Do I need HRT? Or therapy? Anxiety meds? Or something else?

[samecrapdifferentname]

Wasn't sure whether to put this here or in Mental Health.

I had a thread recently about starting a new job which gives a bit of background to this (here: www.mumsnet.com/talk/am_i_being_unreasonable/4543013-aibu-to-have-a-wobble-about-this-job-offer), but probably no need to read!

I've recently accepted a job offer which means going back to work outside the home after nearly 18 years, and which has sent me into a spiral of panic and anxiety.

Some anxiety is obviously to be expected but I feel like what I've been experiencing is out of all proportion to what's actually going on.

I am pretty sure I'm experiencing peri-menopause but everything seems to be feeding into everything else - I've not been sleeping much beyond 4am, I've had my first ever night-sweat this week and I've noticed that since I started my period in the last couple of days the anxiety has been massively reduced so there seems to be a hormonal element.

Added to this, it's been a very tough couple of years. Two bereavements (one parent, one sibling) in 2019 and 2020. Shielding as a family with our CEV child from March to August 2020. General feelings of isolation and loss of many relationships with friends over covid as people seemed to re-set after lockdown in different ways from us.

Lots of reassessing some fundamental beliefs about how life works.

A very wise friend has suggested that I need to pay attention to how things are (I am a total 'roll up you sleeves and get on with it' person) and take some time to process the things which have happened to me personally and to us as a family. (And actually this is stuff over the last 20 years if I'm honest.)

I think she is right but I'm also not sure what that looks like. I think I need to speak to a GP about it all, but that's easier said than done at the moment and I feel like if I don't communicate clearly I'm not going to get the right thing.

I don't even know if any of this makes sense - but I think the hormonal stuff needs addressing; but also that I don't want to just leave it there but maybe pursue some therapy or counselling but I don't know how to go about it.

It just feels like there are suddenly a lot of interconnected threads to untangle.

Just giving this a little bump, but also reading other helpful threads.

How old are you ?
The anxiety about working outside the home is to be expected, and will go once you get used to it. The rest of it does sound peri.

Yes sounds like peri. Download the balance app and record your symptoms. Then you can show that to the GP instead. That's what it's for.

Do you get any down time? Which would be when you would think over the day at work and other events. If you don't can you make some.

Peri or underactive thyroid. I felt very similar with both issues.

I'm 46.

I know that the anxiety is to be expected but the extent of it is out of all proportion - feeling sick, randomly bursting into tears, overwhelming thoughts about how awful it might be....

Your link to your previous thread doesn't work :(

Have you any other peri symptoms? I know you have listed a few.

You've had a lot going on and it's not surprising you feel exhausted and emotional.

I'm not sure you need 'therapy' but maybe something like half a dozen sessions with confidence coaching to help as your self esteem and confidence sounds low.

How soon do you start the new job?

And I'd definitely give the HRT a try. If you get the dose right, it can be great, and it's a bit 'suck it and see'. if it works that's your answer.

Sounds like you have lots of things going on here, no wonder you feel anxious. It sounds like you also could be peri menopausal which doesn’t help. I had similar symptoms at your age and it took me 5 years to realise what was wrong. My mind was so much in a whirlwind not knowing why I felt as I did. I felt so much better after I started HRT, increasing exercise, healthy diet and cutting down alcohol. I had so much more energy and felt the best I’d felt for years, I wish I’d tackled it earlier. Why not explore peri menopause options, establish better sleep etc. You might then feel stronger, more clear headed and more resilient at tackling other aspects of your life. Be kind and take time to look after yourself. You will eventually see a way through I’m sure.

Therapy wouldn't do any harm. HRT neither. I'd push for both. You've been through the mill & now your hormones being out of kilter could well be pushing you over the edge. We all have a breaking point. You sound very sensible - there's no shame in getting help xx

www.mumsnet.com/talk/am_i_being_unreasonable/4543013-aibu-to-have-a-wobble-about-this-job-offer

This might work. I think the end bracket somehow got involved in the link.

Start date for work not agreed yet but probably beginning of July.

I'm not sure about confidence and self esteem being the issues but I'm taking note of what people say.

When I'm feeling the anxiety, it's not that I don't think I can do the job, it's more that I don't want to change things about my life. But I don't want them to stay the same either!

I had the anxiety and waking early thing too. Started just before I turned 47. I'm two months into HRT and my mood is much more stable and things seem more manageable now. I'm sleeping soundly every night too which helps enormously.

It's definitely worth a try. 💐

maybe you could separate out the two issues as it sounds as if you are conflating things, which may not be connected.

On the one hand, you could try HRT to help with your peri symptoms. Anxiety might be one, but it may not be.

What stands out from your posts and other thread and this one, is you are not really comfortable with your decision over work. Maybe that's not how you feel but it comes over that way. Do you have to work 3 days? Could you not ease yourself back in more slowly? No idea what work you do, but is it something you could do freelance, to have more control over your hours?

Is it a career step or simply a means of making money so your DH can work fewer hours?

I don't think therapy is the right sort of help. I do think that coaching, with a good coach, maybe with a psychology background, could help you unravel your confused and conflicting thoughts.

Because what you see to be saying is you are terrified of change. And that you want guarantees in advance that this change is going to work.

No one can have that! About anything.

Nothing in life is certain, but unless you are doing something that is not reversible, ever, then you can make new changes.

I do see what you're saying and I can understand why it's coming across that way.

I don't want to get into the details massively but I think some of what is going on is:

a) I've had lots of really difficult things to deal with over the last couple of years and longer term. In general I've dealt with them well and I'd like to examine what's making a difference this time

b) I do wonder if a life-time of just rolling up my sleeves and getting on with it when I've had no choice is leading to a massive aversion to making a choice which makes me uncomfortable even if that discomfort is reasonable and likely to be short term.

Anyway, this in itself has been quite helpful, so thanks!

Do you need to make this change now? Maybe you could think of it as a trial run - applying, being offered it , etc- but you are not in the right place emotionally yet.

It seems a lot to take on considering the last 2 years .

Honestly, I get it. I really do. Am in a very similar situation and have just visited the Dr. I would try all three! You could start on hrt. The risks have been overstated. Hrt will take around 3 months before you feel any effects. Also the Dr should run blood tests to check your iron and thyroid symptoms as these can also cause similar issues. It may be well starting out on a low dose of antidepressants as these will only take 2-3 weeks to start to kick in. You can also self refer for CBT online via a link from the NHS website. It sounds like a combination of issues going on here (the same as with me), hence me going for a three pronged approach. If the hrt improves things, then I can always reduce the antidepressants or come off them. The CBT is a no brainer as an additional add on as it can be very effective. You can even start with an approved NHS online course whilst waiting for a referral which can take months. You might as well sign up now. Don't forget that you don't have to commit long term to either medication. You can try them out for a few months and then review.

If taking up a new job is causing too much anxiety, then perhaps delay and take on some voluntary work instead until you get back on your feet. I'm having a bit of a low moment myself and awful pmt (I start my hrt next week), so am off to bed soon as my sleep has also been disrupted. However feel free to message me. I won't reply tonight though as am off to bed.

For a variety of reasons HRT isn't a good idea for me so I'm on a mild (37.5mg) daily dose of Venlaflaxin - it's an antidepressant that is good (for me at least) reducing hot flushes and - in my case - anxiety. It might be worth asking your GP about it perhaps?

Anti ds are only for women for whom HRT is medically unsuitable.
GPs are advised by NICE that they are not to be used for peri meno symptoms like anxiety. It's taken over 15 years to get this message over. No one should be asking for them as they are proved not to work anyway. (Plenty of evidence on the website of Dr Louise Newson on this.)

Agree re the antidepressant comment if the primary cause of the depression is hormonal. It's not always and not always obvious. Often the two become interlinked.

I can really identify with this post and your sense of things being tangled. I am 45 and have spent the last 6+ months wondering what the heck happened to me... is it hormonal? mental health? lockdown? family issues? work? all of the above? I have found myself adopting the 3-pronged approach: HRT, CBT, AD (plus sensible lifestyle choices). Not sure which ones if any are working so far. I find it interesting with the CBT that the practitioner has acknowledged my need to find the 'reason' for how things have changed but she's discouraged me from putting too much weight on this, emphasising the importance of behavioural and belief changes. Wish you all the best from the bottom of my heart.

Thank you Furryfeet; I wish you the same. I think it's this sense of everything being tangled up which is my preoccupation at the moment.

First stop, GP then I think.