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[Patience]

I know a lot of women are prescribed antidepressants for perimenopausal anxiety, especially if they are unable to take hrt.  Unfortunately, due to the large number of relatives in my family with hormonally driven cancers, my gynecologist will not prescribe hrt.  I'm 54 and had my last period in August.  I started having anxiety 2 years ago when my periods started to become irregular.  I have heard that menopausal anxiety lifts when estrogen levels settle.  However, over the past couple of months, my anxiety seems to have ramped up as my estrogen levels drop lower. 

My question is: has anyone been able to taper off antidepressants permanently after the menopause transition?  My mother took high-dose oral hrt for 10 years until she was forced off at 62.  She had no problems coming off hrt and never had another hot flash.  So, I'm hoping by the time I'm 62 (if not before) my anxiety will lift along with a need for an antidepressant.  I can only hope!

[CLKD]

Well firstly your GP needs to up date his/her information.

Ask to be referred to an Oncologist for advice?  Unless it is a very near relative: and unless the particular cancer was oestrogen driven: there should not be any reason for you not to try HRT.  I am quite sure that there will be ladies along who know more about this and/or who take HRT successfully.

It isn't the absolute cure for some.  I've taken anti-depressant medication since 1988 as well as different types of anti-anxiety pills.  Do look out for vaginal atrophy [various threads here!] which can be treated with localised 'HRT" i.e. Ovestin or Vagifem.  This should not be discounted by the GP as there sin't anything else that will ease symptom which may present with urine infection-type symptoms.  Dryness down there interferes with sex, irritates the bladder etc., ett., etc. 

Browse round. Read the green banner 'treatment' threads above.  If necessary ask your GP for anti-anxiety treatments if he/she is reluctant to prescribe HRT, I have found Rescue Remedy mouth spray useful in the past.


Ladies should not be forced off any HRT treatments these days ;-)

[racjen]

CLKD, hormonally driven cancer generally does mean driven by oestrogen, and if Patience has quite a few family members diagnosed with this type I think it's pretty unlikely she'll get a doctor willing to prescribe HRT. Also I doubt an NHS oncologist would be available to give advice to someone without a cancer diagnosis - their surgeries are already packed full of people needing cancer treatment. If she's already seeing a gynaecologist I'd have thought that advice would be pretty reliable.

Patience, I had breast cancer last year but as mine was triple negative I have been allowed HRT. From what my oncologist and GP have both said they wouldn't have prescribed it had the cancer been hormone driven.

[Hurdity]

Just to add that I recently found this link to the referral pathways for familial breast cancer and risk depending on who (how close) and how many relatives - which might be helpful:
https://patient.info/doctor/familial-breast-cancer

In your position Patience, I would want to have information on my actual risk of getting breast cancer - through referral as above if indicated.. If unable to take HRT for this reason I would also take the prescribable non-HRT options rather than herbal remedies if my symptoms (such as flushes and sweats) were debilitating, although in the early stages of peri-menopause some phyto-oestrogens can help as they have a weak effect. I think St John's Wort is also recommended for anxiety? However some women who have had breast cancer are not advised to take some phyto-oestrogens at all and this is mentioned in the link below.

Here is a recent paper on the non-HRT options:
http://journals.sagepub.com/doi/full/10.1177/2053369117711646?hootPostID=6690d93930a10b86869c48433ab506e7

I am sure you will have researched this but to reduce the risk of all cancers, weight loss, exercise, healthy diet, reducing alcohol and stopping smoking, reducing stress (as necessary) can all help - and are recommended for all women at this stage of their lives with our without familial breast cancer history. I would also try out as many of the behavioural strategies/therapies that were offered - for example you might be able to ask for CBT on the NHS in your position.

Hope this helps.

Hurdity x

[Patience]

Thank you all for your advice.  I did have BRCA gene testing and the results were negative, which was a great relief!  However, I do know there are many other gene variants that cannot be tested for currently, so I will not be a candidate for HRT.  Racjen, I'm very sorry you had to suffer with bc, but I'm glad you can receive hrt for your menopausal symptoms.  Being able to take hrt does seem to make life a bit easier for most women.

I am still wondering, though, if any of the women who have been prescribed an AD for menopausal anxiety have found they didn't need it after the transition?  My hope is that anxiety, like hot flashes, will taper off after menopause. 

I'm not sure if CBT would be helpful to me as I'm fairly sure my anxiety is a result of hormonal fluctuations.  At 54, I'm still having erratic cycles.  The trouble is, I can't tell if the anxiety is from estrogen falling or rising.  I don't have anxiety all the time, but when I do have it, I feel like my body is in some kind of a withdrawal, similar to what I think drug withdrawal would feel like. The anxiety seems to be worse before I ovulate or attempt to ovulate.  I wonder if any studies have been done on the effects of fluctuating FSH?

 

[racjen]

Like you I suffer from anxiety as a peri and now menopausal symptom; unfortunately antidepressants don't work for me. Talking therapies of various kinds have been supportive but as you say, they don't seem to make a dent in the anxiety itself because it's not about thought patterns or traumatic experiences, it's a purely physical reaction. In fact I've had a very hard time convincing my (male) psychotherapist of this - he's still adamant that the depression and anxiety must have some meaning, and I find that very unhelpful because it gives these intruders a significance they just don't have. I think unless you've experienced the feeling of having a switch turned on and off in your brain by hormones you just can't understand. I really hope ADs help with your intruders, and that someone on here has the experience to answer your specific question x.

[bramble]

Hi Patience,
When I started to go though the menopause in my early fifties, severe anxiety hit me out of the blue. I have been on varying levels of AD since then but now at 64 I still suffer badly from anxiety. It is a stayer, that's for sure! I'm still on an AD and at the end of last year added another into the mix. Anxiety had badly affected my life and my lifestyle.
Bramble

[Samade]

Like you I suffer from anxiety as a peri and now menopausal symptom; unfortunately antidepressants don't work for me. Talking therapies of various kinds have been supportive but as you say, they don't seem to make a dent in the anxiety itself because it's not about thought patterns or traumatic experiences, it's a purely physical reaction. In fact I've had a very hard time convincing my (male) psychotherapist of this - he's still adamant that the depression and anxiety must have some meaning, and I find that very unhelpful because it gives these intruders a significance they just don't have. I think unless you've experienced the feeling of having a switch turned on and off in your brain by hormones you just can't understand. I really hope ADs help with your intruders, and that someone on here has the experience to answer your specific question x.

I so get where you are coming from and I agree that making the intruders significant is a bad thing.

I take an AD and HRT (despite being high risk) I've only just started the HRT so hoping that helps my anxiety. If I thought the anxiety would never level off I don't know how I'd cope, the thought it should pass is what keeps me going on bad days

[CLKD]

bramble - have you been offered a dedicated anti-anxiety medication, to take either daily or 'as necessary'?

[Roseneath]

I find my anxiety is definately cyclical. When I'm on holiday I am so much better (last week!) When I'm stuck at home and the weather is bad is can be terrible (now). When I feel OK I forget what it is like to feel rubbish and when I'm rubbish I think I will never feel myself again.  I have had some wonderful tips from this site; diet and eating regularly is one as is trying to get out of the house and keep busy. I have been on the edge of asking my GP about ADs a few times but as I have bad health anxiety and I am not down for more than a week at a time am trying to manage it myslef with the help the these totally lovely ladies on this site and their understanding and tips.

[CLKD]

Oh thanks!

Roseneath - I can never forget what it is like to feel rubbish, when my brain is upset I am ill - no way to put it off other than take my emergency anti-anxiety pill.  When I feel O.K. I often look over my left shoulder to see when anxiety is going to creep up.

[Patience]

Sparkle, I've noticed also that the roller coaster ride of peri has leveled off somewhat.  None of my symptoms seem as bad as when the whole upheaval started in March of 2015.  It was like being hit by a bus.  Anxiety was by far the worst symptom, but even that has diminished--at times, it's not even there.  Since my last period in August, I seem to have more aches and pains, but the anxiety does seem to have increased a bit too.   Thus far, I've been able to ride out the anxiety, knowing it would end at some point, especially when I was still ovulating.  Now, when the anxiety starts I have no idea how long it will last, which is why I'm considering an AD.

One thing about my anxiety that I know is purely psychological, is that it increases on the weekend.  During the week, I can try to ignore it and be distracted with work and activities, but the weekends are freer and my mind can remember it has anxiety.  If that makes any sense?

[CLKD]

It does, kind of -  make sense.  Anything out of routine can make me feel anxious regardless of the time of week.  If DH goes away for a day then I get anxious but make sure that I have plans so that I can 'get on'.  Last week he went out, I spent the day in our garden, pottering and was fine.  Going to see Mum causes anxiety  as it's out of routine and 2 hours from home.

I am not as structured as I used to be but still get gut wobbles when routine is broken.

Taking Valium as necessary served me well during the 1990s, I have an anti-depressant as well as 20mg betablocka to ease anxiety surges and an emergency drug for when anxiety floors me.  Because I know that they work I don't worry about 'addiction'.  I have had to with draw from an AD in the past, it took 9 weeks of controlled reduction in dose - worked for me ;-).

[rebel2]

Patience - I totally get what you mean about the weekends.  Unlike what CLKD means about the anxiety being caused by the change in routine, what you mean is that, when left alone, your brain focuses on the anxiety.

I have exactly the same problem - if completely distracted all my physical symptoms go and I am 'cured', but the longer I have to dwell inside my head, the worse it gets.    My current cycle has lasted pretty much three months, the longest ever, and has made me thoroughly miserable.  Problem is, I now 'test' any busy times and keep checking myself to see if I am anxious, which means I am losing the ability to be distracted as I am actively training it break through.

I wish you luck but, unfortunately, I have magic bullet and have a prescription for Sertraline that I haven't yet had the nerve to try.

[CLKD]

Oh rebel2 I did all that ......... B4 going into a shop I would go up and down my body to make sure that I was totally relaxed.  These days I am reasonably OK anxiety wise unless my gut lurches = nausea and then intense panic.  Then my head gets going: what if this doesn't end, what if I feel ill as I did in the 1990s  and no amount of CBT did any good  .