PMS and perimenopause

[wtffgs]

Hello, any advice really appreciated. My PMS symptoms are getting worse with every sporadic period. The depression is disabling and the insomnia awful. Now that my periods are unpredictable I can't even plan for low times. This lasts three days or up to 11. I am getting desperate Does anyone have any wisdom to share

Shameless bump

Ask for this to be moved to the Menopause topic. Lots of us there. I have a thread on there about depression / menopause and got a lot of help.

I am taking Sertraline (anti-d) but am also now on HRT (Oestrogel - a miracle) as I also have a Mireno coil. I also take Menopace and Fish Oils and noticed the difference.

But....Dr is the way to go and they CAN help. But...they don't all know much about it and you need to do some reading. See if you can find my thread. Posters were very, very helpful there and many of the links to inform you are on there.

Sorry, no, wondering if I'm in it but periods are still regular. Have you tried Google? Also pestering doctor.

Thanks for replying. I have taken fluoxetine for underlying depression for a few years but this is distinct. I just feel wretched.

I have made a GP appointment - month's wait I had my hormone levels checked a couple of years ago and the receptionist said 'normal' when I rang up so no further action.

I've asked for this thread to be moved.

It is very common for PMS to increase in the run up to menopause.
Blood tests are a bit of a waste of time during peri because your hormones are all over the place so they could show 'normal' one day, peri meno the next and even ( as I found out!) post meno another day (even when you aren't!!)

There is quite a lot of stuff online about how diet, exercise and some supplements can possibly help with PMS so maybe it's worth researching that and trying it out? It might be something simple like reducing salt to cut down on bloating, reducing refined sugar to stop the highs and lows of blood sugar which lead to tiredness and irritability, eating foods that are more healthy,or maybe things like yoga and mindfulness to try to relax. Everyone is different so it's a case of experimenting.

If you give all that a go, then the next step would be to think about some hormonal treatment- some women use the Pill to give some stability to their hormones and cycles, whereas others try HRT.

I suspect your dr won't have all the answers because all women are different and you need to try a few things out first to see if they help.
Good luck

wtffgs - if your periods have become irregular and you have other symptoms, mood swings etc, you might benefit also from a low dose HRT which will prevent the extreme dip in oestrogen levels you get just before your period. As pinkfrocks says blood tests won't tell you much at this point and your doc should go on your symptoms.

That's really helpful. It's just a case of finding a sympathetic GP. I'm seeing a new one - female. Fingers crossed

hi there wtf-sorry to hear about your situation.
i'm experiencing awful pms and believe i'm in perimenopause- i'm 43 (the age at which my mum had her menopause). my periods are still fairly regular, if a little closer together.
i am at my wits' end! i'm terrified of pms now- i never experienced it in my 20s or 30s.
i paid privately to see a pms specialist and she explained ssris are first port of call when treating pms- but you take them the week or two prior to period, then discontinue. like you- i'm on ssris anyway (just 10mg citalopram) and was reluctant to increase dose- also felt it might be futile as effects seem to lessen over years and what about withdrawal every month? however, she explained that ssris work differently in pms than in depression- as you say, it's distinct and essentially a sharp plummet in serotonin rather than perhaps the gradual decline in depression- and this explains why ssris work instantaneously for pms and why there is no withdrawal (serotonin naturally elevating anyway).
The HRT used in menopause- or at least part of it- is apparently not licensed for use in perimenopause/pms so you might have difficulty accessing it- (tho it might be worth a try), however, the second option that the specialist gave me was cerazette- progestogen only pill- to basically stop ovulation- no ovulation:no pms!
it is different to the progestogen in the mirena coil- according to my specialist- and has fewer side effects (i had a mirena and it drove me batshit crazy! awful awful!- but it's completely unproblematic for some people)
so that's where i'm at and i can't decide what to do- i only saw pms specialist 1 week ago. i have some cerazette and i have extra citalopram and i will need to make a decision soon- pms is looming! i'm worried about side effects of cerazette- really, the mirena was so awful! i'm not mad keen on more ssris but i understand the logic behind a temporary increase each month.
anyway, wwtf, i thought i'd let u know what i know and i'm also wondering if there's anyone who's tried either cerazette or ssris for pms.
(it's not actually cerazette- it's cerelle- a cheaper version, but the same thing)
hope you're ok wwtf and thanks in advance to anyone with words of wisdom!

The HRT used in menopause- or at least part of it- is apparently not licensed for use in perimenopause/pms so you might have difficulty accessing it- (tho it might be worth a try), however, the second option that the specialist gave me was cerazette- progestogen only pill- to basically stop ovulation- no ovulation:no pms!

mutton Is this something your dr told you - or have you read it? It's not true! Thousands of women use HRT during perimenopause; you don't have to wait to be post menopausal to use HRT. Out of interest is your PMS specialist a gynaecologist? Or a GP? I'm a bit worried that they don't know how to prescribe HRT!

There is another link in this forum to the draft menopause guidelines produced by NICE on 1 June.

This is from page 12:

^Ensure that menopausal women and healthcare professionals
involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline
on depression.^

At the start of the report they say that they will discuss peri meno and meno under the same umbrella term of menopause throughout the guidelines.

Obviously 'low mood ' is not always the same as PMS though PMS ca include low mood! what are you main symptoms?

I'd be concerned about using a progestogen during peri as it sometimes causes (in a normal cycle) the PMS women get. The type in cerazette is desogestrel and this is different from the Mirena, but there are also 3 other types of progestogens and bio identical progesterone that can be used as part of HRT.

I don't know a huge amount about ssris-though have a friend who is a pharmacist- and was led to believe that all these types of drugs need several weeks or months to have their full effect so that seems to be contrary to what your dr says that they have an instant effect.

what do you think you will do?

hi pinkfrocks and thank you so much for your response!
i think my pms specialist is a gynaecologist so i'm wondering if i misunderstood her- i do know that she said that a part of-(i think)- the progesterone/progestogen part of HRT was not licensed for my condition- i'm not sure if she meant my condition of PMS or perimenopause- i think PMS.
But it is the fact that i'm in perimenopause that my pms is bad so i guess it's both- how confusing!
re the ssris, i definitely got the impression that the doctor believed this was the first choice of treatment but, again, i think she meant for the pms rather than the perimenopause. i do have pre-existing depression but i dont think this was why she considered the ssris for me particularly- also i'm on quite a low dose.
i actually feel very confused because i dont know whether i should be seeking assistance for perimenopause, pms or both!
i appreciate you asking what my symptoms are, so...(brace yourself!)
foremost is horrible anxiety the week or so prior to period including night time/early morning fearful wakenings
i'd say second is mood swings throughout the month- i'm definitely far more up and down these recent months than ever before and i really dont believe this is due to circumstance or general depression- feel quite out of control sometimes and dreadfully sad but as i say, up and down
physically i'm not massively bothered by symptoms but i'm sure it's of note that i have raging acne on my forehead/quite painful for most of the month...never had that before!
my periods are starting to get a bit lighter and slightly closer together
i cant think of anything else- i just wish i didn't have periods! what you say about cerazette is kind of what i was worrying about- i think the progesterone part of hrt is meant to be more natural/bio-identical but, as i say, the doc said it's not available to me!
is hrt generally seen as the way to go for problematic perimenopause? i really feel like my life is on hold- i'm just waiting until my periods finish and i dont really like having appointments, holidays, nights out because i cant face them if have pms/mood swings (i even had to rearrange my pms appointment because of it!)
sorry to have gone on but i do feel rather desperate!
also, sorry for wtff for any misinformation from me
as an additional note, i have a recollection of my gp saying i was too young for hrt when i sought help for pms due to perimenopause- is this not the case...i'm 43.
thanks for any help

It sounds horrible for you

Peri is a time when PMS gets worse, often.

The new guidelines from NICE say that women aged 45 and over ought not to be given blood tests for peri symptoms as it's par for the course at that age.

But you are in the 40-45 age and they do seem to say that there is some sense in doing blood tests - in your case you have a family history of early meno too.

Might be worth looking at the website of prof John Studd who talks a lot there about PMS and depression and treatment.

HRT would normally sort out your moods because it will give you a stable amount of hormones and re-set your cycle. It may take a while to settle down though because as your own hormones are up and down you may experience some blips with bleeding etc.

final paragraph of this page
www.studd.co.uk/meno_pms_clinic.php

brilliant! thank you so much.
i will settle down on the sofa and do some serious reading!
also i will look on the menopause forums given that you explained that NICE guidelines tend to consider peri and meno together.
may some good karma come your way!!

Hiya

My PMT and associated depression went through the roof a few years ago, linked to peri menopause (insomnia, mood swings etc etc).

I didn't realise there was a link to progesterone for me - in that anything too heavy in progesterone really sent me downwards.

HRT really helped me - been on it since I was 43 (ish) and still on it now. Took a couple of go's to find the right one and a sympathetic GP. Highly recommend doing some research yourself - so happy reading! Hope you find the thing that helps you.

(Having said that definitely hormonal today - the cat is looking scared!)

that's really interesting, thank you, mycat- you did well to find a gp to prescribe the hrt.
i hope u dont mind but i have an tonne of questions!
can i ask how long you've been on the hrt and is getting the right one a case of tweaking doses rather than changing hormones?
how did you "qualify" for hrt? were you still having periods ie perimenopausal rather than menopausal?
did you find that although there were clear patterns of PMS (obviously at specific times), you had mood swings generally throughout the month- more pronounced than ever before?!
when you say that you feel hormonal today, is that still less pronounced than before the hrt? hope you're ok, by the way!
finally, is your cat ok?!
big thanks for any help

by the way, on a vanity note, does hrt help with stubborn weight gain- and lethargy, for that matter...i'm pretty sure my energy supplies have dwindled more than they should by 43...feel like an old woman!

Most importantly cat is fine but he is a git!

I first asked for HRT when I was late 30s - as was bleeding all the time, though lightly. GP said I was probably peri menopausal but too young for HRT.

Nurse had prescribed me some gel for vaginal dryness but GP refused to prescribe any more...helpful.

Went back when in early 40s - again as lightly bleeding all the time - again no HRT.

Went back when 43 (ish) after a flooding incident on holiday. Said to GP (the 3rd different one) that I never wanted that to happen again and he asked if I had ever thought of HRT? I could have kissed him.

At that time I was also getting really quite violent mood swings, I've always had PMT but of the slightly snappy, bit depressed, eat carbs kind. This was different, really, really down for substantial parts of the month, crying, and really quite a horrible person.

The first HRT was, I think, one of the older ones - Prempak maybe or Premarin?

It helped with so many things (anxiety, general niceness, insomnia), and made the periods of depressive behaviour less awful but they didn't go away. Talked to GP again who said I might be finding the progesterone difficult and suggested Qlaira, which is also a contraceptive, and is marketed as a mimic of the natural cycle.

I still get a bit snappy and depressed for a couple of days a month (not very predictably as I suspect I'm getting to a stage where my hormones are all over the place) but it's much shorter duration and I feel much more stable generally.

The Qlaira worked for me, but I suspect there are lots of different hormonal factors there for every woman and a one size fits all approach isn't going to work.

great- thanks for all that, mycat- like you say, everyone's different so i'll take my time reading up- though first thing i'll do is gen up on qlaira!
it looks as though you experienced symptoms at a younger age than me and that the physical ones are different- my mum always talks about the time she flooded! i've never experienced this
mind you, the emotional symptoms you expereinced are very, very familar!
i have gp appt now actually- ostensibly to renew ssri precription but i may ask tentatively about hrt!
thank you again- you've given me some hope!