Menopause or mental health?

[amberdog]

I'm really struggling to work out what's what here. I had my first experience of anxiety and depression - which showed up as pain in my body for which no cause could be found - when I was 41. The trigger was being made redundant. GP prescribed Citalopram and Amitriptyline to manage the pain and over the next year or so I recovered, but stayed on a low dose of Citalopram for years as I just felt better on it than off it.

Fast forward 10 years, my periods stopped when I was 51. In the years leading up to this I started to suffer more with anxiety and insomnia but didn't really relate it to menopause. Last year when I was 54 and following all the publicity (Davina and others) I started on HRT - Estradot patches and Utrogestan. I haven't really noticed any benefit from it other than the Utogestan makes me drowsy at bedtime.

In the last 6 months I've experienced a real dip in my mental health again, anxiety with racing heart which I've never had before, insomnia off the scale and an ever increasing list of things I worry about. I'm on an increased dose of Citalopram, take Propranalol when I need it and have had 3 months off work - just going back now.

I keep thinking it might be worth changing my HRT and then I tell myself I'll be wasting my time as my problems aren't hormonal. How do I tell? I'm 55 now, have had no periods for 2 years and barely recognise myself. I'm anxious, have no confidence and am such a poor sleeper.

If anyone can relate or suggest any way of unpicking the is it / isn't it hormonal puzzle, I'm all ears!!

I was 48 when I called the GP mad described my symptoms and she couldn’t say if it was menopause related (still have af but other symptoms so poss peri) or depression because of work. Was Put on Mirtazapine cos I wasn’t sleeping after 4 months I was having panic attacks and now have Propanol on stand by.
sleep is much better and I lived to a less stressful job but I still have the FuckYouAll days.

hormones are strange I would suggest you speak to your GP and see what they say

Thanks WetWilly. I'm glad Mirtazapine has helped you. I've considered asking the GP but concerned about weight gain as a side effect. Has it affected your weight?
Wondering if anyone else has had an experience of upping their oestrogen or trying a different HRT to help with psychological symptoms?

Up until last August I was on HRT, it had stopped the hot flushes but I had terrible insomnia and sleep problems, palpitations were awful ( lots of ectopic beats rather than racing heart) muscle and joint pain ( the reason I had originally asked to go on HRT) was slightly improved.
Basically HRT made some of the minor symptoms more bearable but seem to amplify others.
Anyway I was diagnosed with breast cancer which was very hormone sensitive. Immediately came off HRT and straight onto hormone blockers. So basically cold Turkey. I was dreading it.
But 9 mnths on all the really distressing symptoms have gone. I sleep like a baby, my moods are very stable, palpitations gone, still have muscle and joint pain but that is improving. A few hot flushes but short lived and easy to cope with.
I am so much happier, maybe the major health scare has made me realise how insignificant the menopause is in the whole scheme of things. And maybe fast tracking it has helped.
I’ve always wondered whether being post menopausal is actually better than being peri/pre or actually menopausal and I can confirm it’s actually pretty good.
Stable moods, patience ( I’ve recently taught my son to drive, something I couldn’t have considered a couple of years ago).
My DH recently had a stroke which was pretty frightening but I’ve been able to deal with it well and with the patience needed.
I’m enjoying life and zero hormones is pretty cool. My libido disappeared but has returned, I think that was more to do with surgery and cancer treatment.
This year is a pivotal year for both DH and I after both of us have had to face up to our own mortality. Clinging onto to hormones that had never made my life easy ( endometriosis and fertility issues) seemed a little pointless.
What I’m trying to say is that filling your body with hormones and mood enhancers may not necessarily be the answer. Maybe lack of wildly fluctuating hormone is the answer.
I really thought I’d miss them but I don’t.

@amberdog My advice is that you try changing your HRT first. The other thing you could try alongside all of this is CBT (online free courses) or in person, or even counselling. I can't tell, of course not, but your first reaction that caused pain was a result of something that occurred- a life event. Maybe talking therapies then could have helped? Is it ever something you have thought about?

There is also a lot of growing evidence that exercise is as good as mild/moderate use of ADs and that for many people on ADs long term, it's a placebo effect.

Do you exercise daily? Brisk walks, or similar? (MIND has advice on this.)

With HRT are you using Utrogestan daily? If so, it might not suit you. You could try using it sequentially, which will give you a monthly bleed, OR carrying on with the 100mgs dose daily but use it vaginally. This means it doesn't get to the brain/ nervous system and cause side effects.

You could also increase the estrogen dose. What are you on? I'd assume at least 50mcgs or even 75 for a young person like you!

Increase the dose and give it 3 months, but also think about talking therapy/ CBT and exercise.

I had anxiety, panicky, awful palpitations, can't take HRT ended up in an ambulance three times. Consultant prescribed beta blockers for palpitations low dose but they work. Exercise even housework helpful. Diet well certainly some foods now disagree with me. So gluten free pasta, lactose free milk, avoid onions, chilli, tomatoes have helped. Too much bread is bad. Take low dose of omeprazole in the morning. It's trial and error

The symptoms you are describing @amberdog are those that many women used to have, 50 years ago, when HRT was hardly used. I remember friends of my mum being given valium and amitrip to help calm them down or sleep.
No one ever linked it to menopause.

NICE guidance is that HRT is the first step for all these psychological issues, along with perhaps talking therapy.

As you are already on hrt it makes sense to increase the estrogen (and possibly reduce the progesterone) and give it a try.

Thanks very much @JinglingHellsBells @Angrymum22 and @justasking111 for your replies. I'm really sorry @Angrymum22 to hear about all you've been through - you're right, it's important to keep perspective.
I have had quite a bit of counselling/therapy over the years and have had therapy recently to help me with some difficult things that I hadn't dealt with, but which are likely behind this current episode with my mental health. When all this kicked off I was in permanent 'fight or flight' and unable to sleep at all. I am really frightened of going back to that place and this fear fuels my insomnia. Maybe CBT would help with this - although the sleep restriction that seems to be part of CBT for insomnia scares me a bit.
I'm fortunate that I really enjoy exercise. Before all this I was probably doing too much, following a training plan and putting myself under pressure, but now I walk every day and cycle or run a couple of times a week.
I will speak to my GP about increasing my oestrogen. She has been reluctant until now, wanting me to recover from this episode with my mental health but I can ask. Thanks again for your replies x

@JinglingHellsBells I'm currently on 50mg oestrogen and Utrogestan orally each day

Your symptoms are very much peri menopause. Sounds like you need to increase your oestrogen, see your GP.

My GP has agreed to increase my oestrogen to 75mg. She didn't make any suggestions about the progesterone. Would you suggest I see if the increased oestrogen helps before doing anything else @JinglingHellsBells Hope you don't mind me asking, your suggestions are super helpful!

@justasking111 I had heart palpitations too, thought I was going to have a heart attack. I started eating hormone balancing foods and I now never get heart palpitations and in fact all my menopause symptoms have disappeared

I thought I would update this thread to say how much better I feel now. I no longer take Amitriptyline or Propranalol and have reduced my Citalopram to 10mg. I am no longer anxious, I'm sleeping well and feel myself again.

A few things have helped, regular exercise and some therapy, but by far the biggest impact has been the increase in oestrogen to 75mg. It took nearly 2 months for me to really feel the difference, but it's been transformational. Even my sex drive has returned and that's been gone for years!!

I feel disappointed that the push to try HRT and then increase the dose had to come from me - I had to ask my GP on two separate occasions both times - but relieved it has made such a difference. Posting in case this helps anyone else

@amberdog thank you so much for updating your thread. I'm in a similar position to you, spent the best part of a year trying to get on top of my severe anxiety/depression and not knowing whether it should be treated as hormonal. I've finally started on hrt (I did start it once before but stopped after a month as I was worried about the progesterone part) and am really hoping that this is the missing part of the puzzle. It's so helpful to hear about your experiences. I'm so glad that you are feeling better.

Good news op.
I could have written much of your post and having started HRT about 4 weeks back am back to sleeping much better and have no longer got that racing heart anxiety.