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[Sally66]

Hello,
I guess the question above has no straight answer but I hope you can help me with some of your excellent advice.

Brief history:
50 years old.
Been feeling very tired and anxious for the past 4 years (no history prior to this).
Incredibly bad PMS (much worse than when I was younger) and heavy periods.
Diagnosed with anemia in August last year and given iron tablets.
January this year had dreadful panic attack and signed myself of work.
GP thought AD would be preferable to HRT and prescribed Sertraline.
I couldn't tolerate the Sertraline - too agitated to work.
It also seems to have stopped my periods (or has correlated with that natural process)
I'm going to ask to try the HRT.
Have read stuff about progesterone sensitivity and think this might be a problem for me.
Worried the GP will put me on the cheapest drug and I will have to go through months of trial and error.

I'm now getting into serious trouble with my work which demands high levels of concentration and long hours. I've been put into a performance management programme and worried I'm going to lose my job. I'm single and this would be a financial disaster.

So if anyone has any suggestions about a 'gentle' HRT which I could ask about (maybe with some research behind it?) it might save me some time with the GP.

Thank you all so much in advance! 

Sally

[Greyhoundgal]

Hi Sally and welcome to the forum.  Sounds like you're having a pretty rough time of it at the moment, try and talk your GP round to the idea of HRT, I suspect it will suit you better than the AD's.  I was in a very similar place when I first started and I was started on Femoston, this is one of the gentler HRT's and seems to be better tolerated than some of the older types.  I'm just going back on mine having come off it around Christmas time.  Thought I was ok but things had started going back to how they were before I started, had an appointment this morning (I use our practise nurse) and she has given me a prescription to go back on for a while......I know that within a couple of weeks it will start to kick in (well, it did before) so hopefully you can get something similar.

Good luck 

[Sally66]

Hi Greyhoundgal

Thanks for your reply

Yes, having read through various threads, I think I might like to start with Femoston. However, in my health authority they have a guidance sheet for GPs (publicly available online!) which goes something like this:

1st line: Ellste Duet (£9.20)

2nd line: Premak-C (£6.25)

Then  *if* progesterone side effects are present:

Femoston (£16.16)

(I checked out the prices by the way!)

So if I just 'go with the flow' when I go to see the GP, then it's probably going to be 6 months before I'm even put on Femoston (assuming 3 months each on 1st and 2nd line prescriptions).

However, at the rate I'm going at work at present, I'll be sacked and in default well before then!

I think one of the problems I have with GPs is that I tend to put on this 'professional person' persona (not consciously, or willingly, just years of being obliged to behave like that - a kind of  habit I suppose ...).

So perhaps compared to the many other people GPs they see throughout the day, who probably have far more 'life threatening' conditions than menopause (!), I probably seem like I'm coping relatively well with things.

But on the inside I feel like I've been shattered into a million pieces ...

Anyway Greyhoundgal, thanks again for your reply and it's good to hear that Femoston worked for you.

S x

[MicheleMaBelle]

Hi Sally66- welcome.
Firstly, you should not be penalised at work for so called underperformance when you are ill. They should be supporting you but unfortunately a lot of employers do not realise how ill the peri and menopause can make women. The official body for occupational therapists have printed guidelines about menopause in the workplace. Dig about- they are on this site somewhere so print a copy off and make an appointment with your line manager/HR people. If symptoms are severe enough they could actually be considered a disability but there appears to be a lack of knowledge and acceptance from employers regarding this. I don't know if your employer is big/ small but is there someone you can speak to in confidence about this.
I had something similar 6 years or so ago and I accepted it at the time as I was going through a divorce and they thought it was all down to that. In hindsight,I now believe it was the start of my menopause journey. I've had 2 period of absence since then and am currently off yet again as I have made myself worse, been treated with AD's ( Setraline- hallucinations and shaking ) and been banging my head off a brick wall with GP and 3 different HRT preps all containing same sort of progesterone.
Now on 4th attempt with new regime after paying to see consultant privately.

Standard HRT , one size fits all works for some women but not others and some women do have a progesterone intolerance. So it's trial and error I'm afraid and you do need to give them time to work
My consultant has recommended oestrogen gel and utrogestan, taken orally at first, then vaginially if I don't tolerate the tablets.
If this doesn't work he will try Femeston and if that doesn't work he's talking about oestrogen gel and a mirena coil although he wants to leave this last as it's the most invasive. I was put on Elleste Duet to start with too- it does contain progesterone that can have side effects.

He's not sure if I have clinical depression as well but he wants to get the hormones sorted out beforehand and then look at other therapies such as CBT instead of anti depressants. could your employer offer CBT sessions?

You need to look after yourself and maybe you need to consider taking some time off work. Stress does make the symptoms worse so maybe you need to book a long appointment with your doc, print off the HRT guidelines on the site , the NICE guidelines and consider taking some time off work if you can.

Sadly, I don't think your experience with your employer is untypical. I have struggled on and on, making myself worse, my job taking what little energy I had, so that I'm now off work and to be honest, not sure when I'll be able to return.
So, don't let it drag on, make a nuisance of yourself with your GP and look after yourself. Big hugs x

[Sally66]

Hi Michelemabelle

Thanks so much for your reply.

Yes, I think I will try to speak with the HR department. I've been through their policies on line (it's a large organization) and I could possibly get unpaid leave for a month. But that kind of timescale doesn't really address the fundamental problem that I have which may last for a couple of years yet. They're also looking to make over a 100 redundancies in the next year and I just get the feeling they're looking at me as an easy target ...

You're right, I will print off the NICE guidelines and talk again to the GP and see if there's a way we can start with what are known to be the (somewhat) 'gentler' treatments.

I think CBT might help too - my employer might offer this, I'll look into it. My GP suggested I look at an on-line programme called "Mood Gym", this is helpful - I'll keep trying with the worksheets that accompany it. It might be worth paying to see a clincial psychologist privately (in my area the NHS waiting list is well over 6 months!). So I'm in this strange place where I know my decison-making is poor and distorted for some hormonal reason but I still can't actually find the energy and concentration to counter-act it.

I can understand your decision to go and see a consultant privately. GPs in my area seem to be ill-informed or confined by standardized local health authority guidelines.

Hope you too manage to find a treatment regime that works for you!

  x

[dazned]

Hi something to bear in mind and put into a bit of perspective remember that there are thousands of women out there doing very well on those hrt preparations that you have mentioned 
The members on this forum are unfortunately in the minority ,those of us who have found difficulties on finding one to suit them. It really is all about trial and error. I did really well with ellest duet for years for example,so if you do try hrt try to be positive about it ,after all the percentage is in your favour to be ok too. Also some women have to use an AD alongside hrt to tackle the mental issues surrounding menopause as hrt alone sometimes doesn't help. Good luck in finding a solution that suits you.

[Binbon2]

Hi Sally66

I hope that your GP can help get you the HRT that suits you and enables you to stay in your job. I had some CBT and it really did help me to accept things and realise that I can't help how the menopause symptoms have affected my life. Hopefully you can get access to CBT through work.  In my area we are able to self refer for CBT, so that may also be worth looking into. Your GP should also be able to refer you.

I feel for you with regard to the performance management programme. It is hard enough dealing with work during perimenopause without the added pressure of someone constantly checking up on you. I know how you feel as I ended up on an improvement programme. I would never have believed that I would ever end up on such a programme as I have always tried my best to do a good job. Try and take it day by day if you can, and try not to worry about what might happen in the future. Easier said than done, I know.

it doesn't hurt to let that 'professional person' mask slip while seeing the GP. Have you made them aware of how your peri-menopausal symptoms are affecting your working life?

Good luck - let us know how things go with the HRT

[MicheleMaBelle]

agree with all the comments Sally66- the HRT initially prescribed may work a treat for you. My consultant has said that it does work for some, for others tweaks and changes along the way may be needed too. As I said earlier, the Setraline didn't work for me but there are other ADs out there if you feel that you need them so speak to your GP and take a list of your symptoms with you and give them to the doc- don't hold back!

I too work for a big company and again a lot of stuff is online. you may need to dig a bit further to request support but you do need to flag your issues and concerns with your line manager/ HR.
Put it all in writing too and keep copies. I don't know how long you've been working there - I'm assuming not very long .Either that or the employee assistance programme/ benefits aren't very good if you are only entitled to up to 1 month off unpaid. You don't know about any possible redundancy criteria and there is little point in worrying about it at present- it's difficult I know but please try not to worry about it and please take care of yourself and hopefully you'll soon get on the right track. Keep us posted and no worry or concern is too trivial to be shared. X

[Sally66]

@dazned

Thanks, yes, wise words!

Forums are great sources of advice but as you say, they tend to be places where those who have had difficulties post more often. I'm sure there are many women who are doing well on the first line treatments.

Ah well, I'll see what my GP has to say!

S x

[Sally66]

@binbon

Thanks for your message. Yes, I've told my GP about my work problems but she didn't really say much. I suppose they get that everyday ...

I think there's a bit of a vicious circle going on. I find the fact that I've been put into performance management very humiliating and stressful. And so this in turn exacerbates my menopause symptoms! Like you, I've always tried my best at work and would never have imagined this would happen to me.

I'm going to follow up on the CBT too. The online course has helped a lot but I think I need the reinforcement of being in a 'real' therapeutic setting.

S x

[Sally66]

@michelemabelle

You're right, I haven't been there very long and so my support options are somewhat restricted. Though I suppose there may be some room for negotiation, especially if I can get the GP onside.

I think as I mentioned to Binbon, being put into performance management has really upset me and is making me worry even more than if I was just having the usual horrible menopause moods!

Thanks so much for your understanding, and to all the other people who've been in touch. It means a lot. I don't really have another outlet to discuss these issues and all your online support is very much appreciated.

 

S x

[MicheleMaBelle]

sally 66- you can only do your best but the anxiety that this has caused can't make things any easier. Remember, you are not well.You are not " underperforming " I do think that CBT would help you manage the stress of what you're going through so push for support either through your employer or GP. I hope it all works out for you.Keep your chin up 

[GypsyRoseLee]

I think you can react differently to the same AD, at different times. The last time I tried sertraline it had me climbing the walls. But this time I had virtually no side effects at all, except for tiredness. Infact I credit sertraline with helping me turn the corner, it has been wonderful. I took trazadone for 5 months and I just got worse and worse on that.

[Hurdity]

Hi Sally66

The AD won't have stopped your periods - this is a coincidence and as you are going through the peri-menopausal transition then this is to be expected.

No you should not be given ADs for menopausal symptoms at your age - they are not supposed to be prescribed as first line of treatment for hormonal problems and especially if no history of depression.

B****r the guidance sheet on HRT!!!! They are just that - guidance for the GP who might not know what to do - but not to follow slavishly if someone asks for something else.

If you want to try Femoston then please go to your doc, put on your professional persona and ask for it! The doc should not refuse if you have a convincing reason. You are entitled to choose the appropriate licensed medication. So - compared to Elleste it's the same oestrogen (as Femoston), but Elleste has a synthetic and androgenic progestogen in it called norethisterone. However the progestogen in Femoston is called dydrogesterone and is very close to our own natural progesterone that our body makes and is the least androgenic of the synthetic progestogens. This info is available here: https://menopausematters.co.uk/perimeno.php . As for Prempak - I wouldn't touch it with a barge pole. It is a mix of horse oestrogens (not pure estradiol as the other two are) made from mare's urine and a synthetic progestogen. I know it works for some women who are quite happy on it - but if you are thinking about what to try - then no doc should make you have this one for obvious reasons and if you would prefer to try another one!

Docs are too free dishing out ADs to keep women quiet so  many women are "hooked on happy pills" rather than taking the right hormone treatment and adopting other strategies to cope with hormonal anxiety where HRT doesn't quite cut it completely. Sounds like you have the right mind-set and are doing the right thing with CBT - if this works for you.

Good luck and let us know how you get on.

Hurdity x

[Sally66]

@Michelemabelle Thanks for your supportive message. Yes, I think structured CBT would help - I'll try and get sorted out one way or another!

@GypsyRoseLee It's good to know you had a positive experience with Sertraline the 2nd time round. I've also read that some doctors prescribe a short course of diazepam with it for those who are having difficulties getting used to it. I won't completely dismiss it just yet but will give the HRT a go next ...

@Hurdity Great advice. Thank you! See my next post to see where I am now ...

S x