Menopause Community

Maybe trying a different anti-depressant would be worthwhile. I became severely depressed (thought about suicide almost constantly) after an unnecessary hysterectomy with ovary removal. I also was anxious, very irritable, no sex drive or response and had many severe meno type symptoms - insomnia, hot flashes, fatigue, loss of concentration, memory loss, etc. To make matters worse, my hair fell out and my skin aged overnight. I kept thinking I was in a nightmare but every day I woke up realizing it was my new reality!

Estrogen is my new best friend. It lifted me out of the awful depression and anxiety and allowed me to sleep, concentrate, etc. Too bad it hasn't restored my youthful appearance and sex life! Since estrogen by itself (without a progestin) doesn't appear to increase risk of breast cancer, I don't need to worry about that. But even if it did, I would choose quality of life over the increased risk.

I am 50 with a menstrual cycle that continues to run like clockwork. For several years now, I've had difficulty sleeping. I think that my last restful nights' sleep was in March of 2005. I've also been very irritable at times; to the point that I couldn't stand myself. Believing that it could be hormonal, I went to my gynecologist because I felt like my emotions were out of control.

He tried me on a low dose of fluoxetine (Prozac) and had me come back in six months. While I had felt "better" I still did not feel right. He told me that there was nothing more, within the scope of his practice, that he could do and suggested that I go see a psychiatrist.

I wasn't comfortable with going to a psychiatrist and so I put it off. At that time, I had been employed in a highly stressful position. I , too, found myself crying and sobbing uncontrollably; twice within the same week. During one of those crying episodes, I felt it necessary to leave work. I was having suicidal ideas, and a plan, which really scared me.

Finally, I went to a psychiatrist. I told him about the irritability that would last for a few days, feelings of sadness, difficulty concentrating, anxiety in the form of chest tightness, difficulty sleeping, endless fatigue, moodiness and the suicidal thoughts. He increased the medication and sent me for a sleep study.

Okay, so I was diagnosed as having obstructive sleep apnea as well. I use a CPAP machine every night and still do not feel rested when I "wake up".

I've been going to the psychiatrist for over a year now and currently take four different medications daily. I switched jobs and I'm now in a less stressful environment. I was hoping that a new job would alleviate all my symptoms. Nope. I continue to suffer from the symptoms of my "illness" which has been diagnosed as depression and panic disorder. I still have the excess worry, the chest tightness, fatigue, etc.

Since the medication does not seem to be hel;ping as much as I had hoped, perhaps I should try a new gynecologist. I do not, however, have any interruption of my menstrual cycle nor do I have "hot flashes".


How do I know whether this is hormonal or truly psychiatric?

Dear An_248575,
Perimenopause is an extremely difficult diagnosis to make. However, presuming you have no absolute reasons not to take any hormonal medications (such as actively dealing with breast cancer or a blood clot), I would suggest a try of one of two things. If you are not a smoker, a month or two of a low dose birth control pill might be helpful. A birth control pill will shut down your own ovaries, and give you a fixed amount of estrogen and progestin, so that your body will see no hormonal fluctuations; you can see if those fluctuations are impacting how you feel. Another totally reasonable approach would be just to have you wear an estrogen patch for a couple of months. That will not remove the variations of your hormone levels, but it would give you additional estrogen, so that you would know that absolute estrogen deprivation isn't involved in your symptoms. A trial of either, or doing both, in a sequence, (don't do them at the same time) would be very helpful, I think, to give you further clarification of what's going on.
Good luck,
Mary Jane