Anxiety returning at 40: sertraline again or explore perimenopause and HRT?

[padampada]

Hi all, I've had quite bad anxiety in the past. I spent 10 years on and off sertraline. I put that all behind me and found some ways of coping. Lots of things have helped. I changed job, moved nearer support, my kids are older, I exercise more.
Ive been off sertraline for 5 years and now suddenly the anxiety is back. Im 40. A year ago I had blood tests for early perimenopause which were inconclusive but suggested hormone levels were changing was told maybe should get checked in 6 months. My question is, should I look to go back on sertraline, which worked well for me, or should I be thinking this is perimenopause stuff and look to having more tests and think about HRT? I know i need to do something because i can feel this spiraling. Thanks for reading.

I think you should check your bloods again, if it is perimenopause then sorting out your hormones will work better (and longer term) than the sertraline.

Thanks I think I've been put off because it involves addressing it properly and something new. I know sertraline works for me but probably should get those tests done again

What are you anxious about? Anxiety is not an emotion we 'have', it's an emotion we do.

For me its an overreaction to everyday things which were previously manageable. I have really physical symptoms and catastrophise. Tiny problems take all my heads pace.

Try propranolol op.

I think that’s really common in perimenopause and sorting the hormones will be a better solution than sertraline as it’s targeting the root cause

i suggest the mirena coil, worked wonders.
And then (although you may have already done so) look into neurodiversity as a possible underlying cause. Good luck and I hope you feel better soon

The brain doesn't know the difference between real and imaginary threats, which is why the physical response to both is identical. Once you can understand why you are overreacting and catastrophising you can change those emotional responses, which then become the default reaction. CBT teaches you the mechanics, which is often enough.

Thank you. I will definitely look into this.

I previously got my anxiety under control with setraline and cbt.

when it returned with menopause I started on hrt and it got the anxiety under control within a week.

it was definitely the hormones

For many women, the return of anxiety symptoms around the age of 40 can raise an important question: is it a recurrence of a previously managed anxiety disorder, or could hormonal changes related to perimenopause be contributing to the problem? In clinical practice TMS therapy , both factors are often interconnected. Some individuals respond well to restarting medications such as sertraline, while others benefit from evaluating hormonal fluctuations and discussing options like HRT as part of a broader treatment plan.