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[coldethyl]

Hi, my name is Deborah and I'm nearly 50 and currently going through the menopausal transition. I've suffered from anxiety most of my adult life but since hitting the transition it has become unbearable, especially in the last three months. I've developed palpitations, ( for which I take a low dose BB) and terrifying health anxiety that has me running in panic to the a and e so many times the staff almost know me by name! Have had numerous ECGs which are fine and today's one was pronounced " boring which is what we like." My problem today turned out to be serotonin syndrome as I'd started on sertraline two days ago at my GPs advice- seems I can't tolerate it anymore and am now reluctant to try any other SSRIs. I'm not sure where to go from here as the symptoms are getting worse- night sweats , horrible adrenaline surges that start in my core or chest and whoosh through my body leaving me anxious and sweating (these seem to be part of the daytime hot flushes) on top of periods that last for weeks, bleed through my clothes or disappear for months. My surgery seems to have an embargo on HRT as I've spoken to three GPs about my issues and basically had ADs or nothing offered. I'm based in Cumbria but could travel to a menopause clinic if anyone had any recommendations in the North. My aunt had a hormone dependent breast tumour so I'd really like to explore my options with someone more qualified than my GP who told me to try a thinner nightie.

[CLKD]

   'wear a thinner nightie' - you hold him, I'll wrap it round his neck 

Recent NICE guidelines are going to have to make GPs change their views on supportive menopausal women.  They c an no longer hide behind the fact that there may be associated breast cancer risks nor can they hide behind not referring ladies to the appropriate Clinics.

You sound 'within normal limits' to me  - unpleasant symptoms that need treatment.  Are you able to change your GP Surgery?  Some people do react to Sertraline but 2 days isn't long enough to give your brain time to adjust.  I have taken ADs for years - once I found a tablet which helps; it's not a cure; I have a life again. 

But if you are suffering hormonal fluctuations then HRT should be discussed.  Do you have a Practice Nurse who may be more sympathetic?  Is there a Pharmacist close by who could tell you which Surgeries support HRT etc.?

I had an oestrogen activated breast tumour removed in 199? but would insist on treatment should I suffer symptoms: quality of LIfe is important, that bus might catch me behind the knees before treatment killed me ;-)

[coldethyl]

That made me laugh. He is otherwise a good GP so am going back next week to have a chat about where I go from here.
Personally I've never found ADs helped me much so wasn't in a great hurry to try the sertraline and even less so now to try any others. Although I've suffered from anxiety before , I can't seem to make my doctors understand that this feels different and my techniques don't help. I've had constant high levels of anxiety before after working myself up but these days, it's more like a switch suddenly goes on and boom , that's it for the day.
My mum finished her periods at 50 so I'm hoping I'll not be too far behind that. Are there any good blood tests that would show me how far along in all of this that I am?

[Ju Ju]

Having an aunt, who had breast cancer, is not a bar to taking HRT, as long as you do not have 2 or more close relatives who have had breast cancer. Mothers and sisters are close relatives. In fact my sister died from oestrogen sensitive breast cancer, but as I have no other close relatives who have had breast cancer, she is considered 'a blip' in my family history, in the words of a breast cancer consultant. Obviously, I was worried and avoided HRT for many years, but quality of life outweighed the risks to me.

[Kathleen]

Hello coldethyl and welcome to the forum.


Your problems seem totally hormonal to me and I agree that the type of anxiety that comes with the menopause is very different to 'normal anxiety' in fact  in my experience it is unique.

Perhaps when you see your GP again emphasise the diagnosis of serotonin syndrome and ask for a referral to an expert so that you can try HRT.

Many doctors seem to be out of their depth when dealing with the menopause  so getting the correct treatment may require persistence ( if your GP still doesn't see the light you can always threatened physical violence as suggested by CLKD, using a suitably thin nightie of course!)

You are not alone in your suffering and we are here for comfort and advice.

Take care and wishing you well.

K.

[coldethyl]

Thank you ladies. Today was so bad when I woke up with heart racing that I took myself off to our Primary care assessment unit again. Ended up seeing the mental health crisis team as I was so upset by it all. The nurse said I really obviously needed something for the hormonal issues so I'm going to have to think seriously about going private if I get no joy at GP.

[GypsyRoseLee]

I completely agree with you that this hormonal anxiety feels very different to conventional anxiety. I've felt anxious many times before, taking exams, interviews, driving test etc. But this hormonal anxiety has a really nasty tang to it, unlike anything else. It's more akin to full blown dread really.

The only other time I have felt anxiety like this is back when I had PND. So to me, this proves that there is definitely something different with hormonal anxiety.

[coldethyl]

It is very similar to the anxiety I had when I had postnatal OCD which has a hormonal component too. It's the fact that it just swoops in from nowhere that floors me- I've suffered from panic attacks for years buy with help was able to spot one coming and do things to avert it. This is different in that it just just me in one blow and I can't do anything or so it feels. Seeing my GP again this week but really there's only HRT left to try and he isn't keen.

[Taz2]

Do you know why your GP isn't keen?

Taz x

[coldethyl]

I'm not sure .. I've spoken to three GPs at my surgery about my menopausal issues and they just seem to want to focus on the anxiety side of it , which is the worst symptom I have but I'm not convinced that ADs will help if it is hormonal. There was one lovely lady GP who offered me HRT a few months back but I wasn't as bad as I am now so I said I'd wait and now she has left. I know there are risks with taking it and I may not be a suitable candidate as I have endometriosis , migraine and stress induced BP issues but I would like to be able to have a more useful discussion about it than I have hitherto had. I just feel that it is far easier for them to chalk everything down to my anxiety than work with me to find a solution. At the minute my anxiety is sky high and I've been back and forward to out of hours and the GP and A and E for the last month and everyone says it's perimenopausal anxiety but no one seems to want to tackle the hormonal side of if.

[Taz2]

It is difficult when you are met with such a set point of view. You will see from the information on this site contained in the drop down menu at the top of the page that at your age the benefits outweigh the risks http://www.menopausematters.co.uk/balance.php

 I must admit that HRT has done nothing for my anxiety - sorry but that's the truth - but by controlling the hot sweats I at least got a good nights sleep and felt better in myself so that then goes some way to improving the anxiety levels. Anti depressants are often offered now if your main symptom is hot flushes - a low dose is effective in a lot of women - or blood pressure pills. I have two friends who are on Dixarit and they have no flushes whatever now. Endometriosis can be a problem with HRT as it can cause it to grow much as with fibroids. Have you asked to be referred to a menopause clinic? There is a link at the very top of the page "specialists" where you can put in your postcode to see if you have one near you.

Taz x

[coldethyl]

Thanks for replying. It is appreciated. I'm not sure I even want HRT just a more adult conversation about my issues than I've currently had - some of that is my fault for being so anxious and tearful that I guess ADs seemed the answer. All they did was give me serotonin syndrome , raise my BP which is now higher than it was because I'm freaked out and have developed white coat syndrome even with my home monitor!! I've bitten bullet yesterday and emailed a private psychologist as when I was at the a and e yesterday because I was agitated they had me speak to mental health team and they suggested that very in depth Cbt would be a good place to start and that they'd recommend seeing a psychologist only the waiting list was over a year!! I think if I could get a grip on the health anxiety that all these hormonal surges have set in motion, I'd be better placed to see what I'm left with and what I can and can't cope with. I take beta blockers which do help a bit and yesterday took one of my diazepam which relaxed me and made me feel almost human for a few hours again so I'm hoping my GP will let me have some for when it all gets too overwhelming. I know they are addictive if used regularly but I've had 28 since may 2014 and have two left of that prescription. I do think your suggestion of a referral to a menopause clinic is a good one even if I ultimately decided HRT wasn't for me as I'd get chance to discuss my symptoms in more depth than in a rushed GP surgery.

[Hurdity]

Hi coldethyl

 

I didn't realise you had started a thread here as well so I answered your other one about flushes and asked some questions which I see have been answered here!

Current NICE Guidelines are not to prescribe ADs for menopausal symtpoms of which hot flushes and sweats are the prime ones - but as Taz says many doctors prescribe them but they should not do so now, if you are not contra-indicated for HRT as I said on the other thread.

Here they are:
 
Contraindications for HRT.

    Pregnancy
    Undiagnosed abnormal vaginal bleeding
    Active or recent blood clot or myocardial infarction (heart attack)
    Suspected or active breast or endometrial (womb) cancer
    Active liver disease with abnormal liver function tests
    Porphyria cutanea tarda

http://www.menopausematters.co.uk/contraindications.php

You probably needn't have been given beta-blockers either if there is nothing wrong with your heart - because palpitations are also a classic symptoms of menopause/oestrogen deficiency and HRT would have helped here too.

There are many ways to help reduce your blood pressure and this should be one thing to focus on - reducing salt is the easiest, increasing exercise, and if necessary reducing weight to a healthy BMI etc - all detailed here:
http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974

How frequent are your periods? This might give you an indication of where you are in menopause but of course we are all different in the pattern of periods as we head for menopause!

If you have endometriosis you would need to take a progestogen all the time as part of HRT which does make it more difficult - there is some information here:

Endometriosis   
    There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.

http://www.menopausematters.co.uk/atoz.php#GlossE

As Taz says - a menopause clinic is the way to go if your docs insist on giving you medication without considering whether a hormone solution is possible in your case.

Hurdity x

[coldethyl]

Many thanks for replying, Hurdity.
My BP is usually fine apart from when I'm panicking which has been a lot these last few days -it shot up to 181/94 because of the serotonin syndrome reaction but is at 140/80 now- still higher than my usual 124/68 but I figure I'm stressed out about it all so much that it is having an effect. I'm a tyoe 2 diabetic so watch my weight and diet anyway ( lost five stone last year!) but my blood sugars are up because I can't eat with the stress at the minute.
Period wise I always has very irregular cycles and needed fertility treatment to conceive but I used to run at 35-42 days until about 2 yrs ago when they dropped to a more regular 28 days. My male GP thought this was a good thing!! At 48 who needs a monthly bleed! In August I had a period so heavy I has to run through Manchester to the nearest Tesco Exoress and buy pads and wear two at at time as I was bleeding through my clothes. Next one was fine, then I has one that was so light it was hardly worth it but it dragged on for 4 weeks. Then I went ten weeks without one and have had a very heavy short bleed with lots of clots( sorry if this is Tmi) - so really I don't know where I am with it all other than fed up.
Am looking at a private consultation in Leeds if I can't persuade my GP to send me a clinic.