Perimenopause or 'just' anxiety

[QsGal]

I was wondering if anyone had any advice before I take myself off to the doctors to talk about the awful anxiety I've been getting.

Pre-Covid I went to the doctor's to discuss my low mood, disassociation and heavy periods, thinning hair, brittle nails. They did the basic blood tests which all came back fine, and sent me off with the advice of taking a holiday. As I was leaving I questioned whether I could be perimenopausal to which they replied. Possibly, yes, and closed the door.

Recently I've been getting bad anxiety - racing heart, restlessness, poor sleep and the feeling I'm just going to have to leap up and run out of wherever I am or I'll go start screaming. Yesterday I started crying in the car with no apparent reason and so today I've decided I need to do something about it. I have started a new project at work which does seem to make things worse, but it feels like my anxiety is disproportionate to the new pressures. I've reached the stage where my body seems to be fight or flight mode all the time, so I don't get any rest or relaxation on my days off/weekends.

My question is, how do you know when symptoms are attributable to perimenopause (I'm aware it won't necessarily show up in my blood tests) and not just anxiety? I feel I may have to be prepared to challenge my doctors or risk being dismissed again. I'm not having hot flushes but I do get night sweats ahead of my period. I do get mood swings but that seems to be linked with the anxiety.

I'm 42 and my periods are still regular, but when I had IVF 7 years ago I had a low AMH which I suspected would mean early menopause but that's without any scientific justification! My mother started going through the menopause early 40's so there is history.

My next concern would be taking HRT. If my symptoms are attributable to perimenopause I know it can help, but when I've used oral contraception in the past (not since my early 20's) I had a bad reaction and ended up depressed. Is there the risk that HRT could do the same?

Sorry for the rambling post but I got up this morning knowing I have to do something as I cannot carry on like this. Any advice/help would be much appreciated.

If your gp will prescribe it then you only get it for 2-3 months anyway so you can try it? See if it makes a difference?

Heart palpitations are not good for you and should be checked out in any case. They are a classic peri symptom.

Hi OP Have a look at this website which has loads of very useful information including how to talk to your GP about HRT. Dr Newson is brilliant. www.menopausedoctor.co.uk/

Thank you for your responses. I’ve watched a couple of Dr Newson’s videos and she is brilliant.

I’ve just had a telephone appointment and the doctor was wonderful. She is going to start me on low dose citalopram to help with anxiety while we wait for the blood tests (the waiting time is quite long and she didn’t want me to have to go on like this in the interim). She did explain that there is a lot of focus on not prescribing antidepressants for menopausal symptoms and she was very clear that there will be future discussions about the long term treatment once the test results are back. And she also said that FSH testing might not be very useful anyway, but I’ll guess we’ll see. I’m going to use the time to research into it so I’m prepared next time.

She sounds very well meaning. Have you read the NICE guidelines on prescribing anti-ds? As you are under 45 that is standard I believe.

Blood tests are not always helpful so keep talking to her and don’t be fobbed off

Hi @QsGal, just read your post with interest. I'm a couple of years older than you and I do have some history with anxiety and depression. But in Feb, having been well for around 5 years, I had a couple premenstrual panic attacks and severe anxiety, which didn't fully go away with my period. After a couple of weeks I contacted my GP and decided to go back on SSRI. I'm a few months in and a couple of months on an increased dose and though it has helped I still don't feel well. My periods have changed over the past 6 months or so, a very long cycle and a very short cycle and changeable, lighter, couple of episodes of severe breast pain ... my PMS is dreadful. I'm now thinking I may be peri ... there's been other stuff like you mention ... night sweats particularly second half of my cycle, aching hips, insomnia, but anxiety and low mood are the worst things, and more recently mood swings. I feel so unlike myself. I can relate to what you say in terms of wanting to run out screaming from situations. I also tried hormonal contraceptives as a young women and felt they worsened my mood so have always avoided them since, concerned HRT might do the same. That said, I'm thoroughly sick of feeling as I do and desperate for help. I am due to speak to GP in three weeks and will be discussing then. X

In a similar boat though a bit older than you. The peri. has added yet another layer onto my existing anxiety issue (I have c-ptsd), I am almost certain of it. Problems with hormonal contraceptives so avoiding HRT.

You have my sympathies but I don't have any answers I'm afraid.

Watching with interest.

I had a Newson appointment and my main symptom was anxiety. It was explained to me that anxiety with no previous history (although for me I had anxiety after the birth of my kids, when oestrogen is at its lowest so probably an indication) could be perio related. HRT takes a while to tweak and get right and psychological symptoms are the last to be resolved apparently. Blood tests won’t show anything as your hormones fluctuate literally hourly, at our age it’s diagnosed on symptoms. HRT can be body identical, depending on what you’re prescribed, so less likely to cause additional mental health symptoms. I’m trying it for a few months to rule out if it’ll help before I try anti anxiety or AD’s, but I’m being patient with the dose and you should allow 3 months for each tweak to show results. Good luck and try to stay positive

Such a good point from pink rabbit. If nothing dramatic has happened and you now have anxiety then it may be peri. Mind you the past year is a enough dramatic for anyone but I do think women know themselves and their mental health more than we give ourselves credit for

That's interesting @pinkrabbits39. I'm 3 and half months on AD and now wondering about exploring the hormonal stuff because I'm not convinced increasing my dose of AD will help when I suspect my issues may be peri.

Really hard when you have a history of anxiety/depression to know if you're having a recurrence or if this is peri related. I suspect a bit of both.

Always good to talk to your doctor about anxiety, but also diaphragmatic breathing in small steps. If you feel too anxious that you can't possibly focus, even contemplate relaxing in any way, then taking 5 -10 belly breaths actually tells the nervous system that it's okay to stop ' being on high alert'. Breaking being trapped in 'anxiety mode', like rebooting a computer circuit. Have tips on www.the relaxation pod.co.uk

Did you end up taking hormones? How did you react to them? Am in the same boat x