Night sweats, sobbing at night and extreme anxiety

[areynold]

I am in my early 40s. I have become increasingly anxious in the last few months. As an example I lie in bed going round and round small mistakes I might have made at work and can't go to sleep, making me exhausted in the day. I can barely cope with work at all and mostly think about resigning. Some nights I have night sweats and others I find myself sobbing uncontrollably at night.

I saw a gynaecologist who has prescribed Sandrena which is a form of Hormone Replacement Therapy. I have been taking this for more than a month and it hasn't helped at all. The suggestion is that I might be peri-menopausal I think.

Has anyone seen these symptoms before? They are making life very tiring at the moment. Is there anything I can do?

Sorry you are suffering.
What you describe are classic peri meno symptoms. There is loads on the web- have a look.

Did you have other symptoms except for those you listed above? How are your periods?

Has your gynae done any hormone tests? These are not advised for women 45+ ( unreliable tests during peri) but if you are younger, it's worth doing your FSH and estrogen levels (but must be days 2-5 of a cycle.)

Sandrena- what dose ? It comes in two.
Are you using a progestogen with it? (You must unless you have had a hysterectomy.)

Thank you PollyPerky

I was put on the Mirena Coil at almost the same time as Sandrena. Before the coil my periods had become heavy and difficult which is why I volunteered for it. I don't have any other symptoms except that for about 2 weeks after I started Sandrena my libido dropped to zero. It then recovered but today is back down to near zero. Since starting the coil I have had quite a lot of spotting but no real period.

The gynaecologist did do some tests before putting me on Sandrena, I think for estrogen levels, but they all came up completely normal which was frustrating.

The Sandrena dose is one 1.0 mg gel a day rubbed into my thigh. I am not taking anything extra on top of this.

Although the Mirena was / is considered a very good part of HRT, some research has shown that the progestogen in it does get into your system as if you were taking a daily dose of it. (As in a combined patch for example.)

It could very well be that the Mirena is the cause of your moods and weepiness. The amount of Sandrena you are using is quite low for someone in their early 40s (I use more gel and I'm 60s), so you could simply have too much progestogen in your system compared to the estrogen you're getting.

It's not my place to advise on the dose BUT with your dr's consent you could try a higher dose of gel or swap to Oestrogel, where the starting dose is 1.5mgs and you can self-titrate to 3mgs ( 4 pumps daily) if needed.

The other option is to remove the coil and use a progestogen for 10-12 days a month only.

ps You need to give it a bit longer because 1mg for only a month won't do much when combined with the Mirena. If you can. stick with it for 3 months then re-assess, or ask for Oestrogel where you can increase the dose every 2-3 weeks to see if that helps.

Thank you. Do you know, medically, what causes the anxiety? It’s really crippling.

I'm sorry, no, but progestogens are known for causing low mood in women (as in PMS as well as some kinds of HRT.)

Your symptoms could also be stress related. I am also early 40s, and I found that I could no longer handle as much as I used to, my sleep was affected and I got very tearful. It's taken some years, but I did not go down the HRT route on advice of my GP. I read up on menopause (Christiane Northrup and Sara Gottfried were the best) and worked on getting to know my older self and looking after myself.

I have worked a lot on my thinking. Every night I write down 3 positive things from my day. During the day I try to reframe negative thinking and praise myself. If my brain starts negative thinking at night, I stop it. I use a trick of counting backwards from 20, I don't know why it works, something to do with the frontal lobes, I think, but it does work. I also think of a good film/story and retell the narrative in my head. I keep telling myself that I am a great sleeper and that I will wake up refreshed after a good nights sleep.

You could also try meditation (didn't work for me), there are many apps to get you started, a guided meditation is a good start.

Also I prioritise exercise, I go swimming (and then sauna) 2-3 times a week. Really sorts out my head!

With the night sweats, try a light summer duvet (down or silk).

Vitamin B6 might work for you, it really helped me, as did Spatone iron and magnesium lotion (Better You).

I think at our age we have to look at the whole picture, diet, exercise, thinking patterns and life choices. Are you happy in your job? How are your relationships? You are at a point in your life where you can no longer settle, you can no longer compromise.

. It's taken some years, but I did not go down the HRT route on advice of my GP.

Were your periods irregular or had they stopped by early 40s?
If so, your GP's advice is against all accepted medical advice unless there was some strong medical reason not to use HRT.

The advice now given by specialists is that any women whose periods stop before 50-ish should seriously consider HRT (and before 45 is considered a critical age) to prevent bone loss and heart disease.

I agree 100% with your ideas that lifestyle is important (including looking at your whole life ) BUT if a woman is lacking estrogen , it must be supplemented to prevent other serious disease later on.

This is the advice of NICE and every gynaecologist.

If you did have an early menopause (before 45) you should have your bone density checked by the age of 50 in case it's fallen and you will then need a plan to prevent osteoporosis.

Polly, my periods have always been irregular, so no surprise there. I still get my period. My GP was very sympathetic, and she would have put me on HRT if I wanted to, she just wanted me to try some other things first as I was clearly stressed as well.

Exercise (especially weight bearing exercise) prevents osteoporosis.

The menopause is not a disease, it's a natural part of life. It's great that HRT exists, but it should not be the very first choice.

The trouble is usually not lacking oestrogen, it's fluctuating levels of oestrogen.

Our society has come to expect to take a pill for everything and you wonder why the NHS is over stretched. I think a pill should be the very last resort.

I think we're going to have to agree to disagree on this one!

1:2 women have osteoporosis. Loss of estrogen is the cause . Exercise helps and can build bone but not usually on its own (I am speaking from experience of serious osteopenia, treatment and research here.)

Osteo is caused by loss of estrogen. It affects not only post meno women, but women who have had irregular periods ( so fewer cycles over a lifetime) women with eating disorders who miss periods and athletes who miss periods due to low body weight and overtraining. (These are the words of my gynae who is a UK expert.)

The cost of osteoporosis, and the complications from it, cost the NHS far more than HRT! Osteoporosis is the cause of more deaths per annum than breast cancer, and most other female cancers put together.

Menopause may not be a 'disease' but it's only in the last couple of centuries that women have lived much beyond 50 and spent a third of their lives with no estrogen. This is a whole new landscape.

The International Menopause Society produced a very interesting paper on this which looks at women's health in midlife onwards. You can find it by googling- it's an interesting read.

misscph1973 I do hate my job but there is a cause and effect problem. I don't know whether I hate it because I am so anxious or if I am anxious because I hate my job. I tend to think the anxiety is medical but I should probably get a new job anyway (if only there were another one locally). A double whammy.

Polly, you have obviously done your research and you know a lot more than I do about menopause and osteoporosis.

I do still think that there are other factors in this. I don't think we can blame menopause only for osteoporosis. Lack of vitamin D, alcohol, coffee, stress and not enough exercise also affects the menopause AND osteoporosis.

areynold, that's a tough one with your job! It's really hard to make a rational decision when you don't get good sleep. Try some of the things I mentioned, and see if you feel better over the Christmas break. December alone can make anyone irrational!

Ultimately I think you will have to make some big decisions about your job. But you need to be in a (well-rested) position to do that.

If estrogen was not the most important factor in bone density, men would show the same level of osteoporosis as women. Clearly, they don't.
Here are some stats:(it's from the US but it's the same in the UK)
www.ncbi.nlm.nih.gov/pmc/articles/PMC2266953/

Osteoporosis affects over 20 million Americans and leads to approximately 1.5 million fractures each year, making it one of the leading public health problems in the United States (1). The most important risk factor for bone loss in midlife women is the menopause. Women lose about 50% of their trabecular bone and 30% of their cortical bone during the course of their lifetime, about half of which is lost during the first 10 yr after the menopause (1,2). Approximately 40% of all postmenopausal women will eventually experience fractures (1,2). In 2001, the National Osteoporosis Foundation estimated that the annual cost of health care and lost productivity related to osteoporosis was $17 billion.

The other things you mention like Vit D, alcohol, exercise, etc are relevant but if someone has osteoporosis, taking Vit D (only benefits those over 65-70 in terms of bone health), etc can help but it's not going to prevent it, or 'cure ' it if it's advanced. All those things you mentioned may help it getting any worse.

I am going to tell you what helped me and saved my life.

People will disagree, I'm sure.

I take a St Johns Wort and a 5-HTP capsule in the morning. After 2 weeks it changed my life. The terrible anxiety and feelings of worthlessness stopped. I stopped wanting to kill people. The dreadful rage boiling inside me reduced by a huge amount.

It does help some, I tried both, no effect for me. I think it's trial and error, it's very individual what works.

I absolutely agree with you Polly. Areynold, I was at the same situation. Very tired, without sleep, terrible anxiety and no function to my work. Low estrogen's levels causes a great difficulty at our brain's function, anxiety and the feeling that something terrible will happen. I did not feel good at work but it's due to my tiredness and my low mood. I'm 42 and my gyn said that hrt is a necessity for me due to my age. His diagnosis based more on my symptoms and not on my hormones. He said that it's harmful to leave my body to suffer and that the consequences to bones, my heart, my brain and my skin would be devastating! Early menopause isn't something natural, is more a deficiency for me and Hrt gave my life back! Sorry for my English! 🤓

Thank you Emerald13. We are the same age and I really hope I find the cure you did. What HRT did they put you on exactly and how long did it take until you felt better, if you don’t mind my asking.

I'm on cyclo progynova high dose, 2mg estradiol and 0,5 norgestel and I felt almost immediately better! I was first on livial for a month and it was a disaster! I changed my gyn ( I spent a lot of my energy and my money to find an informed one) and he said that I can try some forms to find what suits to me better. I feel good on cyclo progynova but I'd like to try micronized progesterone latter maybe, because it's more safe regarding breast cancer risks. My gyn said that at our age we have to protect our body immediately from the lack of estrogen. He said that It's very important for me to understand that hrt is a necessity to young ages. Hope you feel better soon! 💐

I second loveka's use of a daily 5-HTP capsule. 10 days after starting them I felt no longer felt anxious,or had that 'feeling of dread'.
Honestly changed my life too. To be honest I can hardly believe it. The tablets were recommended to me and I thought I might as well try them...well they work.

We’re you prescribed 5-HTP by your GP? Looking it up, it doesn’t look like the sort of thing you should self medicate with.

5 htp isn't available on prescription I don't think. It is prescribed in other European countries under another name though.

I did a huge amount of research on it, not just a quick google. I get it from Holland and Barratt. I wouldn"t buy it cheaper from the internet.

It has changed my life.

If your anxiety is a result of loss of estrogen AND you are under 45-ish HRT is essential. It's replacement ( HRT) and is similar to what someone would use if they needed insulin or thyroxine. You have a deficiency ( menopause 10 years before average) which puts you at risk for heart disease, osteoporosis and even Parkinsons disease, in later life.

The small risks with HRT do not apply to women who are younger (under 50) and even after 50 the risks only start to increase very slightly after 5 years.

Using herbal products or supplements might help with anxiety, but they aren't going to help your long term health of bones, heart and brain. Herbal products aren't always safe either- many of them have side effects and cannot be taken alongside many common day medicines (antibiotics for example, or the Pill.)

Thanks PollyPerky. It looks like I will have to stick with the current Sandrena programme for another month or so and then maybe the doc will increase the dosage. I too am not generally a fan of unproven medical remedies.

It would make me a lot happier if any of the blood tests actually showed I had low estrogen/whatever levels. Maybe they will next time.

My GP would not do any tests at all, as hormones fluctuate a lot.

I don't think it's wise to assume that you have low oestrogen and that you are in early menopause. You definitely need to make sure that this is the case, as your symptoms could be stress related.

I think there is a tendency in our society to assume that if a woman above the age of 35 isn't coping, then there is something physically wrong with her.

areynold It might be well worth asking to swap to Oestrogel simply because it's so easy to adjust it- it's one of the most popular types amongst consultants.

Re blood tests. The 6are^ unreliable but NICE guidelines say test women under 45 but not over 45.

You need to have 2 tests at least 2 months apart, on days 2-5 of your cycle (so when you are having a period.)

You might find the Daisy Network website helpful- charity for women with prem /early menopause. Some women have prem menopause in their 20s. If you look at the site (which is run by doctors) you can find Diagnosis and Treatments in the menu bar.

You have already seen a gynae so if they are any good (!) it sounds as if the treatment is right at the moment. Presumably they took a full history before the arrived at the choice of HRT for you? They will have far more info from you than we have here.