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[Mindfulmoomins]

Hi everyone,

Thank goodness for this forum.

I am really looking (quite desperately) for some advice ahead of speaking to my GP tomorrow.

I have had anxiety (mild) in the past and depression but have done a lot to work through it (I'm a therapist) and haven't had any symptoms for several years. Then perimenopause hit and low moods, aches, crashing fatigue and irritability. It felt like I was pregnant (I really did not glow in pregnancy and felt very tired and low. That improved loads after giving birth). I had a few months of post-natal depression about 3 months after giving birth and worked through a lot of stuff with a counsellor and felt very well for 4 years before the confusing perimenopause symptoms.

I was prescribed Evorel Sequi 50 mg about 4 months ago. The aches and pains went quite quickly and the brain fog cleared. However, anxiety started to become a constant companion about 6 weeks ago (after being on the sequi for 2 months).

I eating really well and am an experienced meditator and do cardio to help but I am still off work as the anxiety can be quite debilitating. I still go out and see people but I just don't feel like me.

I am very tearful especially if anyone is kind and I feel quite desperate at times. I have self referred for CBt and am doing a worry diary which helps but doesn't feel like it's addressing the root cause.

I have been on fluoxetine 40 mg for many years now which has helped. I am not also taking amitryptaline 20 mg at night to help me sleep. This helps too but again doesn't feel like it's addressing the cause.

I am not over the moon about taking medication as I do as much as I can to help naturally but acknowledge it's place as a tool.

Can anyone offer any thoughts about what to ask for from my Gp tomorrow? Could I be reacting to the progesterone? If so what might help? I am near London, is there a specialist place I could ask for a referral to? I would go private if I had to despite not having much spare funds.

If you've read this far thank you thank you thank you!

With much love for everyone on this path.

[Dancinggirl]

Hi and welcome to MM Mindfulmoomins

Your story is quite typical for many women.  The Meno can hit us hard, with even the most sorted and strong women finding they cannot function. HRT can help to a degree but it is not a cure all - dealing with anxiety and low mood is particularly difficult.

It may be the progesterone in this particularly HRT that is causing you undue problems. Perhaps try something different at this stage e.g. Femseven sequi patches or Femoston 1/10 tablets?  Femoston has one of the kinder progesterones so can often suit many women very well.  Some may suggest Utrogestan but this can have a sedative effect - women either love or hate this particular progesterone.

The patches are medium dose which can be too high for some women, in peri meno particularly, you might do better on a lower dose.  Don't feel bad about using HRT - it's hormone replacement, not a drug, and the oestrogen in most HRTs is now bioidentical.

Great to hear you are taking care of lifestyle - exercise, diet and Mindfulness - this is so essential.  You can doing all the self help things that I would suggest.  I'm afraid some women do find they need a ADs/SRRIs alongside HRT to really get anxiety under control and as you are already on some ADs, perhaps these need tweaking a bit? However, do try an alternative HRT first - finding a progesterone that suits you can be a real challenge and you may have to kiss a few frogs before you find your prince.
You might be someone who benefits from having a Mirena fitted with separate oestrogen as gel or patch alongside.  After some initial side effects after fitting (some erratic bleeding and maybe feeling a bit sedated), the Mirena will usually settle and cause few problems over it's 4 year life and you may not get any bleeding at all after the first few weeks, which can be a real plus - no ups and downs of a cycle ? !!!!

As you are in London, there are a number of NHS menopause clinics - I believe many you can simply phone up without a referral to make an appointment.  There are private specialists but I wouldn't jump to pay out just yet - I believe Dr Panay's is one of the best.

Write out all your symptoms and questions for your appointment - also print off stuff about the various HRT types on this site (under TREATMENTS) - it can make it easier to focus during the appointment.
Good luck and keep us posted.  DG x

[Mindfulmoomins]

Dancing girl, thank you so very very much.

I will speak to my GP about what you have said re the HRT and read up some more.

My goodness this is hard and your support helps enormously xx

[CLKD]

 

[Lanzalover]

Hi Mindfulmoomins


   Dg has give you some good advice.


Good luck for your appointment  tomorrow and let us know how you get on.


Lanzalover x

[Mindfulmoomins]

Thank you CLKD and Lanzalover. Fingers crossed I get some help tomorrow x

[Taz2]

Hi Mindfulmoomins - I agree with Dancinggirl - the progesterone in Evorel sequi/conti can give many women anxiety and pmt type symptoms although it worked wonderfully to combat my hot flushes etc. it affected me in this way. I changed to FemSeven and those symptoms disappeared.

Taz x 

[Mindfulmoomins]

Wow Taz2 that's great. I hope that a change in HRT may help me too. Thanks for replying.

[Mindfulmoomins]

Hi everyone,

So I wrote out all my concerns about Evorel Sequi and the progesterone part causing anxiety and spoke to my GP this morning.

She is going to speak to a friend and colleague who works in a specialist menopause clinic but she thinks the Mirena coil and Estrogel might be the safest and best route.

I am pretty scared about the Mirena coil as there is loads online about it causing depression and I really could do without that as I feel desperate enough at times. Has anyone got any experience of this (Mirena and Estrogel?). Good or bad.

The GP said the progesterone in the Mirena is localised to the womb so shouldn't cause any problems with mood. She also said that the evidence/research doesn't show it causes depression.  She said all this really nicely as I explained I was really struggling.

She couldn't find anything about using Ultrogestan (micronized progesterone) vaginally on her computer (which is something else I asked about having read about it on here). Has anyone got this from their Gp along with estrogel?

So I am speaking to her again on Wednesday and on Thursday I will be at the end of my cycle so it would be an ideal time to start a new regime. Obviously if I go for the Mirena it's unlikely they could fit me in on Thursday but if I get a prescription for something else I could start that.

Thank you so much for any advice and experience. I'd be pretty lost without this site. I showed my husband the replies I got and to my first post and he was amazed that people were so well informed, kind and wise.


 

 

[CLKD]

Well done on the GP seeking advice!  Some won't bother, they simply keep altering what the woman is taking until they find/not something that eases symptoms.

[Dancinggirl]

Mindfulmoomins - The best HRT regime I ever had was the Mirena with Oestrogel.  Yes, there were some sedative side effects at first but it was great not to have the ups and downs of a sequential HRT or have the awful side effects of continuous progesterone. 
Utrogestan taken orally can give quite a lot of side effects - when I tried it, I felt slightly high and sedated and not in touch with life - actually quite a nice feeling but basically not good.  Some use it vaginally and find this fine but, as it is not licensed to be used vaginally in the UK, you may find your GP won't sanction this. You may have to see a gynaecologist privately to be allowed to use it vaginally - there will be women on this forum who will recommend using it vaginally and even suggest you use much lower doses for a shorter time each month but I must caution you that this should only be done under professional supervision with regular uterine scans. So Utrogestan is a marmite one - some love it and some really can't get on with it. 

Reading your posts, I think you need more consistency, so the Mirena is worth trying - you can always have it removed if things don't settle after 2-3 months.  I slept like a baby for the first 3-4 months after it was fitted but I certainly didn't feel depressed or anxious. After 3 months, I didn't get any bleeding which was fab. Horror stories always make their way onto the net - if women are doing OK with the Mirena they tend not to bother to report this - I was told by my gynaecologist that the Mirena has something like a 90-95% success rate in terms of women finding it good.  There are very good reasons why the Mirena is a favourite of most gynaes for treating so many things. Dg x

[Mindfulmoomins]

Thanks so much DG. That's reassuring as there are lots of horror stories about the Mirena and I can't seem to get a balanced view.

[CLKD]

   DG