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[Kathleen]

Hello ladies.

I am thinking of asking my GP to assess me for a form of mental illness as my mood changes continue to plague me daily. I can be fine, normal and calm but later on I am overwhelmed by panic or crying. I feel that I am going mad and I am exhausted.

I am sixty seven, very post meno and I have been using HRT for ten years.  I took a 12 month break a few years ago and after a few weeks of zero Oestrogen I saw a return of hot flushes, night sweats, increasing vaginal dryness and very low mood with daily crying episodes. The mood problems were the worst part and my GP suggested that I go back on HRT which I did.

Many more experiments followed and I am now using one 1mg sachet of Sandrena gel and 5O mcg of Cyclogest on alternate nights.
My GP recently measured my Oestradiol and it is 174pmol/L. This is slightly above the 118pmolL  level expected from post meno women not on HRT.

I really need to know if my hormones are the problem or if something else is going on because I just can't be on this emotional rollercoaster for much longer.

Thank you for reading this and take care.

K.

[SarahT]

Hello Kathleen,

I know we have shared posts on forums before. My moods have with out doubt been the worse symptoms during this hormonal crap. I know I am still peri, Whilst you are lost meno, but the distress remains the same when it affects every sale for your life.
I know hormones have played the biggest part in my poor mental health. My own gp was very understanding of this. I do take a small dose of and anti anxiety medication which seems to suit me well. Mirtazapine,  I have also just begun talking with a counselling,  I have an amazing range of huge  changes going on in my life,and I think I will benefit from this.
Please do speak with your gp.  If you wish they can refer you to a mental health group on the nhs. In my area Herts\Cambs you can also refer yourself. I am not sure what is available another counties but may be worth looking up a website? Once you have filled in an online form, they call pretty soon I speak with you to assess your needs. It did take a few months for the actual therapy to start, but a my help you.

Please ask for help. It is not being weak but being strong in recognising you need a helping hand. We look after our physical health with medication so why not our mental\emotional. You are not alone Kathleen, x

[Dotty]

Hi Kathleen

I’d say that your oestradiol reading is very low. You may need a much higher level to combat mood swings , anxiety and depression. I think Professor Studd recommended much higher levels .

[Kathleen]

Hello ladies and thank you for your replies.

Sarah T - I am pleased that you are getting the help you need and I wish you luck.

Dotty - I think that my levels are low for someone on HRT.

I have to say ladies that I have tried everything now and I am running out of ideas. In the past my Oestradiol levels have been in the six hundreds and I still had panic attacks. I have also tried CBT and talking therapies and I am still seeing a counsellor every week. I have also been on 150mcg of Venlafaxine ( also known as Effexor) for years.  I have a good diet, I am slim and walk miles daily.

I usually sleep okay but my moods are changeable through the day. As I have said I can feel absolutely fine and normal, sometimes even optimistic and upbeat but at some point in the day, often late afternoon I am prone to sweats and panics. This usually lasts about an hour or two before normality returns.

I have always thought of these symptoms as hormonal as they started in post menopause and my trusty Meno book has a description that is spot on.  The problem now is that I can't take much more of this. I need to see some progress so that I can live a normal life.

My fear is that this 'journey' has seriously harmed my mental health and left me with a mood disorder.

I have had enough of HRT, drugs, therapy and supplements. I need something that actually helps me live a life not blighted by mood swings.

I will see if I can see a GP soon but if they suggest something that I haven't tried I will be pleasantly surprised.

Sorry to moan ladies and I do appreciate your comments but having had a good day yesterday but a massive panic attack this afternoon I am once again despairing of the future.

Wishing you both well.

K.

[Minusminnie]

Kathleen
Could i suggest that if you feel now that you have exhausted most else and might need to see a psychiatrist that you ask to be referred privately if that is possible for you. 
The waiting lists on the NHS can be a year or more and you deserve better than that.

[Kathleen]

Hello Minusminnie

Thank you for your reply.

I would like to see a psychiatrist because I need to know if my problems are entirely hormone related.  I don't think it is possible to self refer but if my GP could write a referral I could approach a psychiatrist privately.

Thank you so much for the suggestion.


Wishing you well and take care.

K.

[Mary G]

Kathleen, it sounds like you have a missing ingredient that you produced pre menopause that you need to get back.

This is what happened to me and in my case it caused silent migraines but in other women, it causes other symptoms like depression, anxiety, panic attacks plus much more.

I can't remember if you use testosterone but if not, it's definitely worth a try.  I had always been pretty indifferent to testosterone but since reading that it increases seratonin levels, I think it's worth sticking with it.

Your oestrogen level is also too low.  To give you an indication, that is what my oestrogen level was in 2007 immediately post menopause before my own levels had completely bottomed out and before I started HRT.

Obviously I'm not a doctor but I think your problem is a lack of seratonin or perhaps it's not circulating sufficiently in your brain.  Low oestrogen (and apparently low testosterone) cause low seratonin levels which leads to a whole host of disorders in different people.  In my case it's silent migraines in your case it's low mood etc. 

You mentioned venlafaxine (an SNRI) which is an antidepressant and one of the migraine preventatives that my hormonal migraine specialist recommended to me.  I opted for amitriptyline (a TCA) but changed to nortriptyline (the sister of amitriptyline and also a TCA) a couple of weeks ago because it's possible to get the same results on a lower dose and I have to say it is just as good - I just switched from one to the other.  TCA's generally work better on aura type migraines which are caused by cortical spreading depression but sometimes you need to switch meds or mix a couple of different types of antidepressant that work on different parts of the brain. It's important to get it right.  To give you an example of how it can go horribly wrong, I started taking escitrolapram and it was a complete nightmare.  Far from preventing migraine auras it actually caused them.

The type of episode you describe happening in the afternoon sounds like a different manifestation of my migraine auras which were also always at a certain time of day. 

I honestly think your problem is seratonin.

[Gnatty]

I would also like to add that if you see a psychiatrist then do make sure they are clued up on hormones. Otherwise they will just throw all sorts of different drugs at you and you may end up more muddled than before. Get your hormones up first and then if there is still a gap that might be the time to add in something else.

[Kathleen]

Hello Mary G.

Thank you so much for your comments.

I assumed that 15Omcg of Venlafaxine would raise my serotonin levels and this would help to prevent or at least diminish my anxiety and depression episodes but that doesn't appear to be the case.  I understand that ADs can stop working after a while so perhaps switching to a different drug would make a difference. I will certainly ask my GP about making a change.

I was prescribed Venlafaxine at the same time that I started HRT so I never really worked out its specific effects.  However when I came off HRT altogether a few years ago I continued with the AD but my mood symptoms definitely worsened and other meno symptoms returned or increased. I concluded from that experiment that Venlafaxine wasn't really helping.

I take your point about something missing since becoming post menopause which is when my problems started. Oestrogen is the most obvious answer but I dearly wish that my aging body would finally adapt to lower amounts of this hormone. Presumably women who don't use HRT adapt to the new normal.

I have tried testosterone in the past but I didn't feel noticeably better unfortunately. It had an effect in that I became aggressive and grew dark hair on the application site on my thighs and my libido changed. After about eighteen months I decided that it was one more hormone that I struggled to balance so I gave up. I recognise that many women have great results from using T and every doctor I've spoken to at Newson Health has suggested it.

My afternoon dips are definitely a feature and could be just tiredness I suppose or some other circadian event. After my melt down yesterday I slowly felt better and by the evening I was just about normal lol. This often happens and this makes me think that something cyclical is at play though it may not be the whole story.

I think that trying and failing to balance my hormones for over ten years has really taken its toll. If I wasn't prone to anxiety and depression before I think I am now. It has been too much for too long. I am going on a trip at the end of October  and I know my moods/emotions will be doing their thing and I hate it. I just want to be emotionally stable.


Thank you so much for taking the time to respond and I appreciate your comments.

Wishing you well and take care.

K.

[Kathleen]

Hello Gnatty

Thank you for your comments.

I agree that I need to see someone who understands the menopause as well mental health. Not an easy task given the pathetic amount of knowledge most medics have about the effects of the menopause!

I am wary of raising my Oestrogen again because of all the bleeding and breast pain that I have had in the past with higher levels. When I was at over 600 of Oestradiol I felt fine some of the time but also panicky and tearful at other times. That dosage came to an end when the bleeding became severe and I was told to reduce as soon as possible. Thankfully tests revealed no harm done but it was a scary time.

I will ask my GP about other types of HRT as my low numbers might be a result of poor absorption and a different product might make a big difference. It is certainly worth a try.

Thank you for posting your thoughts and I wish you well.

Take care.

K.

[lilbebel]

Hello Kathleen, I’m so sorry you’re going through this awful time. I was in a similar situation and my family doctor told me that a quick way to access a consultation with a psychiatrist is to go to the emergency room at a hospital and say you’re suffering from severe depression. If you have a family doctor, you can even ask them to give you a referral to bring with you. They won’t commit you unless you say you’re actively suicidal.

They will take you seriously though. This is what I did and I had a consultation with a lovely young male psychiatrist who was very validating and said that it’s well established that a drop in female sex hormones can have detrimental consequences for female mental health and cognition. Low progesterone and oestrogen can cause severe depression, anxiety, panic and even schizophrenia. It’s crazy what we have to live through. He set up a good game plan for me to bring to my family doctor and now I’m being followed once a week by my family doctor until I feel more stable in terms of my mood.

I wish you the best and please stay in touch and let us know how you’re doing.

[Kathleen]

Hello lilbebel

Thank you so much for your comments.

It is reassuring that the psychiatrist that you saw confirmed the mental health problems of the Menopause.

When I came off HRT a few years ago I could cope with the returning physical symptoms but the mood swings were very difficult to deal with. My GP at the time said that they were also due to low Oestrogen and suggested that I restart HRT which I did.

I will definitely persue all this when I see a doctor. Hopefully something positive will come from it all.

Thanks again and wishing you well.

K.

[Cally]

Hi there, I am sorry to read of your suffering with symptoms. They seem familiar. I just wanted to mention low blood sugar levels ( hypoglycaemia) can affect our moods. Roberta Ruggierio has a website with lots of good information. My foster child had aggressive meltdiwns and by giving him a protein and carb snack, 15 minutes later he was calm. Low blood sugar can cause irritableness, tiredness and can manifest as mental health symptoms. Low iron and vitamin b12 coukd be checked too as low in these can cause mental symptoms.

I wish you better days 😊

[Kathleen]

Hello Cally


Thank you very much for your comments.

I have recently increased my protein intake which I have added to my main meals which contain plenty of carbs. I take your  point about low blood sugar though.
My recent blood tests were fine but I will pay more attention to iron and B12 to see if it helps.

Thank you for your suggestions and I wish you well.

K.

[Wrensong]

Hi Kathleen, I was thinking along the same lines as Cally wrt blood sugar crashes being a possible cause of panic & mood swings but didn't suggest it this time because I know we've chatted about that before & that you're well informed about nutrition. 

I know you're hypothyroid like me & that we've also chatted about T3 before, but did you ever manage to get it tested & are your FT4 & TSH optimal do you know? 

I think you mentioned adding soya to your diet fairly recently.  Have you noticed any changes to your symptoms as a result of that?   I think I probably mentioned before that many years ago I was advised by a dietitian to drink soya milk in preference to dairy & also added soya beans to my diet, but I avoid both these days, partly because I felt no benefit from them & partly because of the potential for adverse thyroid interaction.

My only other thought is that I believe you've mentioned supplementing with flax seeds?  If so, I find I really can't tolerate them, with similar effects to those I always get from progesterone (very hot, wired, jittery, racing heart, worsened insomnia).  You'll know it's said the high lignan content in flax seeds can make them act like anti-oestrogens & I suspect that's what's happening to make me feel as though the beneficial effects of my HRT are being blocked by them.

None of this may apply to you I know as we're all so different, but you've struggled for so long to get well & as I also have some resistant symptoms nearly 2 decades from onset of peri, I really feel your frustration & despair.
Wx