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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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I have started my first cycle of hrt and had a period ,I was

Customer Question

I have started my first cycle of hrt and had a period ,I was coping well then without any warning my anxiety escalated leaving me not coping and very tearfull. I couldn't cope and now feeling scared about this. My doctor upped my dose will this improve my anxiety and ability to cope thanks joanne
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. C. replied 2 years ago.
Dr. C. :

Hi and welcome to the site. My name is***** and I'll be providing your medical information today.

Dr. C. :

If your symptoms are due to menopause, then the increased dose of EPT should help. This is something that would be expected to improve VEY quickly, within 3-5 days of starting the higher dose.

Dr. C. :

If the increased dose doesn't help during that time period, then there could be something else going on.

Dr. C. :

Depending on the type of progesterone being used, some women do develop mood destabilization with synthetic progesterone that is sometimes used with EPT.

Dr. C. :

VERY not VEY

Dr. C. :

If you're not making any progress, I would check an estradiol level to see if you're absorbing the estrogen properly.

Dr. C. :

Some women have trouble absorbing the estrogen if taken my mouth. Those women may do better with a patch or even putting the estrogen pills inside the vagina.

Dr. C. :

If not feeling better reasonably soon, seeing a doctor who specializes in menopausal management would be helpful.

Dr. C. :

I hope this information has been helpful. Please REPLY if I can clarify anything or provide more details.

JACUSTOMER-4f0qiack- : Thank you that has reassured me that things will improve cos the anxiety isn't pleasant and I don't feel in control and that is a worse feeling , I also have suffered from depression which doesn't help the situation. I feel every day is a battle
Dr. C. :

This can happen. Sometimes it can take a little while to figure out the best combination of the EPT, dosing and way of delivering it.

Dr. C. :

It's best to be under the care of a gynecologist who has the interest and time to manage menopausal issues.

Dr. C. :

Luckily with EPT, the improvement with each change is noticed pretty quickly, within 3-5 days.

Dr. C. :

I also recommend not changing 2 things at the same time, for example don't change dose and way of delivering the estrogen in one step. It helps to make one change at a time to figure it out.

Dr. C. :

Testing for the estradiol level is also helpful in figuring out if the problem is not absorbing the medication.

Dr. C. :

Meanwhile lots of self care is important such as taking brisk walks daily for 15-60 minutes.

Dr. C. :

It also helps to learn a technique called "paced breathing". Use it not only for the hot flashes but also for the waves of anxiety. Let me get you a handout I wrote on paced breathing. I'll be right back.

Dr. C. :

http://www.cascadewomenshealth.org/download/PDFs/HealthEducation/Menopausal%20Management/Paced-Breathing.pdf

Dr. C. :

Remind yourself that this is temporary. In some situations it may be helpful to add an SSRI medication just for managing the depression and anxiety part of it more effectively.

Dr. C. :

I hope you feel better soon.

Dr. C. :

Anything else I can help with today?

Dr. C. :

If no more questions, please leave a feedback rating. I aim for excellent service.

JACUSTOMER-4f0qiack- : Iam taking 100mg of setraline for my depression so that helps i just cant wait not to have this horrid feeling of panic will that go too
Dr. C. :

Good so you're already on a mood stabilizer. Hopefully the new dose of EPT will help soon. If your doctor is using a synthetic progesterone such as medroxyprogesterone acetate, it may be helpful to change to a micronized progesterone. But be sure to give it at least 3-5 days at the new dose before making another change.

Dr. C. :

And remember to ask for an estradiol blood level to be sure you're absorbing the estrogen properly.

Dr. C. :

I do hope you feel better soon. Meanwhile do the paced-breathing for the anxiety, take a hot bath and take brisk walks daily.

JACUSTOMER-4f0qiack- : Iam on a pill where u take one pill for so many days then two tablets for the remainder of the days before having a bleed
Dr. C. :

So you're on a cyclical regimen. This is actually safer with regards ***** ***** cancer risk. This way of taking it doesn't increase the risk of breast cancer.

Dr. C. :

Can you tell me the names of the 2 medications and the doses?

Dr. C. :

I'm thinking you're taking both of them by mouth.

JACUSTOMER-4f0qiack- : So i have to relax a bit more and should feel better again and more in control i find i think about it all the time which doesnt help
Dr. C. :

Right, learning some meditative techniques so that you don't focus so much on it will help. It won't be 100% gone, but you can get it to a place where it's not so pressing on you.

JACUSTOMER-4f0qiack- : Its called prem pak c and is 1.15 mg does that help
Dr. C. :

Yes, this is the higher of the 2 doses available. It does have a synthetic progesterone in it but because you're taking the synthetic progesterone just some of the days, if the mood destabilization is on days you're not taking it, then it's not due to the synthetic progesterone. But if you feel worse on the days you're taking pills with the synthetic progesterone in them, then it could be part of the issue.

Dr. C. :

Premarin products do sometimes have poor absorption because they come with a hard shell on the outside of the tablet.

Dr. C. :

In that case, testing blood level of estradiol will tell whether you're absorbing properly or not.

Dr. C. :

Anything else I can help with today?

Dr. C. :

If not, please do leave a feedback rating. I aim for excellent service. I hope you feel better soon and have a good holiday.

Expert:  Dr. C. replied 2 years ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Customer: replied 2 years ago.
I had no side effects or anxiety until
I had a period and i started to notice a decline in my well being about 5 days into the period and thats when the anxiety started
Expert:  Dr. C. replied 2 years ago.

In that case, it's during the withdrawal days. Are there some of the days when you take no pills at all?

If there are no days on which you don't take any pills at all, it may be due to the synthetic progesterone building up. The synthetic progesterone is the round pills you take only some of the days.

Customer: replied 2 years ago.
No i have to continue the packets without a break do u think i will get better
Expert:  Dr. C. replied 2 years ago.
No doubt this will all get better at some point. Nothing ever stays as bad as this. If you feel fine the rest of the pack but get bad towards the end, I think it may be the synthetic progesterone. In that case you may be better off with a micronized natural progesterone. But mostly I think it will get better if you attend to the paced breathing when you are feeling a wave of anxiety and also making sure you are getting brisk walking in for 15-60 minutes daily. That has a huge positive impact on taking the edge off anxiety feelings. Also something like yoga can be very helpful. I've helped many women with your situation. I myself have been through menopause and noticed increased anxiety for sure. Take good care of yourself and know that there really is nothing bad happening to you.
Customer: replied 2 years ago.
Your advice is really been good for me and the reassurance has really helped i do tend to punish myself cos of how i feel
Expert:  Dr. C. replied 2 years ago.
Right, it can go into some ugly places for sure. One deep breath at a time. You will feel better. None of this is permanent and there really is nothing bad happening right now. Have a good holiday.

Thanks for your feedback rating and feel free to ask follow-up questions if you think of any later.
Customer: replied 2 years ago.
Thank you iam already panacking about the way iam going to feel in the morning
Expert:  Dr. C. replied 2 years ago.
Try not to focus on it. Instead take some nice big deep breathes. If possible go for a walk to get yourself out of yourself and looking outside of yourself. Be kind to yourself, take a bath, whatever works. Find that kind mother inside yourself and talk to yourself as a kind mother would to you. It's all temporary. If necessary, find a doctor who specializes in menopause.
Customer: replied 2 years ago.
Thank you so much for your support
Expert:  Dr. C. replied 2 years ago.
I'm glad to help.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience: 30 yrs experience, awarding winning educator
Dr. C. and other OB GYN Specialists are ready to help you
Customer: replied 2 years ago.
Hi i asked a question about my feelings of anxiety today and needed some reassirance i managed to cook christmas dinner despite feeling a bit odd just still worried about these feelings and being anxious and the tablets making me depressed
Expert:  Dr. C. replied 2 years ago.
I'm glad that you were able to get your Christmas tasks done. Try to continue to focus outside of yourself, on the task, the people around you, try to pay more attention to the people around you more than the feelings inside of yourself. The more you focus on your bad and uncomfortable feelings, the bigger they will seem. You can print out our conversation from yesterday and follow the steps and suggestions. It may take a few weeks to get the rignt balance. But if your feelings are related to menopause, you'll almost certainly notice improvement either just with time or by following the suggestions to find the right EPT method for you. Again, seek care with a menopause specialist if needed. Meanwhile, remember the paced breathing and do get out for a brisk walk. Take a family member or friend with you if possible.
Customer: replied 2 years ago.
I shall continue as planned what u said to me and it will get much better and my worst problem is to stop worrying about how i feel and being depressed
Expert:  Dr. C. replied 2 years ago.
Sometimes you just have to use discipline to focus outside. Here is a list of things to focus on daily:

http://www.cascadewomenshealth.org/download/PDFs/HealthEducation/Other%20Information/Dealing%20with%20Depression.pdf

Print it out and focus on doing this list daily. Write you plan for how you're going to do this in a journal if that helps. Keep reminding yourself that there is nothing bad happening to you right now and remember people all over the world who have harder circumstances to try to get a sense of gratitude about your own situation.

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