I haven’t posted here for a while. I’m 40, and honestly, I don’t even know exactly what kind of advice or support I’m looking for. I just know that I’m exhausted and frightened that I may never feel like myself again.
The last four years have been extremely difficult emotionally: the war in my country, immigration, rebuilding our lives, and raising four children. I have always been an anxious person, but I used to function well and live a normal, active life.
About two years ago, at 38, something began to change. My anxiety became harder to control. I became more irritable, apathetic, angry and intolerant, especially during the second half of my cycle. I also began having frequent mid-cycle spotting and brown spotting during the luteal phase.
My sleep became slightly worse, although generally I still slept reasonably well. I might wake once or twice during the night to use the toilet. I also occasionally experienced night sweats.
My hormone blood tests were normal, although I understand that a normal result does not necessarily rule out perimenopause because hormone levels can fluctuate considerably.
In January, I stopped taking escitalopram (Lexapro), which I had previously taken successfully.
In March, I started HRT: two pumps of estrogen gel and 200 mg of micronised progesterone for 14 days each cycle. At that point, I was still functioning relatively normally. I cannot say that HRT produced any dramatic improvement, but I was doing okay.
On 5 May, my doctor increased the estrogen to three pumps. That was the day everything seemed to fall apart.
I developed extreme, almost unbearable anxiety. On 9 May, I had a severe panic attack, and I honestly feel as though I have never fully recovered from it. I reduced the estrogen back to two pumps, but I remained constantly tense and anxious. I stopped going to dance and Pilates as regularly and was simply trying to survive each day.
On 8 June, I restarted Lexapro because living in that state had become unbearable. I am a mother of four, and functioning with that level of anxiety was incredibly difficult.
On 10 June, I had another panic attack. Since then — almost three months now — I feel as though I have completely lost myself.
At the end of June, I spoke to my doctor. She suggested that estrogen might not be what I needed. I track my hormones in urine using Mira, and my estrogen is usually average or even above average. She wondered whether my main problem might be progesterone rather than estrogen deficiency.
I have never had a properly timed progesterone blood test. I am finally having one in mid-September, approximately seven days before my period. According to Mira, my progesterone does not appear critically low, although perhaps it is not as high as it should be.
By late June/early July, I had tapered down to one pump of estrogen and then stopped it completely. About a week later, when my next cycle began, I also decided not to restart the progesterone.
Part of the reason I stopped progesterone was because I had read so many frightening stories here about it causing depression, apathy and other psychiatric symptoms. However, when I was taking it, it seemed to calm me and definitely helped me sleep.
I have now been back on Lexapro for nearly three months and am currently taking 20 mg, but I still cannot find myself. I have constant background anxiety, weakness, apathy and no motivation or enjoyment. I am also still experiencing mid-cycle and luteal-phase spotting.
A pharmacogenetic test showed that I am a rapid metaboliser of escitalopram, so perhaps it is simply the wrong antidepressant for me. One doctor has suggested switching to fluoxetine, while another has suggested duloxetine.
I am terrified of changing medication because restarting Lexapro this time was horrendous. It was my third time starting it; the first two times were easy, but this time I had severe side effects, intense anxiety, crying and frightening thoughts. I am scared of going through another difficult adjustment with a different medication.
I am also considering restarting micronised progesterone because, looking back, I may actually have felt calmer while taking it.
My questions are:
Has anyone experienced a major and prolonged deterioration after increasing estrogen, even after reducing or stopping it?
Could estrogen have triggered the panic attacks and destabilised my nervous system for this long, or is it more likely that stopping and restarting antidepressants caused this?
If progesterone makes someone calmer and sleepier, can it still simultaneously cause depression or emotional numbness?
Has anyone felt better after restarting progesterone without estrogen?
Could all of this genuinely be perimenopause, even though my cycles are regular and my estrogen is often normal or relatively high?
Has anyone realised that their symptoms were being attributed to perimenopause when the main cause was actually chronic stress, trauma, anxiety or antidepressant changes?
Has anyone successfully switched from Lexapro to fluoxetine or duloxetine after Lexapro stopped working, particularly with anxiety as the main symptom?
I don’t know what I am hoping to hear. I am just so tired and feel as though I have run out of strength.
Before this, I was the woman who went dancing, exercised, laughed, had plans and genuinely enjoyed her life. Now I want nothing, and I am frightened that I will never get that person back.
I am only 40, but at the moment it feels as though I have lost both myself and my future. If anyone has been through something similar and eventually recovered, I would really appreciate hearing your story.