Anxiety, hormone related, perimenopausal, where to turn?

I suffer from what I think is anxiety, feeling nervous and shaky but not outwardly shaking.  A few years ago when I asked my gynecologist about it, she actually felt it was due to hormone changes and after several different meds, we finally settled on Prozac and Estrace.  I'm 53, perimenopausal, last period was 2 months ago.  When I asked if she would continue to prescribe this or refer me to PCP, she truly felt it was hormones and if she felt differently, she indeed would send me to PCP.  I've never had this before.  Was given Ativan also for times when nervousness was worse.  Now I'm out of Ativan, out of Estrace, and still on Prozac 40 mg a day, but nervousness is worse, every day, but not continuously.  Last saw gyn in September and she did not renew the Estrace but did the Prozac.  I called her nurse and was told I needed an appt. to talk to her to be sure it is hormones, otherwise will send me to PCP, since this feeling is worse.  I'm confused as where to turn now, Don't know if I should return to gyn, or go to PCP.  My gyn already knows my history of the anxiety but yet I don't want to go back to her only to be told to return to PCP, and vice versa.  Any insight into this and where I should turn?  

[Machelle Seibel, MD]

Feelings of anxiety and nervousness in the menopause can be challenging when it comes to treatment. Many women do get referred back and forth which in itself can create anxiety. There are a few things to consider. Three common medical problems that can cause this feeling are low blood sugar, abnormal heart rhythms and thyroid disease. See your PCP for a good physical exam. If all that is normal, ask him or her for a mental health referral. Sometimes anxiety situations occur and it is always a good idea to just be certain. If that evaluation is normal, get a second opinion on the estrogen treatment from someone who treats a lot of menopause patients and prescribes estrogen and alternatives. That will give you the best opportunity to get this problem resolved.
Machelle M. Seibel, MD

[goochmeister]

I empathize with your confusion.  The healthcare community can be very hard to navigate sometimes.  HMO's and rising healthcare costs have made it almost impossible to get more than five minutes with a doctor and then sometimes the physician gives little help, either because we are not clear about what we need from them, or because they are not up on the latest techniques or have some other personal agenda that interferes with their ability to give us the help we need.
I found that if I want optimum health, I have to be responsible for it myself and seek as much information as possible on my own.  I started researching menopause issues for myself and found some things that worked for me.  Everyone is different, but you might give these things a try for yourself and see.  I eat a low fat, low sodium, healthy diet of lean meats, veggies, fruits, nuts, beans, dairy, stuff like that.  I eat 6 mini-meals a day.  This balances my blood sugar and my blood pressure (which was high before).  I exercise 30 minutes a day (swimming suits me best, but everyone is different).  I take B-12, Magnesium and Calcium supplements.  I drink only de-caf teas, particularly green tea.  I eat very little sugary foods.  I use USP progesterone cream and and over-the-counter soy/plant based estrogen supplement with chasteberry and black cohosh.  I'm investigating the bio-identical hormones available by prescription and may switch to those.  For really tough times of anxiety, I have used a very low dose of Lorazepam (ativan), which I cut in half to further make it low dose.  I only use that when I've had a little bout of internal shakiness such as you describe.  I heard at a seminar that the anxiety we experience with menopause is not really menopause, it's metabolic - related to the depletion of essential stress hormones as part of the aging process.  It's an adrenal gland problem.  It's usually hindered by the sleep disruptions we also experience in menopause.  That 2-4 a.m. time when our stress hormones should be re-plenishing - if we are awake, that replenishment can't happen.  These are the things I've learned so far.  Beware of all the internet "snake oil" salesmen who will try to sell you some quick fix for all your problems. It has taken me months of research to find a balanced lifestyle that works to alleviate my symptoms and I'm still checking and double-checking all that I hear.  So many opinions out there - you have to find what works for you and what is safest medically for you, too.  

[FitOverForty]

I say ditto to Goochmeister!  I've been writing on the anxiety forum for many folks that are in their 20s and have anxiety disorders, etc.  I wanted to come to a board that is dealing with peri-menopause symptoms such as anxiety.  The thing I get a lot is tightness in the chest.  I'm on ativan but today within 3/4 hours my chest started tightening up again.  I have watched my menstrual cycle very carefully and the past two times, they were only 2 weeks apart lasting for 7 days...that's pretty long for me.  

This anxiety developed 3 weeks after I hurt my back...I had an anxiety attack on a cruise ship.  I remember there would times that I would find myself weeping for no reason but nothing too often.  I saw my gyne and she said you have anxiety.  She said there's no way you are at peri-menopause stage...obviously I had asked.  I know blood work was done only because I DEMANDED it...everything looked fine with thyroid, fats, etc.  There was no hormonal test that she did as she felt unnecessary.  Well, long story short, she put me on Lexapro (UPPER) and Prozac(UPPER) thinking that these uppers were suppose to cure my nervousness.  Geez, the Lexapro sent me to ER with a major anxiety attack.  Thereafter, my esophagus had closed up so bad that I could barely swallow milk.  I needed to weep on the phone with this doctor in order to get her to send me somewhere because something just wasn't right.  Had an endoscopy and the doc. said your esophagus is remarkable...it's got to be anxiety.  I've seen a therapist, psychiatrist and they couldn't really find anything that I was stressing about.  They both said you're in your 40s..your hormones are changing and that, in itself, will cause anxiety.  The extent of it is different for every women.  The psychiatrist said she pops a Xanax a day for her anxiety.

Bottomline, the anti-depressants should NOT be used for anxiety but rather for depressed patients.  Anxiety is already a nervous condition and why in the world would you give someone an UPPER to relieve anxiety??!!!

I'm sorry but the medical industry doesn't have it all together.  And, the pharmaceutical companies I strongly believe are in cahoots with doctors to prescribe the anti-depressants as they costs a WHOLE lot more than ativan or other benzos.  Ex. I paid with insurance $93 for Lexapro which sent me to ER and pay another $4K due to that bill...livid over this bad call on my doc's part.  I pay $2 for 60 pills of Ativan...now you tell me who's making money here?  How does the world go around?  We all know the story with oxycotin and how they were all in cahoots...it's out there for us to know about these practices.  I just find it dispecable that we are suffering with these illnesses and they struggle to give us our sedatives because they are addictive!!!  I got news...all drugs are addictive along with those anti-depressants!  Who's kidding who here??

I hope this gets people thinking about the medical industry and pharmaceutical cos.

[rhonko]

I am 48 and have been having a strange dizziness. It is very light but I just feel off like there isn't enough oxygen going to my brain. I have been checked out by every Doctor. Last month my periods was 2 weeks apart. I was stressed before but fine now. Note, I was also put on lexapro and ended up in the hospital after taking one pill. I am not on any meds, taking vitamins and natural products for peri-menopause. This all started after breaking my foot. I thought it would all disappear after I was healed. Not to be paranoid but how do I know if it's a brain tumor, who would check that. I do feel better when I am outside and active. But what ever it is is not normal. Any advice would help.

[tbird2736]

hello, I am 41 yrs. old. have noticed a change with every period cycle since last summer. I have been experiencing some anxious feelings, dizzy, jittery, lightheaded  comes and goes.  This past week I awoke feeling like a I drank a pot of coffee, next day the same thing it did subside, but I  had a panic/anxiety attack while driving.(I don't know if I Put my self into it by thinking and thinking if I was still anxious)  My Dr. ordered blood work, heart monitor and also prescribed clonzapan 0.5 mg if needed.  This started on Tues 2/19 and I started my period on fri.2/23.  P.S. When Isaw my M.D. my bloodpressure was a bit low and my body temps usually around 97.6 during my period.I am also a heavy coffee drinker and a moderate smoker, both of which I am cutting back on grately and hope fully quitting the latter