Crisis point

[CherryPie864]

Anyone else have a mh crisis in perimenopause? I have had crushing axiety, heart banging panic attacks at 3am and all day every day rumination regret thoughts taking over my life. Saw GP today who suggested coming of hrt altogether as she said my body may not be reafy for it as still producing some hormones. I am so tired from the lack of sleep and so scared

How old are you and what hrt are you taking?

48 2 pumps estrogel and 200mg utrogestin

I'm no expert. Just a 59 year old who is on an hrt journey (annoying one at present as things not totally hunkydory).
So, surely there is the option of cutting down dose before stopping?
On different regime in process of doing that myself for different reasons to you.
Also, at 48, your needs likely different to mine but stopping rather than tweaking/ reviewing seems premature?

Also, I'm sorry you are feeling so low.
Your gp perhaps needs to rethink or perhsps you need to see a different one?

Thank you for the replies. GP also prescribed anti depressants but I am really reluctant to take them as dont want to end up stuck on them forever!

I will try stopping the hrt and having a 'reset' but am terrified of this constant misery, regret, awful feeling that everything is wrong and I am not myself at all😪😪. Never suffered before and always been an energetic and active person so this has floored me

Were you feeling low before hrt? Did the gp suggest halving dose/ tweaking?
I am changing from evorel conti to 25 patch and micronised this weekend. Bloating and spotting on evorel conti and looks like impacting my usually good blood pressure. My initial panic reaction was to come off hrt now but gp suggested a taper down/ change in progesterone and a review in 2 months. It gets you down I know. Also, I panic which doesn't help with monitoring blood pressure which I am going to do over next week!
Before stopping HRT cold maybe get another opinion?
Oats and banana for breakfast for me! Health kick begins!!

If you can afford it I’d recommend a private consult with meno specialist.

id guess your hrt combo is wrong not too much. Your gp sounds ill informed at best.

this is not something I’ve done but know someone who has and it’s made a massive difference

Regarding the SSRIs, I wouldn’t be so quick to dismiss them Though I’d want to consult someone else HRT before taking them in your shoes

'If you can afford it I’d recommend a private consult with meno specialist.
id guess your hrt combo is wrong not too much. Your gp sounds ill informed at best.'

Hard agree with all of this. I would have thought your HRT dose needs increasing, not reducing . 2 pumps is a sensible starter dose, but I had mine increased to 3 at my first review after 4 months, and now I'm on 4 pumps. So many of my symptoms have disappeared now I'm on the right dose. I saw a doctor at Newson Health and I recommend them very highly

Yes, this was pretty much how I realised I was in peri. No other symptoms other than mental health/emotional.

HRT sorted it for me but I had to try a couple of different formats and doses. For me a LOWER dose of oestrogen was better. Combined patches were awful (the progesterone phase really didn’t suit) and I’ve used the spray successfully for years now.

How long have you been on HRT? Maybe you need to give it time?

You need to try adjusting the HRT dose and trying to increase the estrogen.
OR reducing it and seeing what happens.

48 is not too young for HRT.

As pps have said, 2 pumps is a medium dose. At 48 with peri symptoms you need more perhaps and should try 3 pumps for a few weeks to see if that helps. The max a day is 4 pumps.

I settled on 2 pumps quickly but in my mid-late 50s had a few months when I needed 3 pumps to settle night sweats and sleep.

GPs are a bit clueless with HRT on the whole (with some exceptions) and it's rather silly to suggest you stop rather than adjust the dose.

Thank you all. I slept better last night and have had no estrogen today. Panic slightly more subdued but who knows what it will be like later. I will come off it for a cycle and see what happens then go back to GP.

I have been on it since September

It sounds like you are on too low dose of Oestrogel. These problems didn’t resolve until I was on 4 pumps a day.

I might be shouted down, but OP when I had crushing anxiety and constant banging heart, I was prescribed beta blockers which I took alongside the HRT. That settled things immediately in the short term so that I was able to eat and sleep again. I am now taking Sertraline alongside the HRT and feel loads better. You won't necessarily be stuck on them forever.

I'm not recommending this approach, however it has worked for me since I lost the plot during peri and a mental health crisis, though admittedly there were other factors at play.

It's not that you will be shouted down but that the guidance from NICE says HRT should be tweaked/ dose change/ type changed before looking at other drugs.

There has been a massive outcry by menopause specialists
against women in past decades being given ADs etc and made to feel they have a MH issue when in fact is a hormonal issue.

That's not to say some need them but many GPs are so uneducated on HRT they reach for ADs .

ADs do have side effects- they are not innocuous drugs and are sometimes hard to come off- and for many women, changing the dose of HRT works.

do we really need 4 pumps of oestrogen, this seems a lot I’m only taking 1 pump

I was on estrogel and had intrusive thoughts and palpitations. I paid privately to see a menopause specialist as my GP is rubbish. She said some people don’t absorb the gel well, and prescribed patches instead. I feel much better.

Thank you everyone. I have a feeling I may be progestoerone intolerant as went on the mini pill years ago and it made me feel very low and depressed. The GP did say that the patches could be better as they give a slow release rather than a big hit of estrogen at once that then wears off. Interesting CeceliaMars that you also had similar problems with the gel, thank you for sharing. I have had no estrigel today and its been a bit better. Still having a lot if intrusive thoughts abour past mistakes but not the full on heart pounding, shaking, actually having suicidal thoughts panic attacks. Will see what tomorrow brings in this joyful journey of menopause!

Oestrogen gel doesn't give a big hit. It's the same dose as some patches (depending on how much is used) and the level in the blood stream should remain the same day to day, as long as it's applied every 24 hours.
A missed dose is listed as more than 12 hours late .

You do need to try to get the dose right (and a lot of posters are suggesting you need more, not less at your age) but you maybe could consider things like CBT and mindfulness etc to help with your thoughts.

Also- do you exercise daily? I don't want to suggest this is THE solution, but exercise and diet also play a very big role in peri and controlling symptoms.

Hope you find a solution.

This is interesting.

I wouldnt be stopping it.
Anti depressant is a temporary fix to get your levels & it suggested to be in them for months rather than years.
Perhaps while you feel low it may help a low dose to get you feeling level. To go off it is done by slowly reducing them...why is that addictive?
Anyone suggesting stopping hrt dont!
Did the docror say it was a imbalance as part of hrt hormones?
What is with uk doctors? It seems a regular comment on mn...
Most hrt need tweaked.
If u go off it how will you sort out the horome fluctuations...this is a normal process that is ideally medicated.

Mindfulness is not going to cut it with hormones and a natural body change.
How can one do mindfulness when it is a chemical lack...lets all deep breath and yoga on thru.

'Also- do you exercise daily? I don't want to suggest this is THE solution, but exercise and diet also play a very big role in peri and controlling symptoms.'

Very much agree with this. Diet, exercise, sleep, managing stress - all really essential tools for perimenopause, alongside HRT

'do we really need 4 pumps of oestrogen, this seems a lot I’m only taking 1 pump'

If your symptoms are well controlled on 1 pump, carry on. I started on 2 pumps, increased to 3, then needed to increase again to 4. We're all different and our bodies are at different stages

Yes but more severe in actual menopause. My anxiety and crying went through the roof in peri but was only using natural supplements.

I'm not against HRT and have used it for over 15 years.
However, my excellent consultant has always emphasised a 'whole body' approach rather than just HRT.

It was when the OP said this -

Still having a lot if intrusive thoughts abour past mistakes but not the full on heart pounding, shaking, actually having suicidal thoughts panic attacks. Will see what tomorrow brings in this joyful journey of menopause!

It is possible to manage thoughts which cause physical symptoms. There is a massive brain-body connection and yes, HRT is the foundation but not the whole answer for some women.

That's why other things like yoga, mindfulness and meditation can be helpful as well as HRT.

The one thing I’d say to be careful about especially in menopause is your anxiety getting worse, insomnia and psychotic thoughts. This was despite me being on HRT. I ended up being hospitalised. Apparently, this can be quite common in menopause and prob even in peri. But not much is known about it (I only read about it here) and research I think is limited. Male doctors tend to be next to useless re hormonal stuff too, ime.