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[Riley04]

Hi I've not been on here for a while as I've had a terrible time. I started hrt kliofem which made me feel terrible, after 11 days I stopped - I did discuss with the dr. After this I started feeling edgy which has gradually progressed to anxiety.
I've been having continual panic attacks and dr has put me on citalopram which I'm getting horrible side effects from. I know I've got to give it a few weeks to settle in my system but I'm fed up of feeling so nervous all the time.
We think I had a reaction to the hrt either taking it or stopping suddenly and triggered the start of the anxiety.
Has anyone any advice?
Xx

[Hurdity]

Hi Riley04

What a pity the doctor was so quick to prescribe you anti-depressants after the failure of one type of HRT! What were you initially prescribed it (HRT) for - ie are you peri-menopausal as in variable cycles, coupled with other menopausal symptoms eg flushes and sweats or worsening pms? The recent NICE Guidelines say that ADs should not be prescribed in the first instance for menopausal symptoms but HRT considered instead. Only after settling on the right HRT and if psychological symptoms persists and can't be controlled through mental strategeis - should ADs be considered perhaps as well as HRT.

There are many different types of HRT and there is surely one that you can tolerate and which would make you feel better overall?

Kliofem is a high dose continuous combined HRT for post-menopausal women - which means not only were you put on a high dose of oestrogen to start with, but you were also taking progestogen all the time - and this particular one - norethisterone - can cause persistent side effects in some women.

Depending how old you are I would start again with HRT - and perhaps think of having a sequential one which gives a withdrawal bleed. I would start with a lower dose and gradually progress to a higher one depending on your age and symptoms. Femoston is a much better tolerated HRT tablet so I would opt for this one - either 1/10 which gives a monthly bleed - or the continuous combined one (1/5).

Hope this helps

Hurdity x

[Riley04]

Thanks for your reply hurdity.
I just need the constant panic to go away. I can't eat and feel sick but I know that's side effects of the citalopram.
I m wondering if anyone else on mm has been on citalopram and can put my mind at rest that the panic and side effects will get better?
Once I've got this under control I will look at the hrt aspect. I'm 43 and post meno, not had any bleed for over 18 months but was diagnosed peri at 36.
Xxx

[Bettyboo]

Hi Riley

I've been taking escitalopram which is the sister drug to citalopram for a few months now. I have/had severe health anxiety and depression. I had a bad time getting through the first couple of weeks but by two months it had settled down and now I feel a lot better most of the time. Yes, I felt even more anxious to begin with and sick/ headaches/bad stomach but that did pass. I have used other strategies as well at the same time - meditation and more recently yoga, which have all had an effect.

good luck

BB

[Mary G]

Riley04, I'm really sorry to hear about the difficult time you have been having, it must have been quite frightening for you to have all those dreadful side effects.

I am worried because I don't think you are getting anything like the right level of treatment from your doctor.  Why did they prescribe Kliovance?  Anyone with any medical knowledge knows that norethisterone is notorious for causing debilitating side effects in sensitive women which can be long lasting.  If it's any consolation, I had a horrendous experience with norethisterone and had 5 attacks of silent migraine (scintillating scotoma) in one day.  If that wasn't bad enough, the wretched stuff stayed in my system for ages afterwards, so much so, when I started the progesterone cycle the following month and was forced to cop out after just 1 x 2.5mg tablet (migraine kicked in within hours) I still had a completely normal period, with a normal flow and a normal scan result - the experience was so bad, I had to be checked out afterwards.  It was truly dreadful and I would rather have a full hysterectomy now, this very afternoon, than ever face that again.  I realise this might be described as an extreme case but nevertheless, it is an example of what this stuff can do - bear in mind I don't have form when it comes to PMS or gynaecological problems and I had not suffered from migraines pre-menopause. 

Back to you.  So what we have here is a classic case of your being prescribed the wrong type of HRT, having a bad experience and subsequently giving up on it and being fobbed off with ADs. 

I am struggling to understand where your doctor is coming from on this and how he/she can justify a woman of your age being deprived of oestrogen for years on end - were you ever actively encouraged to take HRT?  You may well need ADs as well as HRT (many members do well on both) but you need to try HRT on its own first and then, if necessary, take both. 

My advice is don't wait around for too long.  If you were a staightforward case I would be inclined to suggest you stick it out and keep persevering with your GP but under the extreme circumstances, I think you need to see a well qualified hormone specialist like Professor John Studd, Dr Nick Panay or Dr. Michael Savvas if you can afford it.  Because you are so young, I feel it is important for you to be properly checked out (a bone scan perhaps?) and given the right treatment as soon as possible.

I hope that has helped.

[Riley04]

Thanks for your comments, I agree as far as hrt goes I've not been given the most appropriate treatment. At the moment though I've got to get through this anxiety. I feel the adrenaline rushing through me constantly. Mornings are the worse as soon as I open my eyes the panic starts and I feel so sick.
I'm reading self help books, meditation apps and breathing techniques but it's just not letting up.
I've been on the citalopram for 13 days now and I know the side effects are sickness nausea and diareah which I've all of. I just hope the side effects start to wear off soon, most sites say a couple of weeks!
I can't eat and I've lost a stone in 2 weeks, but I'm now managing to have protein shakes so at least I'm getting something. This just came on and took hold so quickly

[Tempest]

Hi, Riley. I'm so sorry you're having a horrible time! Yes, I'm experiencing very similar myself at the moment. Suddenly stopping my HRT has done 'something' and I now have symptoms of very high anxiety. I didn't even have this before I started HRT, despite being over a year in surgical menopause with no HRT.

I have a feeling that somehow this has 'shocked' my adrenal glands and the psychiatrist I am seeing thinks the same. He is not prescribing anything, except occasional diazepam as he feels it would be wrong to try to 'mask' what may very well be a physical problem with psychiatric drugs. I respect his opinion on this, I have to say although like you I am DESPERATE to feel some relief.

Sending you biggest Hugs, and hope we can both find the answer to feeling better soon. xxxxx

[Riley04]

Hi tempest I'm sorry you are feeling terrible too. If only we had a magic wand to make it go away! Anxiety is a terrible thing and I'd probably be able to deal with it better if there was some relief at some point in the day.
I'm sure this has all been triggered by the hrt either taking it or stopping suddenly.
The side effects from the citalopram are truly awful but I know I have to get through it.
I suffered extreme anxiety 16 years ago when my little girl was very poorly I've only just realised that at that time I'd stopped the depovera contraceptive jab after 3 years of having it. I'm not saying that this was completely the cause but it does seem a coincidence
Sending big hugs back at you, keep in touch and maybe we can help each other through this
Xxxxx

[Tempest]

Riley, I agree with you! I think there is a link there seeing as you felt like this when stopping the contraceptive too.

This whole hormone business is way, way more complex than even the experts know for sure!

Yes, let's support each other. If you ever want to PM me, please feel free. I'm rooting for you to feel better soon!
I can thoroughly recommend 4,7,8 breathing - if you pop over to YouTube, the amazing Dr. Andrew Weil demonstrates the technique and it really, really DOES work. Trust me, I use it throughout the day myself.

Sending you....    xxxxxx

[Justjules]

Riley, I can vouch for Citalopram to start making you feel better soon. What dose are you on? 20mg is deemed to be the therapeutic dose but most start with a gentle 10mg for at least a month and then up to 20mg. You need to ask the GP for some diazepam just to help you get over the start up affects. They will calm all the horrible feelings till the Citalopram kicks in. GP's will usually do this short term. Good luck. Anxiety sucks.

[Tempest]

Ooh, yes!! What justjules said. Short term diazepam would help you loads just to get over the brow of the hill. GP's are usually fine with this and you won't be on it long enough to form a dependency, so don't worry.

[MIS71MUM]

Strangely all my problems began when I abruptly stopped a medium dose HRT, on the advice of my GP because of irregular bleeding.

Firstly I suffered with brain fog, then crippling/hyperventilating type anxiety/ hyper vigilance and scanning. I took 2 mg of diazepam as and when needed to calm me down.
Due to the anxiety I became afraid of everything, even taking AD's so I eventually settled on my third tablet duloxetine.
I know how it feels and it really is horrible. The AD's will help and diazepam can calm you down to get you through the start up effects.

[Tempest]

Wow!! You too, Mis71Mum? There has to be something in this, doesn't there? I'm sticking with my theory that the abrupt stopping of hormones shocks the adrenals. I wish someone would take note of this in a professional capacity and run some research. If proven, it should be added to the guidelines for all HRT's to not stop therapy abruptly unless a serious adverse effect indicates it.

I know since it happened to me, all hell has broken loose.

[MIS71MUM]

Yes I know - it's overwhelming frightening at times.
But also it's so avoidable - I actually want to swear right now, I'm so mad. I went to my GP because of irregular bleeding, rather than been given a referal to a menopause clinic or an investigation, she sent me for a blood test. Also told me to stop HRT immediately rather than taper off.  If you look at the guidelines on here, from a mid dose, you should taper off.
I'm so angry that women up and down the country are being totally failed by ill informed GP's and some
lives are being ruined in the process. It's not just me, there are loads of us on this website who are being failed day after day. 
Don't get me wrong I don't expect someone in general practice to know all and sundry about HRT, but why not refer them to someone who does or a further investigation.
I'll be honest right now, if I didn't have my support network and this website, I really don't know where I'd be right now.
Sorry got a bit carried away then 😳 Vent over xxx

[Tempest]

I am totally with you on this, Mis71Mum! I didn't get a referral to a Menopause Consultant until my Hubby submitted a complaint to the NHS! My GP tried throwing AD's at me for a year to 'treat' my surgical menopause (we could tell she was pretty clueless about HRT). I lost count of how many times I went to that surgery feeling absolutely awful and being sent home with useless advice and feeling even lower mentally as I was getting nowhere.

The best conversation I had with her was when she suggested that I try eating tofu for my symptoms! I mean, come on!!! Flippin' TOFU? For SURGICAL MENOPAUSE?

I still have a difficult relationship with her now. I think she's a bit sniffy because now she has to deal with the Menopause Consultant and can't just brush me off, but oh! She still likes to try to assert her 'authority' by disregarding the Consultant's advice on things like letting me have a prescription for the vaginal estrogen 'in case it sends you funny'. I tried explaining that it has negligible affect systemically but she really doesn't 'get' it.

And she is also in a snot at the moment because the Psychiatrist I have just started seeing has written to her and told her to stop insisting on sending me over to the CMHT for matters that are obviously hormonal and that are affecting my mood (although he us happy to help with an antidepressant if I need it once my hormonal levels 'have been corrected', as he puts it. He's one of the good guys).

As for when I return to see the Consultant who did my oopherectomy, I said to Hubby at teatime that I'd love to turn up in clinic with a bedsheet banner proclaiming 'Stop The Inhumane Treatment Of Castrated Women' (he's the one who likes to send home oopherectomised ladies with no HRT and tell them 'ohhhh, you'll be fine)!!!

We are RIGHT to be angry!!!!!!!!!!!!!