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[ClaireIII]

Back in June we had a Menopause session at work with Dr Louise Newson and it was a light bulb moment for me. I hadn't realised how I was feeling was down to menopause as I am 43, I though I had some sort of early onset alzheimers. I went to the GP and had 2 blood tests a month apart showing my FSH levels over 70 on both occasions.
She prescribed Elleste Duet Conti as I hadn't had a period since stopping mini pill back in Feb. Although I haven't had any adverse side effect my menopause symptoms (exhaustion, poor sleep, mind fog, emotionally up and down, lack of labido) haven't improved, I was extremely disappointed. So at my 3 month review my GP has prescribed 15mg Mirtazapine to treat the poor sleep, anxiety and low mood.
I am not sure this is the right course of action as I don't feel depressed, although I do still have low mood and episodes of anxiety this drug seems too much for my symptoms which I am sure are menopause related. The anxiety has come on about 6 weeks after starting the HRT, I am now wondering if this might be related to the meds in the HRT???   
I have gone back to the GP again to ask for a different type of HRT, she has now prescribed patches Evorel Conti,  as I wondered if a different delivery method may be better for me to absorb the meds I need to treat the symptoms even though ultimately it is the same meds?

Has anyone else had anxiety come on since starting HRT?
Will the patches work better at treating the menopause symptoms?
Should I look at alternative meds that make up HRT for me?

Any other advice?

I only went on HRT to prevent the long term health conditions but finding the sleeplessness and anxiety tough to deal with at the moment.

[Hurdity]

Hi Clare111

 

Sorry to hear about your ongoing problems and symptoms. Drugs drugs drugs! That's all some doctors seem to do - prescribe medication – in this instance seemingly to combat side effects that could be caused by another! You're quite right to be wary about taking additional meds – after all you have only been taking HRT for 3 months. Sadly this is indicative of the doc not knowing about all the different types of HRT and the effects they can have.

Firstly – re libido – oral HRT can dampen this so transdermal is preferred.

Secondly some women are sensitive to the synthetic progestogens in some HRT types. In your case the one in Elleste is norethisterone which can cause pms type symptoms, irritability, anxiety and headaches in some women.  When you are on continuous combined HRT you are having these all the time which can mean continuous low grade progestogenic side effects like I described (including I think, reduced libido) – this is recognised by the medical profession as a potential problem with this type of HRT. Your doc has changed from oral to transdermal but the same type of progestogen as you have seen. You may see an improvement but not if you don't get on with norethisterone.

As you are still young I would strongly recommend you go for a cyclical HRT where you would have a withdrawal bleed every 4 weeks. The same type of patch is available as Evorel sequi. At least you would then know if you felt OK during the oestrogen only part of the pack (once your bleed was over anyway). The other alternative is to have a patch or gel oestrogen with separate progestogen (Utrogestan or Provera) or even a Mirena coil. If you are post-meno then eventually you may want to try a higher dose of oestrogen – depending on how you feel. if you've got the prescription for Eovrel conti then no need to waste them - you could have the same number of Evorel 50 patches and then do two weeks of one and then two weeks of the other - to try out.(Evorel sequi consists of two weeks of Evorel 50 mcg followed by 2 weeks of Evorel conti per cycle).

You may not actually be post-menopausal yet though as the mini pill artificially stops periods just as the Mirena does – so you might have gone on to have another one anyway. If you are not post-meno and on continuous combined HRT then you could have breakthrough bleeding due to your cycle anyway at some point.

If I were you I would stop the Mirt... ('sleeping tabs) – especially if this has been given as a result of the side effects of the HRT - and concentrate on finding an HRT solution that best suits your needs and give this a good go – if after trialling a few – including cyclical transdermal HRT, and maybe a gentler progestogen – you are still feeling rough then that is the time maybe to look at something else to help.

Hope this helps and in the meantime the very best of luck with all of this and please ask anything else – hopefully we can help

Hurdity x

[ClaireIII]

Thanks for the reply. I am now thinking along the lines that the original HRT was causing the anxiety.

I haven't cash the prescription for the Mirtazapine, I was too anxious to take something else especially something to knock me out!!!

I haven't cashed the prescription for the Evorel Conti yet either. The GP suggested starting at the next end of the other tablets which happens to be Monday. I was going to try the patches from then and see how I got on. If I am still feeling anxious etc I might just stop altogether - this anxiety is actually worse than how I was feeling before.  She also referred me to Menopause clinic so they might have better advice, I am not sure the GP isn't prescribing on a trial and error basis until something seems ok.

[Butterfly22]

Hi, it's a nightmare isn't it, I've been anxious on a few different thing, sometimes it gets better though. From being on this site I've come to the conclusion it's trial and error, some feel great and find the right one quickly and others search loads and have to go with best out the lot.
You are still Young though may be an idea to keep  trying xx

[dazned]

Mirtazapine isn't a sleeping tablet per se, it is used to combat anxiety especially in low dosage Hurdity.  I am on it as my original HRT stopped working for me and I couldn't find any other to suit me either.See how you get on first with the new HRT regime Claire111,you have the mirtazapine prescription should you decide to use it.☺

[CLKD]

15mg Mirtazapine to treat the poor sleep, anxiety and low mood. . If this is what your GP recommends for these symptoms, stick with them.  Also, I would hot foot it to Dr Newson - either by phone or e-mail, explaining how helpful you found her sessions along with what your GP has prescribed thus far. Has your GP referred you to her?

As dazned explains, the above is used successfully to combat anxiety - along with HRT if this is thought necessary.  I have yet to find out any one who has been prescribed an HRT which works to combat anxiety and/or depression ...... might be NICE recommended  but it can take a while for the body to respond.  I have taken ADs since 1988 and apart from 1 type which made me angry; and although they weren't supposed to kick in for 14-20 days, within 3 I had begun to feel better .......

However, you didn't explain that you hadn't used the Mirtazapine as prescribed, what makes you think that you will feel knocked out       ..... if you have anxiety, regardless of the cause, then take the medication? .... without mine I wouldn't be sitting here  .  Once the anxiety is less you can make informed decisions about other products.  It really is Trial and Error which you will see if you browse here: or you can use the patches  from the GP but it might take 3-4 months B4 you notice any relief as it is suggested here that one should at least have that amount of time B4 dismissing them unless side effects are particularly severe. 

Each one of us reacts differently to medication and this includes non-HRT etc..  For example I have no relief from Paracetamol 

[ClaireIII]

I will keep the prescription for Mirazapine for a last resort situation. I am nervous of using it as the anxiety has only come on since using HRT and I think must be related to hormones, I had post natal anxiety when my hormones were all over the place in the past. I have read that it can make you worse before better, as with other ADs, and can knock you out over night and next day. I have toddler twins so can't be knocked out really.

The GP has referred me to the Leeds Menopause clinic which is run by Dr Julie Ayers who is recommended by Dr Newson (I did email her explain situation to her, of course she said come to see her!!). If I don't get any joy at the Leeds clinic then I would see Dr Newson directly - her clinic is a trek from where I am. In the meantime I will start on the patches, although not sure if to cut them in half initially? 

I appreciate I have to give things time to work but so far the 3 months on Elleste hasn't really made much difference to my initial symptoms 

[CLKD]

Tnx for the reply.   Some ladies find that keeping a mood/food/symptom diary useful, a chart to take to your Appt.. 

Twins will keep you busy! 

Let us know how you get on?

[ClaireIII]

I have got myself a notebook to write down all the background and then use a diary of how I am feeling to take with me. I had seen it mentioned on another post so thought I would give it a go. My memory is awful at the moment so I need to be prepared for when the appointment comes through.

[Bluebell]

Hi ClaireIII, I went on HRT because I suffered from palpitations and flushes/nightsweats. I've been post menopausal for four years.  I used Evorel Conti patches for five months. I can honestly say they made me very anxious. I woke in the night feeling totally wired and having to go to the bathroom a few times because my bowels were in the fight or flight mode.
 I just stopped using them last week and I'm still feeling anxious....I'm now trying mindfulness and yoga to overcome it. I didn't have the anxiety before I went on the HRT?
It's been suggested maybe I didn't tolerate the progesterone and to try a diffent type but I'm too cowardly...just hated feeling that anxious.
I know HRT has been a godsend for lots of ladies, my sister has been on it for twenty years and would never come off.🤷🏼‍♀️
I hope you Feel better soon. X

[Hurdity]

As you say Claire111 - it is recommended to take HRT for around 10 years at least in your case, until the natural average age of menopause so it is important to try to get this right - and as I said not have to resort to drugs to combat what could be the side effects of the HRT ( progestogen) and not depression or anxiety per se. As you only started to experience it after starting the HRT then a hormonal  cause - (and specifically that preparation) could be the culprit, and is EXACTLY why doctors should not treat symptoms in isolation.

I have yet to find out any one who has been prescribed an HRT which works to combat anxiety and/or depression ...... might be NICE recommended  but it can take a while for the body to respond. 

Prof Studd does exactly that!

Claire111 - as you mention PND or at least PN anxiety - you might like to read the work of John Studd who has researched reproductive depression and treats this with high doses of oestrogen - much higher than you are taking. It seems that some women need very high doses in order to feel good. Here is the basic website but there are lots of tabs left and right you might like to look at and specifically before your visit to the Leeds Menopause clinic.

http://www.studd.co.uk/reproductivedepression.php

I still think you would benefit from taking your HRT cyclically as I mentioned in my earlier post- continuous progestogens can have a depressive effect on some women, so I would ask for some Evorel 50 mcg if you can - and take them like Evorel sequi as I suggested - by talking to your doc and saying this is what you plan to do?

Anyway good luck with your appointment at the clinic - hope you get an appt soon - and make sure you read as much as you can before you go!

Mirtazapine isn't a sleeping tablet per se, it is used to combat anxiety especially in low dosage Hurdity.  I am on it as my original HRT stopped working for me and I couldn't find any other to suit me either.

Thanks for the info dazned - I admit I did not look it up but just read the name and then the first symptom to be treated - poor sleep! I'm glad it's working for you and I think you are now past the menopause average age of 51/52? Claire111's situation is different and she does need to find an HRT at the right dose to treat symptoms as well as help protect against osteoporosis and other conditions due to her early menopause.

All the best Claire11 and do keep us updated as to how you get on

Hurdity x

[ClaireIII]

Thanks for the links, I will have a good read prior to my appointment.

I am going to come off HRT in the meantime, I feel so shocking. I actually feel worse than I did before starting taking it. Hopefully things will settle back down and I can start again under proper advice and on a regime that is more suitable for me.

Anyone know how long it will take to come out of my system and I will feel how I did before (I won't say back to normal as I don't remember what that was). I have only been on the HRT 3 months so am hoping it won't be too long.

[CLKD]

Not being able to sleep I realised in the early hours that I hadn't explained myself particularly well - no change there then  [long story short, Mother problems  ] - so take a deep breath 

Having talked in recent week to 4 ladies undergoing symptoms: 1 deeply depressed who went recently to her Nurse Practitioner, the other 3 in various stages: who had gone to their GPs in the last 2/3 years with anxiety and depression with a lack of periods ........ each has been prescribed HRT 'because of your age ' - but it wasn't what they wanted sorted  and although I don't know which HRT was suggested as there wasn't time to go into details - they had not noted any relief, in anxiety in particular.  I don't know their age range as they were strangers to me although 2 were together - they had no other symptoms relative to peri ......... which is why it really is Trial and Error.  The lady deeply depressed was advised by 1 of the others to go to the local MIND walk-in as it was obvious that she was in trouble.  Her husband appeared at that moment and after a short chat took her home. 

I think that taking a list of symptoms becomes important so that nowt is missed.  Also making a double appt. is often useful so that there isn't a feeling of being rushed?

[peri]

Just picking up on your thread ClaireIII.   Sorry to hear you are struggling but I think you just haven't been given the right hrt yet and the issue may be the progesterone which is the problem.  As Hurdity points out Elleste has noresthisterone in it which can cause irritability and anxiety and lots of ladies struggle with it - I know I did.  I think as has been pointed out you would do better to try a sequi regime, for e.g., Evorel 50 or perhaps a gel so that you can try oestrogen on its own.  That way you can determine what is causing the problem.  Oestrogen  is the feel good hormone and hopefully you will get the benefits of this and can then address the progesterone part of hrt.  It really is a case of trial and error with hrt, but once you find one which suits you will never look back.

As for CLKD's comment "I have yet to find out any one who has been prescribed an HRT which works to combat anxiety and/or depression ...... might be NICE recommended  but it can take a while for the body to respond", I have repeatedly posted on this forum how it worked for me immediately (within 24 hours).  I think the problem is we don't always hear about the success stories only the failures.  Don't get me wrong I still struggle with the progesterone part of hrt, but I feel well for 28 days out of 30 so for me it's worthwhile.

Don't give up and let us know how you get on with your referral to the menopause clinic x

[ClaireIII]

Peri thank you so much for a positive post - it is really what I needed to read. I had said to my husband that maybe people who have a positive experience are less likely to report it, a bit like trip advisor!

The more I have read up the more I agree the sequi regime will be more suitable for me with a gel progesterone that I can control. I was fine on the mini pill so am sure there will be something out there I can get along with.