Peri menopause - At a complete loss

[WutheringShites]

Hi there,
I've been experiencing signs of the peri menopause for the past 18months, which include monthly hormone related migraines, hot flushes, tiredness and mood swings.
Far the past few months these symptoms have been getting worse, particularly the mood swings. For around 10 days leading up to my period I am ragey, irrational and basically a nightmare to live with. As you can imagine it's beginning to take its toll on my DH.

After a horrible weekend, this morning I made an appointment to see a GP and am now at a complete loss. After a few basic questions I was offered antidepressants or group talking sessions for anger management.

I really don't know what to do next as neither of these approaches seem to address my problems. What I really want to know if there are any supplements or lifestyle changes that I can implement and was wondering if anyone had any suggestions?

[SestraClone]

Have you tried Agnus castus or black cohosh?

[Chrysanthemum5]

My GP told me about a website called Menopause matters which apparently is very good. She also gave me a very low dose of Prozac to help with the anxiety I was feeling - it has made an incredible difference to me, and the anxiety has reduced to the point where I can use other things such as mindfulness to control it. So, don't rule out the options the GP suggested.

[80sWaistcoat]

I could have written your post 3 years ago - DH and I were heading to divorce because of my unpredicatable mood swings - there was a time when I was 'that' close to throwing a really heavy pan at him...

NICE guidelines suggest that Antidepressants shouldn't be the first choice of treatment in perimenopause.

www.nice.org.uk/guidance/ng23/chapter/recommendations

What helped me was HRT - then the pill because HRT made me depressed. I felt an immediate reduction in the rage and the anger and anxiety.

What also helped was Agnus Castus for the mood swings.

the loss of oestrogen was causing the issues for me - replacing the hormones really helped.

[juneau]

There are many other things you can try too OP. I've read that increasing exercise can help, weight management (if this is an issue), avoiding alcohol, avoiding certain 'trigger' foods, etc. Maybe the Menopause Matters website can help with this - but you certainly shouldn't be suffering in silence and if you feel your GP's approach was inadequate perhaps ring the surgery back, speak to reception and ask them whether there is another GP at the practice who has an interest in menopause management. Alternatively, you could request a referral to a women's health clinic, where you should get more helpful advice. Unfortunately, not all GPs are well versed in this and it seems like its fairly recent that women are finally being taken seriously regarding the debilitating effects that menopause can have on their health and relationships.

[WutheringShites]

Thank you so much for your replies, I have been feeling increasingly alone on this matter so it's good to here from others who have experience.
The kind of lifestyle changes that have been suggested are exactly what I'd hoped for and will definately buy some Agnus Castus this week.

I felt such an idiot at the GP's as he didn't seem to even acknowledge the peri stage. He just basically told me that at 45 and still having periods I couldn't be menopausal, which I obviously know and then went on about depression/anger management. For the next few months I'm going to try and sort things out myself with lifestyle changes and then if there is no improvement seek out another GP.

[80sWaistcoat]

I started with perimenopause at 37 - still going on at 47....

Do some reading up. The feelings you talk about are very common in perimenopause. It may be something else - but you'd think they'd explore that!

I had to change GPs 3 times to get any sense out of anyone re the menopause.

[WutheringShites]

It's ridiculous that there isn't more support readily available isn't it? And having to change GP three times I'm sure didn't help matters! I think the acknowledgement alone that your not going crazy and that it is your hormones is the first step to feeling better about what's in store.

I've been googling like a woman on a mission since coming back from the GP's, have ordered Agnus Castus and am now reviewing my diet . Apparently low progestogen can cause migraines and given that I now routinely get one on day 1 and 2 of my cycle that may be an indication of what's happening.

[nong45]

Me too, 45, hot flushes, monthly migraines, mood swings, fatigue or insomnia or both, restless legs etc etc. Had Mirena on Drs advice, helped a bit but 2 years on feel like my body fighting back. Then low dose amitryptiline (sp?) For insomnia & talking therapy for anxiety, helped a bit but tablets make me a bit foggy & don't always help me get off to sleep. Now trying Menopace supplements with calcium as I read it's supposed to regulate hormonal ups and downs & natural oestrogen in them supposed to help too. Not really noticed a difference though. 1am and I'm wide awake with a busy day at work & ferrying kids around to get through tomorrow...

[nong45]

And I exercise to try and tire myself out so I sleep and eat healthily in the day most of the time, decaf tea blah blah - oh yes and my memory is shit i have to write everything down - i am doing everything I can and I am thinking how am I going to get through the next god knows how many years like this or worse?? I have kids and a difficult job to maintain and some days I feel too bad to function properly, had to have a day off for the migraine last month. I can't face going back to the GP as I don't have any faith that they will be willing/able to help me & ive just got to pull myself together, grit my teeth and get through it. Rant over.

[PollyPerky]

Why aren't you trying HRT? That's why it's there :) Maybe talk to your GP?

[christinarossetti]

I agree with the suggestion not to rule out either HRT or anti-depressants.

A friend of mine was experiencing something similar and was advised not to take HRT for various personal reasons, so takes antidepressants, which made a huge difference to her moods/anxiety/irritability etc.

[PollyPerky]

It's worth reading the NICE Guidelines on this. They came out over a year ago and although they were in the media a lot at the time, women and GPs seem to have missed them.

The key points are that ADs have no place in hormonal -related anxiety, depression and sleeplessness. The first choice must be HRT.

There are very very few contraindications to HRT . This is from a training guide for GPs www.gp-training.net/training/tutorials/clinical/gynaecology/hrt.htm

Absolute contra-indications

There is no absolute contra-indicationg to the prescribing of HRT in post-menopausal women. Extra caution may need to be exercised in the following situations:

Active breast cancer / undiagnosed breast lump
Active thrombo-embolic disease (phlebitis does not constitute thrombo-embolic disease)
Undiagnosed vaginal bleeding
Untreated/uncontrolled hypertension
Coronary artery disease

[christinarossetti]

That's fine polly but empirically antidepressants do help lots of women who might not be able to/not want to take HRT.

[PollyPerky]

I agree with you to a point if women cannot use HRT for medical reasons- NICE says that ADs are not recommended for menopausal symptoms just because a woman 'doesn't want to take HRT'.
They are not appropriate treatment - see their guidelines . (And it's not my view it's a medical view!)

[nong45]

That is all really helpful. In fact this whole thread and others on perimenopause have been enlightening I have always assumed I'm too young for HRT and have just got to wait until I'm either at least over 50 or things get really bad. It is a relief to know I'm not the only one feeling like this and it's not just me going mad!! I made a GP appnt today to see one of the female Drs and will do some research particularly on the oestrogen patch things seeing as I already have Mirena on menopause matters. Thanks ladies

[christinarossetti]

Well, that's lovely for NICE, but they're not the ones living with crippling anxiety, insomnia and depression are they?

Guidelines are just that - guidelines. They're not prescriptive and there isn't enough research about the effects of HRT and ADs (especially over the long term) to claim that one is always the best for every woman.

[PollyPerky]

The NICE guidelines are recommendations based on extensive research. HRT is shown to relieve insomnia, anxiety and depression if it's hormone-driven.

Are you on ADs instead of HRT perhaps?

There is a huge amount of research on HRT- these are all listed at the end of the full NICE guidelines and anyone who wants to know more can read research papers listed there.

[Hairyhat]

Hi there. I'm menopausal. I started at age 40. I'm 43 now and the best advice I can give is drink plenty of soya milk. It has REALLY helped me. I had very severe symptoms at first and was begging for HRT but I'm not allowed it due to a blood problem. Soya milk has been my saviour!

[christinarossetti]

I'm not yet perimenopausal polly, but am of an age where I will be soon, so have done a fair bit of reading/speaking with friends.

I just object very strongly to using guidelines to advocate a one size fits all approach.

[PollyPerky]

I'm just confused Christina why you feel so strongly about something you've not even experienced (assuming you aren't taking ADs anyway?)


I agree that one size doesn't fit all. The whole point of treatment for menopause according to NICE is that it should be individualised. The problem at the moment is that most GPs don't have the time to do this so they reach for the prescription pad, and a lot of them are giving women ADs which are not the right treatment for hormonally-driven menopausal issues, because they have over-estimated the risks of HRT based on flawed data. The guidelines say that HRT is the first route, unless there is a clinical diagnosis of depression not linked to hormones.

[EffieIsATrinket]

Many many women prefer to try ADs for menopause related mental health issues. Often because they have experience of using them for PND or other issues when younger.

[christinarossetti]

Um, I think many of us have experienced treatment recommended by guidelines that doesn't suit us. That's the point I'm making.

I agree that treatment and care should be individual to each woman. Which is why the guidelines should be used as just that, a guidance not a prescription.

That I do feel strongly about.

Yes, Eiffel, that was pretty much the situation my friend was in. She was desperate, unable to take HRT and the ADs were literally a lifesaver. She's taken the before, so knew what to expect.

Surely the measure of a successful treatment is a positive outcome?

[PollyPerky]

Of course treatment should be individualised, but that doesn't mean guidelines aren't worth anything, because you have to look at the history behind the report.

The whole point of the NICE guidelines was to re-jig the approach to menopause and treatment. Too many GPs have been prescribing ADs to women aged 45- 60 when they have said they feel low, anxious, aren't sleeping etc, when in fact the issue was oestrogen deficiency.. So ADs can be a sticking plaster approach- they treat the immediate symptoms but not the underlying cause.

Of course some women do have depression alongside menopausal symptoms, but if they have never had it before AND it coincides with hormonal changes, then ADs aren't the default treatment.

[EffieIsATrinket]

Some woman prefer a 'sticking plaster' or symptomatic treatment.

I don't feel they should be denied medication that would help them to function if, despite correct information re the safety profile of HRT, they are still reluctant to take it.

Breast cancer is so common - it will occur in women on HRT even if it is completely unrelated. Then the 'what ifs' creep in, immune to scientific reassurances.

The washout period re HRT fears is going to take years. And ultimately those fears were based on the data available at the time.

[EffieIsATrinket]

That said I do think HRT should have been discussed or offered to you OP.