Can I attribute most of these symptoms to perimenopause or is it something else?

[Afternoonsnooze]

Or a combination of everything going on in my life?

I am literally at breaking point with my physical and mental health and am really not sure if perimenopause is to blame for the majority of this or not but I not longer know what to do or who to seek help from (and apologies in advanced if this may be a little long winded).

I have not long turned 51 and for the last 6 years my physical and mental health has been really affecting me and it is getting worse by the day.

I have always suffered from anxiety and depression but have now escalated to the point that I no longer no what to do, I’m in such turmoil every day. I dread getting up.
None of this is helped by the fact I help look after my elderly mum who has Alzheimer’s and has recently been diagnosed with advanced breast cancer and having to constantly battle with my dad who is a tight-arsed awkward old man at times and fails to see the stress I am under (I had a meltdown a few weeks ago which I started a thread about and due to the lovely advice given I have organised more help etc so hopefully that will help somewhat).

The physical issues are really getting me down. After decades of gynae issues and endless gynae procedures (including a failed uterine ablation which has left me in so much pain), I have discovered (through my own investigations, no thanks to my gynaecologist) that I have deep endometriosis and diffuse adenomyosis so am looking at the prospect of more procedures and a possible hysterectomy (I have an appointment with an endometriosis gynae tomorrow to find out what the heck is going on).

I have also suffered from gut issues and IBS for decades. To say these issues have exacerbated over the last few years is an understatement.
My digestive system is the bane of my life and completely controls everything right now. I’m having an awful time and despite endless gastro tests, all comes back ok and I’m just left to put up with things. I have tried everything (I mean everything) advised for good gut health/IBS control to no avail. I currently follow a very boring, low fodmap diet and avoid all my known triggers yet still have issues but I could literally eat dust and still have issue. I am certain my out of whack hormones are driving this. I have such unpredictable guts and can have attacks of diarrhoea out of the blue, can be constipated mid cycle, daily gurglings, growling, bloating, excessive gas, feel so nauseous with a gnawing feeling in my gut especially mid cycle, acid, burping, pain. All of this can even wake me during the night or stop me sleeping. There really isn’t a part of my digestive system unaffected and I’m getting to the point of being scared to leave the house.

On top of all the above have a whole host of symptoms these days including,

A red and blotchy face
Itchy skin and last few weeks a very itchy left armpit and all though no redness, dryness, lumps or bumps I am petrified about this since my mums bc diagnosis.
Tinnitus which is driving me to insanity
Smelling cigarette smoke (mainly mid cycle and before period). It worries me that it’s dementia (mum’s first symptom was lose of smell)
TMJ disorder which I’ve had years but has become worse
Sore tongue (but could be related to jaw tension and teeth clenching?)
Blocked right nostril and a lot of catarrh/mucus
Knackered - so so so bloody knackered
Ache all over some days, especially back and legs (no obvious reason for this)
Complete lose of libido (but tbh that’s the last of my worries right now as
feel too crap for sex)
Can go weeks sleeping well then endless broken nights sleep

Weirdly hardly any hot sweats or night sweats unless it’s hot weather!

My mental health is now completely shot to bits. I can’t cope with so much, everything overwhelms me, I’m letting housework build up, bills go unpaid etc. I find work a struggle and would love to leave. I could literally sit and stare at a wall all day doing nothing. I worry about everyone and everything (dc now teens and I worry all the time about them). Worry about my parents and the shit which comes from looking after them etc. My health anxiety is in overdrive. I can not rest or relax and feel as though I have an engine driving me all the time. It’s exhausting. I also have the rage alot everything and everyone angers me.

I appreciate there is a bit going on in my life right now and being a naturally anxious and angsty person is certainly not helping my issues but I wonder how much of this is being made worse by me being in perimenopause?

I don’t know what to do or what to take (currently on no meds other than occasional gut stuff). I have had mixed messages about taking HRT with endometriosis (one gynae said no, another said yes) and have asked on several endo support groups, the general consensus on there was that hrt exacerbated most of their symptoms. I also worry about the bc risk which I know is small but now mum has been diagnosed with bc that really does worry me but I also don’t want the dementia, heart disease and osteoporosis that my poor mum suffers from either - urgh!

My brain is so jumbled and muddled right now that I just can not think straight.

Could most of my issues be made worse by peri? I certainly am beginning to think the endometriosis and gut issues are being driven by my hormones but who really knows? What the hell can I do to try and get back on track?

I so stupidly and naively thought as I have a low bmi, have never smoked or drank and exercise I’d breeze through peri. Well that thought process has well and truly bit me on the arse!

Can anyone with any experience help me….please.

That’s a lot. I’d suggest talking to GP and going on antidepressants as first line for your mental health to give you some immediate space (I’m not usually a proponent but they can be helpful at times like this to break the cycle).

Then get referred to gynae or if funds allow, pay for private like the Newson clinic. At your age it’s most likely almost menopausal rather than peri… and body identical HRT is now thought to be OK for BC risk and actually protective against heart disease and dementia.

Hope that helps. You will get through but please get help asap

Thank you.

I have tried a few antidepressants but they made my gut issues so much worse so not sure what to do tbh as I definitely need something to help with the mental health issues. I do have some talking therapy coming up but I think I need something a bit more hard impacting that that right now.

I would absolutely love to see a menopause specialist privately but sadly funds are low as I’ve had to reduce my working hours due to the gut issues which are so bad in the mornings. I have my first gynae endo appointment tomorrow so will ask some more questions then. Not sure if he can prescribe hrt but will ask.

Anti-Depressants have been a game changer for me with my IBS so I would definitely try again. I couldn't leave the house at one stage as my anxiety and IBS were both so bad and they have changed my life - they also work better than HRT for me. I think my IBS is led by my menstrual cycle too - I am trying to embrace being Peri as I am hoping it will be the end of this IBS crap.

It does sound like hormone imbalance. I've had all the sane symptoms and am considering my options.

I know funds are low but if you could try private acupuncture that might help? £50 a session where I am (the north) and the first session is a bit extra as they take a full history of everything.

Acupuncture is proven to have a good track record of dealing with various things, greatly helped my phlegm ibs and tinnitus. Can help with all your other symptoms and balance you too.

In addition I've just gotten herb tablets from my acupuncturist / herbalist - which I googled and see studies on a university website (one of these ones that has something like nimh in the website) saying they are as effective as setraline! So I'm hoping that'll help me.

Acupuncture can fix things that western medicine can't. You can feel better the same day. Without pills or potions. This is my first time on herbs too though.

I got told to stay off dairy (to reduce phlegm) and sugar (really bad for us but I bloody love it) as well. The sugar is difficult to not have but I've cut it right down.

I hope you find something that helps. You are under tremendous stress and it must be so exhausting. You're doing everything you can for your parents and I'm sorry you're all going through all of this.

Ooh yes acupuncture also a good idea, and helped my gut too. It’s hard thought when you can’t think straight. If you can find a good GP they can help work out a plan of attack, but know that can be hit and miss

Can I ask which ones you took? I found Sertraline made my diarrhoea worse. I would love to try a different one but so worried they will make things worse, I have a prescription for Fluoxetine but so worried about taking them.

I had many symptoms of peri/menopause but the one I didn’t have was hot flushes, so no guarantee you will have them.

HRT really helped with my symptoms, but as you say you may have complications with this

I am so sorry you are going through so much with your DM and your health

I'm sorry you're having to deal with all this - I hope you have some support. Just to say on the smoke smell, that sounds like migraine aura (at least mine) which I get mid cycle and pre period. It's tamped up for me the last few years and only started in perimenopause (I'm late 40s) having never had migraines in my life!

@Afternoonsnooze when I first went on antidepressants, I had awful side effects on Sertraline for the first four days so changed to Citalopram and its been amazing. After previous side effects Dr advised tapering on so started with 10mg a day for a week then up to 20mg and I didn't have any issues. Maybe you could try this with the Fluoxetine?

Thank you. That is really encouraging as I’m actually booked in for my first acupuncture session this Monday, I have been given the first few sessions as a birthday present. I am quite excited about it tbh.
I haven’t had dairy for 20 years as I know it really upsets me and I do try to keep my sugar levels low as luckily I have a savoury rather than sweet tooth. I have kept a food diary for the last 5 years and other than my known triggers, which I avoid, I can’t seem to see a connection to food, I honestly believe at this point I could eat only dust and still have issues!

I am really hoping the acupuncture will help. The lady who does it runs a holistic clinic and offers other treatments such as reflexology which helped me tremendously when I was trying to get pregnant so I will try that if the acupuncture doesn’t help.

I would say topics from your existing list, not caused by perimenopause.
Topics on your new list (plus the anxiety) almost all can be peri (I’ve had most of them).
In the absence of anything else if gp considers it safe I would say why not try hrt? What if it gets rid of the entire new list of problems for you? If it doesn’t improve things after 3-6 months you can always stop

Thanks RosieAway I’m having some acupuncture on Monday, really hoping it will help 🤞

Thank you crumblingschools I’m sure the stress is exacerbating everything, maybe I wouldn’t be so bad if my mum was ok but who knows. As they say, these things are sent to try us!

blobby10 I did say to the GP I was so nervous to try so she has started me on 10mg, maybe I just need to take the plunge and try. Hopefully, like you suggest, I can work my way up?

I'm sorry you are going through so much.

I wonder if you can take a multi- attack approach to this?

Diet
Exercise
HRT
Talking

I'm thinking of support groups for carers which is what you are- for your mum.
You need to be able to offload a bit in real life.
Do you have a partner? You don't mention anyone in your life who's supporting you day to day.

I'm sorry to have to disagree with some posters about anti Ds.

There has been a campaign by meno experts for several years to re-educate GPs about giving ADs to women who are in peri or post meno. They've been told to stop as the evidence is they dont work- and any improvement is possibly a placebo effect.
NICE guidance is HRT is the first line treatment.
Your Mum's BC doesn't count as a risk as she's old (not young- which would be a higher risk.)
And you can take the safest types of HRT for 5 years with no added risk.

With your gut health, I assume you have heard of Prof Tim Spector and the Zoe gut health work he's done? Look at the info on the Zoe website and there are articles there on menopause and gut health ( and how to improve your gut health.)

It's really worth trying this to get your gut flora better. I know that FODMAP is about excluding foods but it is supposed to be done a) with a specialist dietician and b) only for 8 weeks - and after that trying to go back to as many foods as possible.

The basis of the gut health diet is to eat at least 30 different plants in a week ( read up on this) and cut out all ultra processed foods (things with emulsifiers, additives, artificial sugars etc).

Again, this is all on the Zoe website so you don't need to pay anything.

What about exercise? Yoga which focuses on breathing can help with IBS as can getting outside walking in green spaces.

Your endo- has it been diagnosed properly with a alp investigation? Or are you guessing?

I have adenomyosis and have been on hrt for many years. It's not a contraindication.

You say you can't fund private menopause care- not even if you use a credit card? Or your partner helping out? You can get an appt with a specialist for around £300. You would get the time to discuss all of this in detail if your NHS appt doesn't help as much as you'd want.

Oh, that’s really interesting, I never gave that any thought.
I have suffered from aura migraines since my first pregnancy 19 years ago. My mum and sister get them too. Just the aura, often only a mild headache following them.
They started during my pregnancies and then in my late 30’s I started getting them every period but only on the 3rd day so hormones obviously involved somehow.
However, since I had my uterine ablation and iron infusions back in 2022 they went away and I have only had one or two since but maybe they have manifested themselves in a different way?

@Afternoonsnooze I'd really suggest you don't resort to ADs without trying other things first.

They can cause gut issues and also are not recommended for peri and menopause unless hrt has been tried and failed. NICE guidance is very clear on this.

Would histamine intolerance ring any bells for you? Thinking about the itching, redness, migraines. Do you happen to eat a lot of high histamine food? Tbh if you're on Fodmap probably not.

For my IBS I found eating a wider range of foods helped (think mine was to do with gut micro biome). I do think Fodmap might reduce the biome's diversity if it's quite narrow. Though might your IBS be connected to endo?

It sounds like your system is stuck in fight or flight due to chronic stress, I'd power through the antidepressants but would say you need to give it more like 4-6 weeks, I felt worse in the short term but then miles better. Sending you good wishes.

Regarding the hrt, I’ve spoke to two gynaes. One said it will exacerbate the endometriosis the other wasn’t so sure. GP says I’m to go with the gynaes decisions - helpful!
I have an appointment this afternoon with the endometriosis gynae so will ask him his opinion. I am just apprehensive as so many on the endo support groups say hrt exacerbates their endo symptoms.

@DrawersOnTheDoors I know ADS worked for you BUT they are contraindicated in the NICE menopause guidance and meno specialists are tearing their hair out that GPs are still prescribing these often at the request of women.

There are numerous features online from women who were mis-prescribed, some became addicted and others found they made them worse.

It's difficult to disentangle what is going on, I know first hand about the strain of having a parent with dementia and trying to deal with everyday life stuff too. It's not easy.

I really think you should see your GP. But a lot of what you say is ringing bells with me - the broken sleep, aching jaw, tiredness, achiness, bowel issues. All menopause related in my case. And HRT has sorted it out. I would also advise asking for thyroid level checks as there is a huge crossover in symptoms caused by underactive thyroid which can also cause itchy skin, bowel issues and sleep issues (I have a medicated thyroid too!!)

The alternative remedies - well maybe, but I'd always go for the proven medical route first. So back to GP. Ask for a full range of blood tests on your thyroid, iron levels and anything else they think is worth running. If that all comes back normal, then talk about tweaking your current medication or adding in HRT.

You can feel better and you do not have to feel like this.

@Afternoonsnooze There are two issues with endo and HRT.
The first is that a cyclical regimen (which is usually given to women in peri) mimics a natural cycle. This means the womb lining grows and sheds. So that may stimulate endo like your own cycle.

HOWEVER HRT never replaces as much estrogen as you'd have normally- it's far lower.

The other option with HRT is to have what it is called combined continuous, which is for women post meno but also suitable for women with endo. Bothe hormones are taken daily which means no growth and shedding of the lining (and wherever it is in your body.)

So it's not black and white.

There are 2 types of HRT and one is more suitable for endo.

Have a read of the Balance app and online library- by Dr Louise Newson.

There is an article there on endo and HRT saying what I've posted.

Women who have had a hysterectomy are usually given just estrogen if they use hrt. But women with endo are always given progesterone too so that the estrogen stimulation on any remaining endo is reduced.

Oh OP, I'm so sorry you're dealing with all this. I see one thing on your list which could have a quick fix: last few weeks a very itchy left armpit. Could it be that your deodorant is suddenly irritating your skin (as I know mine is now that I am peri age)? Have you tried different ones, or dropping it altogether for a bit, just to see if the itching is still there?

@Afternoonsnooze if you have not eaten dairy for 20 years, how are you getting enough calcium?

Are you making sure you get enough from other sources? If you are also on the FODMAP diet which excluded a lot of vegetables and pulses, it's possible you are not getting enough.

Calcium supplements are not recommended now as there is evidence they can cause heart issues (the calcium ends up in the arteries.)

If you think you are lactose intolerant, ask your GP for some proper tests (there is a simple breath test that's used.)

Also, maybe talk to the Royal Osteoporosis Society helpline on diet (or see their website) because osteoporosis is often hereditary and you are at risk anyway.

I'd suggest you ask your GP to refer you for a DEXA scan on your bones. You're eligible due to your family history and with your gut issues you're adding more risk.

There might be links between some of these conditions. Bowel issues and endo particularly - I had awful constipation / bloating / IBS issues. It turned out to be endo related and was solved when I had an excision.
similarly, TMJ and sinus issues are likely to be connected.

Thank you so much for your advice.

In answer to some of your questions, the endometriosis has been picked up via a pelvic mri (which I requested from my gynae because of the pain I suffer following the failed uterine ablation), this was looked over by a specialist endo radiologist. He has concluded that I have ‘diffuse uterine adenomyosis’, ‘Deep infiltrating endometrisosis’ and ‘Pelvic congestion syndrome’.
I have my first consultation with the NHS endo specialist this afternoon. My regular gynae has explained I will most probably need to have a lap to discover the full extent of the endo. He also stated that I will probably need a hysterectomy at some point due to the adenomyosis.

I am pretty fastidious regarding my diet. I have kept a food diary for the last 5 years to determine the triggers to my gut issues but I do see a pattern with my cycle more than anything else. I do indeed follow Tim Spector on the Zoe podcast and on SM platforms, as well as many others.
I would love to eat a huge variety of plants and I do try but they literally go right through me so I have to be very careful with my fruit and veg intake the fibre content of my diet. I am under the neuro-gastroenterology department at UCLH and working with their dietician.

After many expensive and failed experiments with endless probiotics I have found very few which help tbh, I am currently experimenting with s Boulardii as I do have (not surprisingly) gut dysbiosis and this has been proven to help with the diarrhoea side of things.

I do everything in my power to try and help myself and would probably be so much worse if I didn’t do the things I do but I’m still struggling so very much and can only attribute that to the amount of stress I’m under with caring for my mum and just seeming my parents suffer and struggle so much. I have been fighting the urge to try antidepressants for so long but in all honesty I’m not sure how else I can mentally cope with it all tbh, I’ve tried everything else.

I keep my weight down (bmi of 20). I walk the dog over fields for over an hour a day (I also walk a friends dog), use my exercise bike every day and use a combination of stretching, weights and yoga type exercises daily. I listen to gut directed hypnotherapy daily and the Calm an app every night.

I have a lovely family and support. My dh and I have been together for 35 years and I have two lovely teen dc and a couple of great friends. So all good there (fortunately).

I would absolutely love to see a private menopause specialist but I have had to cut my work hours down due to my issues and looking after mum. I just have no spare funds at all.