Need someone knowledgeable to talk to

[SuggestiveBiscuit]

Hi,

I’ve got to make a decision on what medication to take for my peri menopausal symptoms. I have a complicated health background.

My main symptom is anger, pure and utter rage and paranoia. I can only link it to my cycle once my period has started as my cycle is so erratic between 26 to 60 days. Then I realise why I felt so dreadful.

The symptoms I can live with are; periods that last for weeks; some night sweats; bad skin; aches; tiredness; sore vulva, like a uti bit not.

I am 48 with a history of oestrogen positive breast cancer over 10 years ago. I have autoimmune issues; low thyroid and the blood markings for primary Biliary Choliongitis but no liver disease. I don’t and have never drunk, I’m a slender vegetarian!

I’m on 20mg of fluoxetine daily and 50mcg of levothyroxine.

I have read the Nice guidelines for menopause so I was able to attend a hospital menopause clinic. It has been agreed by a breast surgeon ( not an oncologist) that if I decide to take HRT I will be low risk and monitored.

The options I have been given are.

1- up the fluoxetine to 40mg daily. They can’t do the upping it two weeks before my period as I never know when my period will be.

I know fluoxetine and it suits me but if the symptoms are caused by hormones I don’t understand why or if this will help.

2.be moved onto a specific SSRI that is used for the menopause. I can’t remember it’s name.

I’m worried about changing antidepressants I’m lockdown and any side effects being worse than the benefits. Again I don’t see how an antidepressant can help with hormones but I’m not the medic.

1. Be put on HRT. The doctor would like to give me a patch but as these aren’t readily available she would like to give me one squirt of oestrogel daily for 2 weeks and then progesterone daily for 2 weeks. Then a break through bleed.

I’ve always had dreadful symptoms on any sort of hormonal contraception. Bloating and stomach pains and persistent bleeding being the main ones. I’m told the progesterone in HRT is better tolerated than in contraception.

1. Marina coil. I had it before and I was in such pain with dreadful bleeding and bloating that I got it removed.

I suppose I’m moved to take the HRT but as I was told 12 years ago during my cancer treatment that I’d not be able to take it I’m frightened.

Any help, insight or support would be appreciated.

Thank you!

I'm not an expert but I'm going to tag @JinglingHellsBells (hope I have that right) as she knows loads about this sort of stuff.

If I were in your shoes I'd be inclined to go down the HRT route, especially as you are being monitored. Your symptoms sound awful and you shouldn't feel you have to accept them or put up with them. The vaginal symptoms alone you really do need to treat.

I'd be willing to bet your symptoms are hormonal so I wouldn't be inclined to up your SSRI dose as I also can't see how that would help. I take an SSRI too, not for menopausal reasons, so I know how they work.

I had an easy enough perimenopause, all I took was natural supplements which helped with the overheating (I didn't really have flushes) then started using Vagifem pessaries when the vaginal dryness and soreness got too much. So I don't personally have experience of using HRT other than the tiny amount in Vagifem. I'd have gone on HRT like a shot if I'd felt the need!

HRT is a wonderful thing if you want or need to take it. It certainly would be worth a try for a few months to see if it makes you feel better.

Hi there@SuggestiveBiscuit I'll try to help:) I'm not medical but am a health writer and talk to experts. I've used HRT for many years, from a meno specialist.

I think things have moved on a lot since 12 years ago as far as HRT goes.

There are mixed ideas about HRT and previous cancer. Some UK experts say it's okay because they believe the risks are very small and it's quality of life that matters.

The overall consensus is that estrogen may promote and existing cancer to grow but not cause it in the first place. (There is actually no sound, absolute cause=effect proof for estrogen and breast cancer.)

Also, women who use only estrogen HRT (women who have no uterus) have less breast cancer than women NOT using any HRT.

I don't know where you live, but in London there are menopause experts who can help you with this.

The option you have - gel and Utrogestan- is the most popular type at the moment amongst meno experts.

However, some of those experts may well advise you to reduce the Utrogestan from 2 weeks per cycle to as little as 2 weeks per 6, 7, or 8 week cycle. You'd need to do this with medical supervision and might have to find a private consultant who prescribes this off-label regime.

This is because they think it's progesterone, not estrogen, that's the 'bad guy'.

NICE does not advise using SSRis for menopausal moods. First line of treatment is HRT.

You are suffering and you need to weigh up quality of life over a small risk.

There is a great interview with Kirsty Lang who had BC and is now using HRT only a few years after her BC treatment. It's on the Liz Earle Wellbeing website as podcast so it 's worth finding that and listening.

Thank you so much DramaAlpaca and JinglingHellsBells.

I’m so sorry for writing and disappearing. Another symptom I forgot about is brain fog and forgetfulness. I wrote this, started doing something else, and forgot I’d posted.

Thank you so much for talking me through it all. SSRI were mentioned as the only option if I couldn’t have HRT. Now I can have HRT I “think” I can discard the idea of messing about with them.

I am in London and I’m sure I could talk to the doctor at the clinic about the progesteron regime you mention. However my care has been passed to the GP in the short term. I will talk to the GP on Tuesday. This is so o can get a repeat prescription and don’t have to go the the pharmacist in the hospital. I would prefer to take as little progesterone as possible as I personally think I’ve never got on with it.

I really like the consultant I saw, Mr G. Lieberman at the Whittington.

OP I haven't got much to add except to say I've googled 'menopause and paranoia' today myself

Do you know if your thyroid meds are optimal and well-monitored? Even when on a dose of levo that kept my bloods looking good (tsh below 1, t3 and t4 in the upper range) I never felt well and had lots of symptoms, including low mood. I feel better - physically and emotionally - on combined levo and liothyronine. For whatever reason it's infrequently offered in the UK. Feel free to pm me.

@pawpawpawpaw

No my thyroid isn’t well monitored. It’s shockingly poorly monitored by the GP who never call me in about it. I get blood tests for the liver issue and the liver consultant thinks I should up my levo as even though the markets are all reading fine they’re not fine for someone with autoimmune disease.
Although saying that I haven’t felt this “good” in years in that I can stay awake during the day for most days no problem. At my worst I was sleeping 20 hours a day, vomiting, fainting. I had so much time off work I was in danger of losing my job.
I must have Googled perimenopause and paranoia but I can’t remember doing so. I think they may actually be out to get us.
I would love to pm you. I’ve got to do some parenting now but later. Thanks so much.

Yes, happy to help

It doesn't surprise me that your thyroid stuff is not well looked after. I had to advocate for myself to get any meaningful treatment.

I felt very emotionally low when undertreated: sad, very vulnerable, emotionally cold towards others, easily overwhelmed and anxious. I can't remember if rage was part of it, but despair certainly was.

I'm wondering if there's there any chance your liver consultant could write a letter to your gp suggesting a referral.

I’ll pm you now.

Maybe they could but I have asked to see a specialist in thyroid and been knocked back.

This is my problem. I have lots of horrid symptoms but no one person who knows about ME so I don’t know which of my illnesses/ being a female is causing the symptoms.

My whole body started to pack up on having my daughter. My mood span out of control, I got breast cancer, my thyroid flunked and my liver crashed.