me out of the dark hole.

I am somehow convinced, this is what my intuition tells me, that my body is very, very sensitive to the fluctuation of hormones and that the constant ups and downs are actually causing me distress.

So I'm afraid to try HRT again. But I haven't given up on HRT yet, I just want to stabilize so that I can come to my senses and then find the right HRT.

I admire single moms like you, because I have no idea how responsible and difficult it is to raise teenagers alone and have a busy job.

I'm glad that you found something that helps you and that you can live a normal life.

I'll let you know how I'm doing and thank you again for your thoughts and suggestions

I wish you all the best

Emma

[Sb1974]

Dear Emma,

You are so welcome - we have to stick together and support each other! Great news you are seeing a psychotherapist I am sure she will really help you - and it will be good to have somebody to talk to. Remember your family love you. I too felt helpless and empty but there is hope and getting better will just be around the corner. Perhaps it would be a good idea to go private re HRT if you can afford it so you speak to somebody more specialized and they can help you find the right HRT. Yes life of single working mum is bonkers but also rewarding. Do keep us updated on your progress. Sam

[bombsh3ll]

In this phase shutting down your own cycle with a birth control pill taken continuously which adds back a stable daily dose of estrogen and progestin is frequently a better option than HRT if you are still having a menstrual cycle.

This keeps you bleed free AND hormonally stable, which can be a real help for those with hormone related mood issues.

Any psychiatric medication or therapy can be used in addition as required.

[Emmia49]

Dear ladies, thank you very very much for your response!!!

Thanks for your thoughts and suggestions. I will definitely look into options for birth control pills or HRT as soon as I stabilize a bit.

I'm completely crippled with anxiety right now and can hardly think straight!

I will let you know how I am...

Thanks again! 

[CLKD]

Hi what aspect are you trying to 'stabilize'?

U R taking a good AD .  You appear to suggest that your symptoms are clinical which figures as ovaries can still continue to pump out hormones.  Your Gynae is like many others, with little or no knowledge about peri/menopause 

What bothers you about replacement therapy?  There R many different ways of delivering HRT so perhaps get a referral to a dedicated menopause clinic - there are waiting lists both in the NHS and private sectors.  Make sure that the practitioner has menopause knowledge, due to waiting lists many medics/nurses are 'doing a course' on menopause which doesn't seem 2 b imparting much knowledge!

It mayB that you require a low dose of replacement initially to ease your body into up taking the hormone.  So many regimes seem to start at what might be too high a dose!

Anxiety can be eased by the medication that you are taking as well as 'valium', my GP prescribed betablockas to ease those early morning surges.  I've taken an AD since 1988 with success.  I also have an emergency go to pill when anxiety floors me.

Some find that keeping a mood/food/symptom diary of use.

[CrispyChick]

Hey

I cant read and not post. I am also in peri hell. But I've been here 7 years. And looking at drastic action.

I think you hit the nail on the head when you mention fluctuations. I too cannot tolerate any hrt. Estrogen makes me worse. Because my own is not yet low. But I am severely debilitated by my symptoms. And have recently stopped work.

Bombshell makes a good point about contraceptive pills. Unfortunately they do not work for me. I'm just too sensitive to all hormones now.

For what it's worth, as you are saying the anxiety is the worst, and you have happily managed to get on an AD, I'd up the dose of that first. See if you can rid yourself of the anxiety first.

Good luck xxx

[CLKD]

It may also be 'too soon' for a body to need HRT despite symptoms. 

Whilst NICE push for HRT 'first' in peri-menopause treatments, getting anxiety under control may allow women to make informed decisions.

[CB73]

Hi Emma, I just wanted to reach out and say that you are not alone with this struggle. Please know that it will pass and you will not always feel like this.
I have suffered with anxiety all of my life and I know how distressing it is when you're unable to think rationally or see things clearly. I'm not in a good place either at the moment due to my crazy hormones! I'm 51 and take the antidepressant escitalopram which does help with my anxiety most of the time, but I've had to increase my dose recently as the anxiety has really taken hold of me. I'm also trying to use some CBT techniques that I found online to help me cope and ride the waves at the moment.
It's great that you're seeing a psychotherapist, hopefully after a few sessions you'll start to feel some benefit. I also think it's worth speaking to your GP about increasing your dose of mirtazapine and possibly some other anti-anxiety medication temporarily, just to give you some relief from the mental exhaustion.
I haven't stepped into the minefield of HRT yet, so I can't offer any advice there, but you're definitely in the right place! This forum has been a life saver for me over the last few weeks, just knowing that I'm not alone. xx

[Kathleen]

Hello Emmia49 and welcome to the forum.

As you can see, you are not alone in your struggles. The menopause can be a hell of a rollercoaster ride for some of us. In fact my trusty meno book describes it as such!

I was three years after my last period when I began HRT and sometimes I wish I had stuck it out. It was awful anxiety that sent me to my GP. I was prescribed an AD along with HRT and I also wish that I had tried those treatments separately.

It may be that a higher dose of your AD is all you need on this journey, if so that may simplify things for you in the future.

Having said that, the nurse at my GP surgery is confident that all I need is a higher dose of Oestrogen to feel back to normal. I presume that she is speaking from experience as she has been running the menopause clinic for five years and has helped many women through a turbulent time.

There is plenty of help out there and lots of information and support here on MM and I hope you find that reassuring.

Wishing you well and take care.

K.