Would HRT help with this?

[Mimase]

Would any of you very knowledgeable ladies mind giving your opinion on my symptoms.

I started with perimenopausal symptoms about 18 months ago (I'm 49) - erratic periods, occasional hot flushes but generally felt fine.
Then about 8 weeks ago I suddenly got terrible anxiety and insomnia. It lasted about 10 days then just stopped. This started again 5 days ago - uncontrollable crying, feelings of panic and doom. I have no history of anxiety and I'm finding this terrifying.

Went to the doctors today but she had no idea what was causing it. I asked if could possibly be hormone related but she said anxiety wasn't a symptom of menopause. Despite this, she practically insisted I take HRT even though she said it wouldn't help with the anxiety.

Now I'm not adverse to taking HRT, but felt she just heard 'menopause' and automatically prescribe HRT because she didn't know how to deal with the anxiety (and wanted the snotty, crying woman out of her surgery).

Has anyone else experienced this kind of anxiety as a perimenopausal symptom? Do you think HRT may help? Is it worth taking the HRT anyway as I'm perimenopausal?

Sorry you are suffering.
Some drs think there is some evidence that erratic levels of oestrogen affect mood and can cause anxiety. Anxiety is certainly listed as a meno symptom but it's also important to ask if there are any other reasons for it at this stage of our lives eg empty nest, older ill parents, loss of identity in mid life etc.

No one can answer your question really because everyone is different, but it's worth trying HRT if you are not averse to it. It's also relevant that you have no former history of anxiety so it would seem logical that it may be caused by your hormones.

It's also possible that your other symptoms will come back (flushes etc) because these tend to wax and wane a bit depending on level of hormones. (I started with flushes during the time when I missed 4 periods in a row) then when my periods re-started for many months and were regular, the flushes etc went and only came back once my periods stopped for good around 54.

Hope this helps- but it's a case of deciding if it's worth trying and seeing how you go.

Thanks pinkfrocks that's helped clarify my thoughts.

Everything else in my life is really positive at the moment which makes this anxiety even more baffling. That, and the fact that I have no history of anxiety, is what made me want to consider a more physiological cause (hormones, thyroid etc.).

I do think my hormones are playing a part, either directly or indirectly (may be the perimenopausal symptoms are worrying me more than I realise). So HRT certainly seems worth a try, along with some lifestyle changes (exercise, diet etc.).

I didn't have much confidence in the GP's understanding of HRT though - she refused to prescribe the patches or gel because I'm under 50 and insisted on tablets - Elleste Duet (1mg).

As the pharmacy can't get hold of that dosage, and I'm feeling more positive today, I will do some more research and go and see a different GP next week, armed with better information.

Thanks again.

I don't understand why your GP will not give you patches or gel- age is not a deciding factor. Are you going to query this?

I don't understand why either. She read the information about it and said it was too complicated to have 2 different delivery systems and she wouldn't prescribe it to anyone under 50.

I was an emotional wreck yesterday and, retrospectively, there are several things I should have queried but I'm seeing one of the practice partners next week. I'll go over everything that was said with her and push for a prescription of Oestrogel and a separate progesterone (Utrogestan?) as a starting point.

It really beggars belief that someone who is a dr can't get their head around something as simple as Oestrogen every day then Utrogestan (or another progestogen) for X number of days a month (usually 10-12.)

And the 'under 50' is a nonsense.

It's really annoying when drs don't know the basics and it means women who are sometimes emotionally fragile anyway have to fight for something that is so routine really.

Good luck.

Thanks pinkfrocks

The appointment with the different GP didn't go well. Discouraged me from taking HRT at all (as it has far too many risks) and offered antidepressants - I declined.

Having investigated perimenopause more, I think I'm having far more symptoms than I realised and HRT is well worth trying. So I pushed for the gel and separate progesterone. She had only ever prescribed Elleste Duet and eventually agreed to look into it and get back to me.

She phoned back today and said she would only prescribe tablets (offered Elleste Duet or Prempak-C). She said only consultants prescribe Oestrogel. When I challenged this she said in our region they can only prescribe the gel after everything else has been tried.

She really was not prepared to budge on her decision.

As a last attempt, I pointed out I had recently been diagnosed with a digestive condition so another reason I didn't think tablets were a good idea. She reluctantly agreed to prescribe patches but wouldn't tell me which ones - from the way she describe them (oestrogen only + combined for 10 days) I'm assuming Evorel Sequi or Femseven Sequi?

So it seems as if I may be stuck with trying the patches.

I think this is really beyond the pale in terms of treatment. I am so angry for you that you went along informed and your dr- who is clearly not in the loop re. HRT- dishes out this misinformation. Can you change surgeries or see another GP?

Have a look at the recent threads here and you will see that there is one on the recent NICE report on menopause- came out Monday.

The short version is linked. If you can bear to it might be worth printing off and taking to GP so she can read it. It dispels all the nonsense she's talking with poor you on the receiving end.

It says- summary- that HRT can be used to emotional symptoms, that women should be given the choice an d made aware of transdermal HRT ( patches or gel) as well as tablets and lots of other advisory guidelines.

It is not true that only consultants prescribe gel- if you read the forum on Menopause Matters there are loads of women using it. You could for £25 email Dr Currie there, ask about this ' only consultants prescribe gel' issue and she will reply which you can take to your GP.

Here is the NICE link

NICE DRAFT GUIDELINES SUMMARY

See pages 10 and 11: These key points-

-Discuss the risks AND benefits of short term ( under 5 years) and long term treatment.
-Offer women tablets of transdermal HRT
-Do not give ADs (SSRIS) in place of HRT to women who do not have a clinical diagnosis of depression.

Mimase have you researched other options, for example menopace vitamins or similar? No need for gp prescription and they can be very effective in some people. I can also recommend ' grumpy old women', a hilarious but also informative book about the menopause.

With respect there is no scientific evidence that such products work- but by all means try them OP if you want to spend your money that way.

Since all this started I've read everything I can find on HRT and I put across, what I thought, was a persuasive argument for what I wanted but she just wouldn't budge.

I had read the NICE guidelines earlier in the week so was able to point out some of her misinformation which is when she changed tack from 'only consultants prescribe' it to 'they aren't allowed to prescribe it in our area as a first step'. I assume she was implying they are restricted by the CCG.

I'm not sure I believe this to be honest but if it is true, changing surgeries won't help as anywhere else will also be restricted (although I probably will anyway as there are other problems with this surgery).

But where do you go next when you are completely stonewalled?

Was absolutely fuming when I came off the phone.

Thanks FastForward2. I did start Menopace vitamins a couple of days ago, if nothing else I could probably do with a vitamin B boost, and it can't hurt to try.

You could send a query to Menopause Matters (NOT plugging that site bTW) or you could ask your local pharmacies- they will know if they dispense it.

It's not an 'off label' or weird and wonderful type of HRT! TBH I think she is making all of that up. I'd ask why they can't prescribe- call her bluff and say you will make further enquiries and take it further.

You could offer to pay for it yourself if she will write you a private prescription; I pay for mine as it's private and it's about £10 a can so not that much more than the £8+ NHS prescription.

Good idea about asking pharmacy, they should be able to tell me if it's available.

I did ask if I could have it on a private prescription but she said she would still be restricted o what she could prescribe.
Both GPs seemed to know very little about HRT. Makes you wonder what they are prescribing women presenting with menopause symptoms - probably antidepressants

what is the 'CCG'?

I don't know why it could be restricted. I suspect she is out of her depth re. using 2 hormones that don't come in a bubble packet!

I suppose you have a few options:
ring around and then go back and query.
Make enquiries about why and if it is restricted.
See a consultant privately for a 1-off appt then they can ask your GP to prescribe what they recommend for you.
Change surgeries (if an option.)

There are many women using the menopause matters forum who are on gel- if you were to join and post you could give your location ( and still be anon with your user name) and ask if anyone else has experienced this.

Mimase I suggest you keep going with the vitamins for a month then if it works keep taking it, as I understand it takes a month to build up then has to be maintained, because vit b is excreted not stored. Vitamins are just as scientific as hrt but you don't need a prescription, because there are no side effects.

Menopause is normal, not everyone needs to take hormones.

I am not sure why the first, less experienced, GP practically insisted you take them, particularly as she said it would not help anxiety which seems to be the worst symptom. Why not go with the opposite advice of the second more experienced GP, at least until you have given the vitamins a chance?

Obviously, if you have severe symptoms not mentioned here, which are known to be helped by hrt, that is a different story, I am just going on what you say here, and hope you get sorted soon.

The sad fact is that vitamins are not enough for many women. If they were, would anyone use HRT? I don't think the poster's GP refused to give her HRT on sound medical grounds-but because she didn't understand menopause at all, and the 2nd one refused on the basis of 'risk' without saying what they were. The recommendations from NICE are that women have to be advised of the risks and benefits and then able to choose for themselves- as intelligent people who can be in control of their own bodies!

Maybe have a read of the guidelines posted here under another thread - the NICE guidelines- where anxiety is named as one of the main reasons to take HRT.

Unfortunately, all the vitamins and supplements out there are not going to help with bladder issues, vaginal atrophy, loss of collagen in the joints, healthiness of the arteries, bone density etc in the same way as oestrogen.

It's important that we all look after ourselves during meno and peri meno by eating really healthily, which can help a lot, cutting out alcohol, taking plenty of exercise, maybe adding in some things like yoga, acupuncture, mindfulness, meditation, getting a better work-life balance if we can, but sometimes these still aren't enough.

Vitamins DO have side effects if you overdose on them-- very serious side effects too if they are ones that are stored in the liver.
Vitamin B has long been associated with helping the 'nervous system' and people used to take brewers yeast in the past. You can also take St Johns Wort but this can have side effects and there are a whole load of contra indications when you ought not to take it if you are using quite a number of everyday medicines.

Actually menopause really isn't normal and women weren't physiologically designed to live without oestrogen for 30-40 years post menopause.

Up until only 100 years ago the average life expectancy for women was only 49 and the vast majority of women would still be having regular periods well into their late 40s.

Ergo, menopause wasn't an issue as you were dead before having to suffer through it.

She wouldn't tell you what she was prescribing? Surely that isn't right? I think I'd be looking for another GP tbh OP, she sounds crap. Hope you feel better soon.

I'm shocked at your GPs response. I would do your research using helpful sites like menopause matters. You could perhaps contact your local CCG (clinical commissioning group) and ask for a copy of their prescribing policy for HRT. See what that tells you. I'd also consider speaking to your practice manager, it sounds like some training for the practice GPs wouldn't go amiss, the oestrogen gel and Utrogestan progesterone is the new "gold standard" in HRT, that elleste stuff is much cheaper which may be why she prescribed it. Prices of the various products is on the menopause matters website, You could ask for a referral to a menopause clinic, her to refer to you a menopause clinic, you'll probably have to do the research yourself on that and where the nearest one to you is.