Anxiety and Perimenopause

EmmaL21

I have had chronic anxiety since 2016, but I have always managed to keep it at bay with medication/exercise.

in August 2023 things started changing. Anxiety was consistent. I do have a lot of life stressors inc family, work, moving.
Periods slightly started changing but nothing too serious. I had been to the dr and he told me it could be perimenopause. I dismissed it thinking I was too young. I did eventually start medication for 4 weeks and it made everything worse. So I stopped and went to another Dr. August I changed my medication as it wasn’t getting any better. Slowly started feeling better. However September came and things started going south again. Periods have started changing shorter, sharper, pain in my right hip, and every 2/3 weeks chronic anxiety attack that can last up to 1 week. Waking up in panic almost each morning. I have to take medication when needed to stop the panic. Does anyone have anything similar? It’s getting really tough and not feeling like living anymore. My 3 kids are the only think keeping me going.

Eagle Ray

Dear Guest-65543263,

I can very much relate to what you’ve written. For me perimenopause symptoms started at 41 but were not too bad to begin with, just a bit higher anxiety and slightly irregular cycle. However, at 47 it really went pear-shaped with the onset of extremely heavy anxiety, depression and a drive not to be here anymore. That began to ease after 6 weeks. I then had bouts here and there and then was slammed again at 48 with uncontrollable distress and considered going to hospital. This was 2023. I decided late that year to try hormone medication. Initially it was transformative and I was so much better. But over time I developed a severe histamine reaction to the medication and had no choice but to come off it. Depression has returned but not quite as severe as before and it seems the increased histamine levels are keeping my oestrogen levels a bit higher so my hormones haven’t gone off a cliff like previously. But I’m still struggling with daily depression and routinely feel like just falling on the ground and crying.

A few things that I’ve found helpful just through researching include the Dr Louise Newson Podcast on all things perimenopause and menopause and the app she developed called the Balance app of which there is a free version. It includes ways of tracking symptoms and also a place to discuss experiences with others. I discovered there that many, many people are going through exactly what you describe and what I’ve experienced. It does at least help being able to talk with others who understand. Louise Newson’s approach is quite pro hormone medication but whether that is right for you or not, there’s quite a lot of helpful info on her podcasts.

I know the panic is absolutely awful and I’ve gone for many weeks at a time waking with hideous panic. I’m doing better now and I hope that can give you some encouragement that things can improve. I reached out to helplines a number of times and I would say don’t hesitate to do that if you are feeling really bad. I called both Lifeline and the Suicide Callback Service several times and it was grounding and at least partially calming and stabilising talking to another human about what was happening to me. Always reach out if you feel yourself drifting into that space of not wanting to be here. Your beautiful kids need you and it’s just these horrible hormonal imbalances that are driving your feelings.

There is an Australian psychiatrist, Professor Jayashri Kulkarni, who has been working in this area on the impact of hormones on women’s mental health for decades. There’s some articles of hers on the internet which may be of interest. Also, there’s the option of seeing a hormone specialist doctor. I did go to one and she was very helpful initially but didn’t seem to have anything to offer once I had the severe histamine reaction. So I’m back to doing my own research at the moment. But the thing about hormone specialist doctors is they often know a lot more than GPs, unless you can find a GP really specialised in the area.

How is your sleep? I was hit by insomnia as well when the anxiety was really bad but my sleep is much better now. I’ve also had some night terrors that are very specific to when the hormones are low. I’m trying to keep a kind of distance from these things, recognising it’s just hormones, but of course it’s hard when in the midst of it.

Take care and happy to chat further if you wish to,

Eagle Ray

EmmaL21

Thanks for the reply.
My sleep is ok. It’s the waking between 4 and 5 in the heightened state that’s horrible. The panic comes and goes. Someday a I am fine and the other I don’t know what I should be doing with my life.
I have had my hormones tested but this was by a GP, so I am not sure if this test is as accurate as seeing a hormone Dr? I still can’t work out if it is just me and my life stressors or something is changing in my cycle.
thanks for all of the info. I am tracking my cycle through clue as well.

I just hope something gives, and this eases as I am honestly ready to give up.

Eagle Ray

Hi Emma,

I’m not sure whether or not a hormone specialist does testing that’s any different from a regular GP. Oestrogen levels become increasingly erratic during perimenopause, so there will be times it really drops low and times it’s high. So it’s possible when you were tested things were not outside the normal range as it’s so changeable. From what I’ve read the symptoms are often used as the guide more than testing and my specialist didn’t do testing. But the testing can still be a helpful indicator. I had my levels tested by a GP in late 2022 and oestrogen was definitely low which corresponded with feeling absolutely awful. The morning panic is a very common thing. If you do join the Balance app and communicate with the other people there you will quickly find many others with that symptom.

When oestrogen drops out so does serotonin which can have all kinds of adverse effects. Some women’s brains and bodies navigate this fairly easily and perimenopause is not too bad. But apparently 20% of women get noticeable mental health impacts. Our brains have oestrogen receptors throughout, so when levels drops it is not just a reproductive issue, it can affect our whole being.

I was just at the GP yesterday and found my hormone specialist had written to my GP about my inability to tolerate the hormone therapy. It’s being suggested I try particular antidepressants next. Only certain antidepressants tend to help perimenopausal anxiety and depression which is important to know as not all GPs know that. I’m sorry I can’t mention specific meds on here as we’re not allowed to. When I went on the hormone medication it really transformed me as I was what my specialist called a super absorber. The anxiety just disappeared for me and I remember waking up going, “oh, I feel normal” as opposed to feelings of absolute horror and dread. If the histamine intolerance issue hadn’t happened I’d still be on that medication.

It’s good you are tracking your cycle. Please know there are treatments out there and it can be trial and error finding what works for you. I’m almost 50 now and likely near the end of perimenopause. An ultrasound last year showed one ovary has no eggs and the other almost none so I must be close now. I’m hoping to feel more stabilised as this process completes and my body finds a new normal. If it’s any encouragement the morning panic has pretty much subsided for me now. I know it’s just awful when experiencing it but reach out for help when things get tough and let your GP know how bad it is. And if they’re not understanding try another GP or a hormone specialist doctor. Also feel free to communicate here anytime if you just need to chat about what’s happening.

Take care,

ER

Annas1

Oh Emma and ER,

What a journey this perimenopause is! You have both described the symptoms I experienced at the same age. I did not link my increased anxiety, insomnia or digestive issues to hormonal changes, and neither did my doctor nor the psychiatrist I consulted. As a result I spent several years trialling different anti-anxiety/depressant meds only to come full circle and find significant relief with MHT. When MHT supply was short, I had an impromptu break for 6 months, with the return of most symptoms, I have decided to resume it. (If I need to stop in the future I would look to natural supplements, particularly magnesium and zinc, following advice from a naturopath endorsed by my menopause gp. Apparently magnesium is supportive of brain function - which is what estrogen does, and zinc is good for tissue health (skin and hair).)

The recent journalism on women being underserved/disserved by the medical sector is pertinent here. I have followed Prof Kulkarni's work too and feel a lot of relief and validation about my own experience, as well as astonishment and frustration about the lack of knowledge about women's hormonal health and wellbeing more broadly.

My sense Emma is that you are really having a rough perimenopause experience in the midst of a full and demanding family life. I am learning to grow some inner compassion for my own physical and mental wellbeing challenges and 'coach' those near and dear to approach my needs in the same way. Of course this is a patchy process, and sometimes I forget not to get lost and down on myself when I'm over-wired and under-slept. But the heroine is the woman who reminds herself of her unique value and tries her best after a defeat. It's so understandable that you feel overwhelmed and hopeless at times. This is really tough. But you will get there, with the right practical and moral support and lots of patience. Be as kind to yourself as you can and be patient as your wellbeing improves. I believe in you. Go well.

Eagle Ray

Thank you for sharing your experience Anas1. I’m so sorry you’ve had to go through this all too. I was certainly confused myself about the sudden plunge into a mental health crisis as although I have a complex trauma history and have been through certain challenges, the type of anxiety and depression I was suddenly in was something different. It was very perplexing in the beginning so it must have been so hard for you too, going through those trials with medication and then finally getting relief with hormone meds.

I’m seeing a naturopath at the moment who is very helpful and I’ve done advanced microbiome testing with him. He’s putting me in contact with a nurse practitioner who can prescribe MHT as I may be able to restart a component of it. I’ve become discouraged with the hormone specialist doctor I saw as she seems to have given up based on my histamine reaction and doesn’t have any idea for how I can go forward. Whereas the naturopath is knowledgeable about histamine, mast cells and hormones.

Yes, the lack of understanding about this area of women’s health is astounding. So many women have been misdiagnosed with a mental health condition that is not being correlated with what is happening hormonally and is off the mark. Some women are fortunate enough to get through these years without much difficulty, but for some it’s a rollercoaster and there needs to be much deeper understanding.

Emma, I hope you are going ok. As Anas1 says, it’s a case of finding the right practical and moral support. I have found it’s worth persisting until you find such support. As well as hormone specialist clinics, I know there are some GPs in regular medical practice who have a focus on this area of women’s health. It may be worth trying to track down someone like that with a good grounding in perimenopause. It’s so important to go gently and as Anas1 says be really kind to yourself.

Take care,

ER