What now? Peri-menopause - brain fog, apathy, hopelessness

[Roow]

I'm early 50s. I'm 30 months into HRT from NHS GP, so Utrogestan and 75mg estrogen. Lots of symptoms went away. Panic attacks, stuff joints, early waking anxiety spikes, etc... What still remains is that dreadful feeling of being numb and frozen. Stuck.Lacking positive,excited emotions about doing things. Everything feels too much effort for little gain. I just want this feeling to go away now. I want to be the me that was optimistic, always trying something new,ambitious about improving my career, not scared to take a risk.

I go through the motions of doing stuff. Last year I made myself do a lot and I became overwhelmed. This year I've underscheduled life and ended up feeling lonely and depressed. No wonder I feel I just want to go away to a sunny retreat and be surrounded by understanding women.

I trialled 100mg estrogen and it made no difference to these symptoms so I went back down to 75mg.

On the outside I seem the same to others. Its not the same as depression. I've been clinically depressed. However, I've reached a stage where I can't go in like this and don't know what to do.

If I go to my GP what will they do? Are ADs ever the answer? Can I get a referral to a menopause clinic or would I need to pay? Will GPs ever measure hormone levels. Is Testosterone replacement the likely answer?

I've also been diagnosed with two autoimmune diseases this year, which can't be helping.

I think on some level we need to accept the change. We are never going to be the person we were 20 years ago.
I’d try testosterone, you can always drop it if it makes no difference.

That's a good point. I'm happy to accept life won't be exactly the same as it was. But I want to move forward in life still doing and desiring something

I do understand, I’m the same. No desire to go on holiday, or on a day out, but then I like my home and where I live.

Are you using Utrogestan daily?
If so it may be worth trying it for 12 days a month (200mgs for that).

It's well known that Utrogestan is a 'mood flattener' for some women. It's action is sedative and a nervous system depressive.

I've used HRT for just over 15 years and there is no way I'd use it daily for various reasons.

It's not mandatory to use it daily (many GPs and women think it is) but it's actually a choice. my consultant is fully supportive of sequential even many years post menopause.

You don't need your GP to okay this, and you could try it for 3 months.

Hi OP, I help to run a menopause networks at work and what you describe is familiar and I wish there had been more advice when I was peri. However, I would go back to your GP and have a chat about testosterone as it certainly sharpened up a number of colleagues and from what you have detailed, your GP surgery does appear to be on the ball. There is a real issue with some GPs going to anti-depressants as a default, so ask for it explicitly.

Next, set up your own menopause group at work... I have to be honest, those calls are the highlight of my month, because we laugh and learn. We share what works for us and there is no judgement...

Finally, yes, your body may be slowing down as you age but you can make sure that it is fit for purpose with diet, exercise and attitude.

Thanks. There is actually a great menopause support group at work. I've attended a few online things but not the support group, as it is online. I think my library might have an in person group though. I'll make a point of going in January.

Being blunt, all the talking in the world is not going to help if it's Utrogestan that isn't suiting you at the current dose.

With HRT, it's often necessary to review the type and dose.
After almost 3 years it's time to reassess.

I don't feel great on Utrogestan but it's only 12 days every few weeks. I have off-licence sequential , which is a longer cycle than 4 weeks (through a private consultant, one of the best in the UK.)

Please do consider changing the dose, or trying something else like a Mirena coil.

The way you're feeling is not 'mind over mood' that talking will resolve.

@LatteLady early 50s is very young these days. Not an age to slow down. 😀

@JinglingSpringbells

Thank you. I have been taking the Utrogestan more spread out - however, I haven't found a problem with Utrogestan. If anything, when I took it only 12 days, I found myself more anxious on the non Utrogestan weeks.

I would agree with @JinglingSpringbells i felt very flat with utrogestron had a Mirena fitted instead which gives the progesterone locally and it’s been much better ! Not my old self as such as brain fog worse symptom but def better ! Good luck

Can you say what 'more spread out' means with Utrogestan?

With a patch of 75mgs (which is classed as a higher dose) you need either 100mgs every day or 200mgs x 12/14 days each month.
Maybe you've been advised by a specialist to do something different?

100mg per day

It would be interesting to trial stopping it for a month (and changing to a cycle) and seeing if that makes you feel any better.

One thing to think about ,(although not suggesting you do this on your own but just saying it happens) is some consultants start women on estrogen only for several weeks to get the dose right.

When I started HRT I did 3-monthly cycles for 6 years, using progesterone for 2 weeks every 12 weeks. That was Norethisterone, not Utrogestan.

Hi OP, wondered how you were getting on now?

Much better. I made myself write down all the things I used to think I wanted to do and did research on what was going on or available in the local area. I wrote it all out and made myself pick one thing and started at a running club doing their couch to 5k. I did it, and it had a good impact. I met new people who were kind and friendly. I decided I would present my positive self and keep my menopause and life complaining to my established friends.

I don't much like running but the outdoors and exercise were good for me. I'm now injured and not able to run. 😌 but I can still walk with some of the group also injured. Now I'm going to move through my list and pick something else to add. I've broken the cycle and had a positive experience and feel more like putting myself out there, even if in smaller ways than in the past.

So yes, acceptance and being less ambitious and just doing one thing has been helpful for me. I'm less fatigued ( perhaps due to getting autoimmune disease under control) and less apathetic about life and focused on optimising my physical health. I'm still on 75mg of estradiol and had about 10 days without it when I couldn't get estradot recently. I definitely felt the effects of that!

Ah great to hear!
Does seem like a mix of lifestyle and HRT is the way…
Have recently had similar weird panicky turns and low mood etc… researched that progesterone is often the key leading up to menopause, rather than estrogen. I thought I was intolerant to it but taking it daily as a suppository has been great. It’s such a puzzle.
thanks so much for the update and I hope you keep going from strength to strength

I’ve had very similar feelings to you OP, and when I chat to friends, they also have similar experiences.
I changed to a Mirena coil last year as the progesterone made me feel quite unwell and I experienced all sorts of other side effects. This was a good decision for me, it’s helped so much.

I recently had a review of my medication, I need to book an appointment to ask to trial Testosterone, I must remember to do that today.