New Anxiety - is it hormonal?

[Hatty65]

Not sure if anyone can advise me, but I'm roughly 7 years since I had a period, have been on HRT since 2019 (Kliofem, 2mg/1mg) and all of a sudden in the past 2 - 3 weeks I feel hit by waves of anxiety and panic again.

There is absolutely no reason for this. I'm under no stress, not worried about anything, life is good - apart from the fact that I'm sleeping very badly, awake every hour, racing heart and sheer panic overtaking me. In the day time I'm mostly ok, but still feel sudden wave of anxiety at times over absolutely nothing. It's really unpleasant and affecting me badly.

It feels like I'm back where I was in peri menopause about 7 or 8 years ago, with the waves of panic, feelings of impending doom, etc. Is it possible that my oestrogen (or something) levels have dropped again? Do I need an increase in HRT? I have put a lot of weight on over the past few years, and I'm not sure if the level you are on relies on what you weigh? (Like when the vet weighs your dog, before prescribing a certain dose of something. 😃Do fat women like me need more hormone?)

Drs have previously suggested I might want to come off it, and I've resisted because I've been very happy on Kliofem - it put me back to my old self, took all the menopause symptoms away and I felt normal again. Now I feel I'm back where I was and with the awful menopausal symptoms heading back.

Any advice or suggestions welcome. I'm currently getting outside in fresh air and walking a lot to distract myself, but if it is hormonal and could be helped then I'd like to know.

Hopeful bump

Hey OP I'm sorry you didn't get any responses to your post. How are you feeling?

Thank you so much for responding. I still feel awful, to be honest.

I'm battling off anxiety most of the time and have developed a real phobia about the evenings and bedtime when I know I won't sleep, will keep waking in panic and will be even more exhausted tomorrow.

I was hoping someone might have some wise words! 🙂

Sorry you're feeling like this.

How old are you now?

There are a few points...

You may need a different type of HRT. You're on a high-ish dose already (2mgs) and tablets don't come higher. And even though it's high, as it's tablets a lot can be lost in digestion so you ay in fact only be getting 1.5mgs of estrogen.

It's also better to swap to transdermal HRT as you get older to lower the risk of blood clots.

You won't need 'more estrogen' because of your weight. In fact it's the opposite- fat produces estrogen. But weight carries a lot of added risk for women post-meno.

Are you doing all the usual stuff to help sleep and anxiety- daily exercise, no/reduced caffeine and alcohol, good diet etc?

@JinglingSpringbells Thanks for replying.

I'm 58 now and I'm a master at trying to sleep - 30 odd years of insomnia means I've got black out curtains, earplugs, don't drink caffeine after my first coffee of the day, don't eat within 4 hours of bedtime, don't go on screens for 2 hours before bed, etc. I don't drink and my diet is pretty good.

I exercise quite well at the moment. I have chronic fatigue so there are days I struggle, but I'm trying to get out and walk daily and I try to swim a couple of times a week. I've put a lot of weight on (due to this - plus, probably meno) in the last 4 or 5 years.

I think a lot of my anxiety is related to - or caused by - my poor sleep. I've always slept badly, but having chronic fatigue has made this worse, and I've got myself trapped in a vicious cycle where I don't sleep, I'm exhausted, I panic about how little sleep I've had and how I'll never get better, then I get anxious about not sleeping, which means I don't sleep, etc, etc.

I'm really grateful, by the way for the responses.

I had hormonal anxiety like this, came out of nowhere for no reason. May I suggest you speak to someone at your doctor's? Mine changed the HRT I was on and the anxiety went.

@MrsLeonFarrell Thank you so much.

I will raise it with the surgery. Can I ask if you changed brands - or changed the dose? And how long you'd been on it previously?

I've been really happy on mine for years, but I'm willing to change if it means the anxiety goes.

Sigh - life is so bloody difficult at times, isn't it? I thought I was through with all the hormonal stuff at my age!!

I was on a combined patch, now I'm on a patch and a tablet. It is a pain because each change takes time to adjust to and see if it's working but so worth it.

Many thanks.

I think it's obviously worth raising and seeing if the surgery have any suggestions. One of the things that worries me is that they have previously suggested I should stop taking HRT as they think I should be post menopause - and I was already reluctant to stop in case all the awful menopause feelings came back.

It's really thrown me being 'back in peri-menopause' symptoms. I've been perfectly happy for years, and there is genuinely no real reason for these waves of terror/anxiety - which is why I wonder if it's hormonal.

One of the things that worries me is that they have previously suggested I should stop taking HRT as they think I should be post menopause -

This is a very odd and outdated idea.

Many of us didn't start HRT till post menopause.

HRT is for women in peri OR post-meno.

There is no limit to taking HRT- you can carry on till you're 90 if you want to. I know someone who's 71 and still taking it and I know of women far older still using it.

However, when you are 60 you will have to swap to patches or gel/progesterone. That's in the guidance.

Tablets are linked to blood clots and you'll need to swap.

I'd focus on getting an HRT assessment. I first went onto HRT for sleep issues so it's quite possible your dose isn't right for you now or you'd absorb patches/gel better.

I'm the same age but have never been down the HRT route. I can have disturbed nights sleep and wake up sweating, but episodes getting less and less.
I take Vitamin D (high strength once every 3 days), iron once every 2 days and vit B12 everyday. Also using a Tens machine on my lower back each evening before bed to relive sciatica pain.

Do you sleep alone?

I developed anxiety out of the blue during this past year. I am 53, been on HRT since 2021 (mirena + gel). I tried increasing my dose but this just seemed to make the anxiety worse. I had no psychological reasons to be anxious. No work or family stress. It was a very physical anxiety and worse at night. Like you, I started to dread going to sleep as I knew I would be awake with panic attacks in the night. If I was busy during the day I could ignore the jittery feelings but as soon as I sat down in the evening it would start to rise up. I tried exercise and relaxation techniques etc. to no avail. In the end I got so fed up with it and was scared of not functioning that I spoke to the Dr. She was very good and agreed that it was probably hormonal. Her opinion was that whatever the cause, once your body gets into this sort of anxiety state it's really hard for your body to shift it. You get stuck in a bit of a cortisol/adrenaline loop (not her exact words!). She suggested I try Fluoxetine (and SSR antidepressant often used to treat anxiety). I was VERY reluctant. Never been depressed and was quite scared of the thought of using antidepressants. I thought it was over medicalising the problem. But I was desperate and thought what have I got to lose? Anyway, to cut a long story short it's been life changing for me. Yes, the first few weeks getting past the side effects were tough but after that I can honestly say I haven't felt this good in years. All the anxiety has gone and I finally feel my old self. I know HRT alone can do this for many women, but for me, I seemed to have needed an extra something and that was 20mg of Fluoxetine! I'm going to try for 6months - 1 year and then reevaluate. Maybe once I'm through the worst of menopause I won't need it anymore, but for now, I'm happy to keep taking it as it has given me my life back.

Just something for you to consider.

A friend of mine had this kind of nightwaking that she felt was anxiety driven. It was actually sleep apnea. Might be worth rulling that out as that could also impact on your levels of fatigue.

The best thing to do is swap to transdermal HRT.You'd need to anyway at 60.

One thing that most GPs won't do/aren't aware of, is that you can try estrogen only for a few weeks to get the level right.

This is what I did with a consultant.
I use gel and was advised to start very low and work up over around 3 months - from half a pump to however much was needed.
I found 2 pumps worked but in my late 50s I did have to go up to 3 pumps for a while. 3 pumps would be roughly the same as a 2.5mgs tablet.

The problem particularly with combined continuous HRT (which isn't mandatory even for women post meno) is that you're using both hormones at once every day. This makes it very hard to determine if the estrogen is the right dose or you're getting side effects from the type of progesterone.

You should try gel and use Utrogestan as the progesterone as it's also sedating and many women like it for that reason- better sleep.

Thank you so much to everyone who has responded to me. There are lots of helpful things to consider - and an HRT review seems to be necessary. I am actually due one.

Went for a smear test today and raised it with the practice nurse, but she was vague and little use - simply suggested I phone the GP next week and try and get an appointment so I shall be doing that on Monday.

@MrsFryingpan Your situation sounds very similar to mine. I have begun to dread the evenings because the feeling of anxiety and panic begins as I think about having another bad night. I am aware that being exhausted and not getting restorative sleep makes everything - including anxiety - worse, and I am just spiralling round in circles as you say. I'm reluctant to go on Fluoxetine (which I've had in the past when they decided my peri menopause was depression) as I put 4 stone on whilst on it and haven't shifted it - I really don't want to put more weight on as I'm clinically obese and have high cholesterol as it is.

@JinglingSpringbells Swapping to an HRT I can control the dose of sounds the best thing I could do and I'll raise it with GP. He has generally been pretty good in the past and is willing to listen to what you would like him to do - it's when I've seen other clinicians/nurses in the surgery that they have tried to get me to 'think about' coming off HRT.

@BurntBroccoli I do sleep alone. DH is banished to the spare room because he snores and twitches and I can't bear it. I also take B6 and B12, Vit D and Magnesium.

@Vintagegoth I've wondered about sleep apnoea but when I've raised it with clinicians in the past they've appeared to have little idea how you would find this out. I've asked if they can refer me to a sleep clinic - having struggled for donkey's years with insomnia - and been told that isn't something they can do. (We are pretty rural)

I'm massively grateful to you all for suggesting various things. I feel far less alone and frightened so thank you for taking the time to offer advice and support.

I really don't want to put more weight on as I'm clinically obese and have high cholesterol

This is another reason why you should be an transdermal HRT and not tablets.
I'm a bit surprised your Dr hasn't joined the dots on this.
Good luck with it all.

@JinglingSpringbells Thank you so much, I really appreciate the advice. It's not something I knew - but it's obviously something I'll raise with him now.