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[sarahy]

My menopausal specialist doctor is advising me to go on antidepressants for menopausal anxiety. The anxiety is very bad and I know it’s menopausal because when I first went on HRT some years ago it was just the same and the HRT helped very quickly – also I have a lot of other menopause symptoms. Now I need some rebalancing and upping of my hormone levels ( blood test showed low results)I have a very slight vaginal bleed that I shouldn’t be having, but investigations have found no cause. So the doctor doesn’t want to up my hormones until the cause is discovered.

Everything I have read says antidepressants are not the answer they at best mask symptoms ( often don’t even do that) and don’t address the underlying cause. So I’m in complete limbo – I feel I desperately need the hormones but can’t have them and the doctor does not think this will help the anxiety anyway which again goes against everything I’ve heard and read.

I’ve only had a few and far between telephone conversations with her, she doesn’t know me – there is no relationship. But because she is a menopause specialist this has all worried me much more than if she was a doctor without the specialism.

Then I would just believe all I’ve read and heard over the last years.

I also don’t know where to turn from here, and severe brain fog is making everything, even simple understanding so much more difficult.

Has anyone found anywhere that has helped with anything similar to this? I’m considering menopause clinics – if I can possibly afford it! Thank you for reading and any insights!
Sarah x

[Flossieteacake]

Hello Sarah. I really am sorry to hear you are struggling with anxiety. Antidepressants are great for depression but anxiety medication is best for anxiety. I do not think there is any harm to try anxiety medication because sometimes this along with HRT is helpful. I personally take an antidepressant and this really helps me.

You said HRT helped with the anxiety but the anxiety came back. Was there an option to increase the HRT or is the Dr waiting until the bleed is investigated?  I am confused as to if you are on HRT right now or you stopped it. If you stopped it then is it possible to go back on it because that would certainty help with the anxiety.

As to a menopause clinic, you are entitled to go to an NHS menopause clinic and you can ask your GP to refer you to one.

[sheila99]

I agree with you, I had menopausal anxiety and they wanted to prescribe ads not hrt. Where are you in terms of meno/peri? If they have done the investigations and found nothing are they ever going to find a cause? What hrt are you on? I've increased twice because of returning anxiety, it's a symptom I get every time my levels are too low. If bleeding is a problem it's possible to increase progesterone or have a mirena though it sounds as though this was a one off rather than problem bleeding. You can get email advice from Dr Currie who runs this site for £30 if your gp will prescribe based on her recommendations.

[Mary G]

sarahy, do you know what your oestrogen levels are?   The level to aim for post menopause is about 300 pmol.

It sounds like your own oestrogen levels have dropped further and you need to increase your HRT dose.  You may also need to add in ADs or anxiety medication but I would start with increasing HRT.

Unfortunately serotonin levels decrease when oestrogen levels are low and this causes depression and migraines in some women.

[sarahy]

Hello Mary G,
My oestrogen level is 100 pmol.
Many thanks for replying, yes I remember reading about the serotonin and oestrogen link, another reason HRT must sometimes help anxiety/ depression!
Yes I very much want to be able to increase the HRT.
Sarah X

[sarahy]

Hello Sheila99,
I hope this is the right way to reply! Thankyou for replying and making me feel like I’m not going completely mad!
I’m post menopausal, still on HRT but it’s effects and my levels have I think plummeted along with my anxiety over the years. I completely agree,also the bleeding could be from a fibroid or vaginal atrophy , they want to look again, it is most days but not a lot. Im on Everol Conti patches. My oestrogen was 100pmol, I have upped the patches 50% for 3 months but anxiety is just getting worse.
Thankyou for advice about Dr. Currie. I am wanting to leave my doctor, but I think it might be quite difficult to find another! 🤯 Thankyou again, Sarah x

[sarahy]

Hello Flossieteacake, many thanks for your reply.
I am still on it and yes the bleeding has halted any further increase in hormones. I did ask about a referral but she said it was not necessary, probably because she’s a menopause specialist. My patches have been increased 50% for 3 months, but my anxiety is getting worse. The doctor actually said when I see the next blood results ( not yet  done) the increase in oestrogen would show me that HRT doesn’t help anxiety. I felt IF that was the case it could be poor absorption or wrong HRT not necessarily her conclusion. I am very confused! 🤯
Thankyou again, Sarah x

[Flossieteacake]

Hello Flossieteacake, many thanks for your reply.
I am still on it and yes the bleeding has halted any further increase in hormones. I did ask about a referral but she said it was not necessary, probably because she’s a menopause specialist. My patches have been increased 50% for 3 months, but my anxiety is getting worse. The doctor actually said when I see the next blood results ( not yet  done) the increase in oestrogen would show me that HRT doesn’t help anxiety. I felt IF that was the case it could be poor absorption or wrong HRT not necessarily her conclusion. I am very confused! 🤯
Thankyou again, Sarah x

I am sorry to hear this Sarah. It sounds to me like you would benefit from being sent to a menopause clinic but I know the Dr will not agree as she will think her advice is just as good. No wonder you are confused. I would be too.

Many members on here have reported HRT has helped their anxiety so I cannot help feel this Dr is not as knowledgeable as she thinks.

[sarahy]

The trouble is you still feel a doctor must ‘know best’ and especially a menopause specialist. It really knocked me badly because it’s been so long just trying to up hormones and hanging on to the hope that it would help as it did so well before. Thankyou it’s so good to hear it has actually helped so many people here .X

[Flossieteacake]

The trouble is you still feel a doctor must ‘know best’ and especially a menopause specialist. It really knocked me badly because it’s been so long just trying to up hormones and hanging on to the hope that it would help as it did so well before. Thankyou it’s so good to hear it has actually helped so many people here .X

I feel there are some Drs that are better at their job then others. I understand how difficult it is as your Dr is a specialist. Is it possible to talk to another Dr just to get a second opinion? You are always entitled to a second opinion.

[sarahy]

The trouble is you still feel a doctor must ‘know best’ and especially a menopause specialist. It really knocked me badly because it’s been so long just trying to up hormones and hanging on to the hope that it would help as it did so well before. Thankyou it’s so good to hear it has actually helped so many people here .X

I feel there are some Drs that are better at their job then others. I understand how difficult it is as your Dr is a specialist. Is it possible to talk to another Dr just to get a second opinion? You are always entitled to a second opinion.

I will try to move doctors, as she’s the only menopause specialist there. She’s done a few other things that were not great at all, but I always tend to think it could be my memory or state of mind, but there’s been enough for me to think she’s not great. The receptionist tried to remove me quite unpleasantly from the practice today( catchment area) I felt nothing but relief! Only to be told they’d made a mistake, I could stay! 😞

[Flossieteacake]

The trouble is you still feel a doctor must ‘know best’ and especially a menopause specialist. It really knocked me badly because it’s been so long just trying to up hormones and hanging on to the hope that it would help as it did so well before. Thankyou it’s so good to hear it has actually helped so many people here .X

I feel there are some Drs that are better at their job then others. I understand how difficult it is as your Dr is a specialist. Is it possible to talk to another Dr just to get a second opinion? You are always entitled to a second opinion.

I will try to move doctors, as she’s the only menopause specialist there. She’s done a few other things that were not great at all, but I always tend to think it could be my memory or state of mind, but there’s been enough for me to think she’s not great. The receptionist tried to remove me quite unpleasantly from the practice today( catchment area) I felt nothing but relief! Only to be told they’d made a mistake, I could stay! 😞

At my GP practice they do not have anybody knowledgeable about menopause so they referred  me to a menopause clinic.

The receptionist sounds so rude!

[Hurdity]

Hi sarahy

Sorry to near about your anxiety - but I agree I would resist all attempts to try to put you on anti-depressants when it is likely, as you realise, your problems are hormonal.

The things is - firstly although oestrogen blood tests are not normally carried out - because they are inaccurate and docs should go by symptoms, in your case because you have both symptoms ( anxiety) AND lowish oestrogen levels - then adjusting the HRT would seem to me the first option.

In terms of actual levels - mine have never been 300 pmol/l since taking HRT - though I'm not sure what they are now! Mostly around 200 when they've been measured ( and less than this at patch change time - have since increased dose) - so it is what you feel - and I have always felt well on HRT with min 50 mcg patch.

So you have already been given an increased dose - off licence by presumably using 1.5 Evorel conti patches, which hasn't improved things?

One thing that has not been mentioned is progestogen intolerance. It could be that your anxiety is partly due to the continuous dose of norethisterone  - which some women react negatively to, so upping the oestrogen dose of the patch also means an increase in the progestogen. If you are a woman who is sensitive to this progestogen then no wonder you didn't feel better on the increase?

Re: "but investigations have found no cause. So the doctor doesn’t want to up my hormones until the cause is discovered."

Bleeding is also tricky to control if you are on a combi patch - if the doses are not the right balance for you. Can you elaborate on what investigations you have had? You should have had a U/S scan + TVS (vaginal) and if the lining is found to be thickened or has any potential abnormalities, you should be offered a hysteroscopy and possibly biopsy.

I can understand not wanting to increase dose until this has been sorted but this should be pretty quick in the case of post-menopausal abnormal bleeding on HRT?

My view would be to go for separate oestrogen and progestogen and/or cyclical HRT so that you can see which if any progestogen you tolerate best. This would enable you to tweak the oestrogen and progestogen doses safely and separately so that you both feel well and don't have bleeding.

I suggest you read up further about the different types of HRT ( menus on this site), decide what you would like to try, and after the investigations are complete, go to your doc (or a different one in the prctice) with your request (having written down your reasoning to help you remember!).


Hope this helps and ask if you need any further advice!

Hurdity x

[Mary G]

Sarahy, that is a very low oestrogen level and to give you an indication of just how low, it's the same level as my oestrogen when I'm not using any HRT and I'm 15 years post menopause. 

I think oestrogen blood tests are very valuable post menopause.   I find them to be very accurate and they correlate with my HRT dose.  Once post menopause, you are not going to see extreme oestrogen fluctuations and have a reading of 100pmol in the morning and then suddenly shoot up to 400pmol in the afternoon.

100pmol is far too low and you need to aim for 300pmol for bone protection and symptom relief.   Your doctor should know this as well as the low oestrogen/low serotonin connection.

[Hurdity]

There is no absolute level of estradiol for symptom relief as women vary in this. Regarding bone protection, some years ago I read a paper giving a minimum level (through trials) which was somewhere in the region of 165 pmol/l if I recall correctly but obviously nice to aim for more than the minimum, especially as the sample of women in the trial would presumbaly be limited....

Mary G - where does the figure of 300 pmol/l come from - if there is some recent work on this please can you post a link as I would be interested to update?

Hurdity x