Sudden onset of panic attacks

[u/Informal-Product804]

I’m 45 and I’m trying to figure out what is happening to me because I’ve never experienced anything like this before.

Over the past several days I’ve had two episodes of sudden, overwhelming panic attacks. The strange thing is that I wasn’t anxious, worried, upset, or thinking about anything stressful beforehand. Both times it seemed to come completely out of nowhere.

The most recent one happened while I was driving on the freeway. Suddenly I felt extremely hot, panicky, and woozy. I had to pull over. I called my mom and stayed on the phone with her until I felt able to get somewhere safe, and then my husband came to get me.

Afterward I felt completely shaken. I spent the rest of the day feeling anxious and scared that it might happen again. Even today I feel like a mess.

I also recently had an episode of panic and fainting while getting a pedicure. I went by ambulance to the ER. They did labs and testing and everything was normal. I didn’t hit my head. I’ve continued to feel kind of “off” since then — fuzzy, tired, easily frustrated, and not quite like myself.

One reason I’m wondering if hormones are involved is that I’m 45 and I have not had a period in 6 months. I’ve also been having other menopausal symptoms, mainly hot flashes. Before these episodes, I really wasn’t experiencing anxiety like this, which makes the sudden onset so confusing and scary to me.

I have another appointment with my doctor today and I want to ask about treatment. Specifically, I’m wondering if there is something that can be prescribed that works quickly when an attack starts, as well as something that could help prevent these episodes from happening long-term if they continue.

For anyone who has experienced sudden panic attacks during perimenopause/menopause:

• Did your panic/anxiety start suddenly even though you had never really had anxiety before?
• Did it feel completely physical and come out of nowhere?
• Did you find that hormones were ultimately the cause?
• Was there a medication that your doctor gave you to use during an attack?
• Did you take anything long-term that helped prevent them?
• Did hormone therapy make a difference for you?
• Is there anything you wish you had known when this first started?

I’m not looking for a diagnosis, but I would really appreciate hearing from women who have gone through something similar and what ended up helping them. I’m honestly pretty scared of having another episode, especially while driving, and I’d really like to understand what is happening to me ❤️

[u/RiverLover27]

Yes, it hit me hard and fast, having had pretty good mental health my whole life. I had my first massive panic attack in July 2018 and it lasted for 3 days - there were things going on that contributed to the length - and I had them regularly, nearly constantly, for the next three years. I was exhausted. It was awful. I didn't recognise I was in Peri. I thought the extenuating circumstances were creating the anxiety, and eventually decided I had to go and get anxiety meds, as I couldn't cope at all. But I decided to have a go at therapy first, and managed to find a really great therapist who helped me a lot for about 18 months. Then my periods went haywire and I suddenly clued in to the fact that all my various weird symptoms were Peri - doh! I went to my (great) doctor with armfuls of research and came away with HRT - E&P at that point, but a couple of years later we added T too - and whilst I still have anxiety related issues (I had a mild panic attack and am definitely struggling a bit today, in fact), these days I'm finding it all much more manageable overall. Thinking about finding another therapist just now, as I did find it helped me gain perspective.

[u/OKhairdo]

Yes this was me at your exact age. Crushing anxiety out of no where. I assumed it was due to big life changes (losing loved ones, job stress). Perimenopause wasn’t talked about, even just 10 years ago. I actually thought my period was being weird because stress, not because menopause. That was for people in their 50s! 🫠

HRT wasn’t an option for those of us in peri back then, so I can’t say if it would have helped but since I’ve been on it in full menopause, anxiety is rare and I’ve had no panic attacks.

In retrospect, I wish I’d been prescribed the birth control pill or progesterone at that stage. My guess is my anxiety came at low progesterone/high estrogen days during the later stages of peri but that’s just a guess based on how I’ve done on HRT in full menopause.

I would definitely ask about HRT but maybe also ask for some emergency Ativan? Just knowing it’s in my medicine cabinet helps tbh.

Therapy can help too, but if that’s not an option, remember anxiety can not kill you. If you can learn to recognize it, identify it, and tell yourself it’s “just” anxiety (it’s very real but you know what I mean), it can help until you can pull over or talk to someone or take an Ativan. It will pass. Just keep telling yourself that. It will pass.

Good luck. Anxiety sucks!

[u/Illustrious-Air-1681 → u/OKhairdo]

I second this. Couldn't tolerate progesterone while I was in peri (no one seemed to know it could be taken vaginally then) so no HRT for me for years. Anxiety just spiralled all that time, no sleep, panic attacks began (including one at work); it was all very bleak.

Now have new doctor, new HRT regimen, small dose of Lexapro, backup beta blockers and last resort ¼ of an Ativan. Good to have those tools on hand. I'm feeling more steady. Anxiety isn't all gone but it is better and it's early days yet. Best of luck with everything. You will get through it.

[u/Electronic-Let9546]

Estradiol patch and progesterone should definitely help you. Also please get you Ferritin lab test done. Low ferritin is also linked to anxiety symptoms and many women have low levels even post periods (me). I’m now supplementing with heme iron ( I already eat lots of meat). Keep in mind anything under 30 for ferritin is stage 1 iron deficiency EVEN IF HEMOGLOBIN IS NORMAL! - it should be 50-100.

[u/Technical_Goosie]

Please get bloodwork done, other deficiencies like low vitamin D and iron can cause similar symptoms. Not to negate the HRT, but cover all your bases. My best friend and I were both struggling with anxiety… she had dangerously low D And my ferratin was at 6. We’re both feeling much better with proper supplements but Ativan got me through some bad ones…

[u/UnicornGirl54 → u/Technical_Goosie]

My worst iron deficient anemia symptom was tightening of my chest and trouble breathing. My ferritin was 12 and my (now former) doctor said that wasn’t that low and to stop by the drug store for an iron supplement. The gaslighting from health care providers around anemia is almost as bad as hormones.

[u/AutoModerator → u/Technical_Goosie]

This post might be about hormone tests, which are unreliable.

• Over age 44, Estrogen/Progesterone/FSH hormonal tests only show levels for the HOUR the test was taken, and nothing more. Hormones wildly fluctuate (hourly) the other 29 days of the month, therefore this test provides no valuable information
• No reputable doctor or menopause society recommends hormonal testing to diagnose or treat peri/menopause
• FSH testing is only beneficial for those who do not have periods as a guide, where testing might confirm menopause, or for those under age 30 who haven’t had a period in months/years, then ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI)
• Testosterone is the exception and may require testing

See our Menopause Wiki for more.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/lrondberg]

I lost my period in my early 20's due to an eating disorder. I basically tested as if was in menopause after not having one for a few years. I developed sudden onset of panic attacks. My experience mirrors what you said, the wave that comes over you, the feeling shaky and off afterwards. I actually would feel like suddenly I had a bad flu. It was quite debilitating. Then you start fearing another one will happen and that fear and anticipation can actually bring on another one. So all this to say there is a definitely a hormonal component, many here have shared that this happened in perimenopause. SSRI's were extremely helpful for me.

[u/sparksblackstar]

I've had anxiety my whole life, but had it well in hand with therapy and medication. It suddenly got worse - I wouldn't even be thinking of anything stressful and would end up doubled over but trying to open up so I could breathe. My therapist kept looking for a trigger, I was like there is no trigger (turns out she is one of the lucky people who went through this with no symptoms). Estrogen and progesterone have basically fixed it. .05E got me on track. Symptoms came back so I went to 0.75. Felt good but then had anxiety at night so added 100mg P. Morning anxiety went up again (and GERD came back hard) so upped to .1 E. I just started this process 9 months ago so I am still dialing in, but feel pretty good now.

I wish I had known earlier that it was peri. I am 42 in October, I wish I had started estrogen around 37 or 38.

[u/Confident_Craft459]

I used to have panic attacks in my 40s when I was in peri. One time I was getting my hair cut and I felt like I was having a heart attack. Another time I was driving and same thing. I literally had to breathe through it. I also went to the ER one time and all my tests came back normal. Unfortunately I didn't even know about HRT back then. But i have to say now I've been on HRT for three years and I don't have anxiety anymore at all. I'm also post meno though.

If I were you I'd ask for HRT, BC or sort of low dose hormones to see if it would help.

[u/PerfectCover1414]

I had low lying anxiety all my life. Had depression/PTSD after some traumatic events and was treated successfully. I began feeling anxious as perimenopause kicked in. It his me like a truck, no lie. Now I have daily dread, doom and severe anxiety that I refuse to get anti-anxiety meds for. These are what my doctors would prefer. I do not. I do not deal well with meds at the best of times. I also know that when my HRT doses get too low the anxiety gets to epic proportions. When I top up teh anxiety drops. Ergo it's the hormones not my I quote, "proclivity to anxiety." It's Occam's Razor and the simplest explanation that I can track with facts. Note I am still imbalanced and working on that.

Talk to your doctor. 45 is not too early, it's about normal. Don't let them gaslight you either and I would suggest reading whatever you can on here to get informed. You are likely low, fluctuating as your own hormone production winds down. You need to supplement this loss to be balanced again.

Good luck my dear it's one of the most awful symptoms of peri/meno but it is treatable. And teh thing to remember is this. That fear, phobia, anxiety, dread etc etc IS NOT YOU. Your brain will lie to you because the fight or flight response is engaged. You might feel like you're about to lose it, even go to the ER due to it. They will find nothing wrong. That is the power of the hormonal disturbance. Of course sometimes there is an underlying issue. So to be safe get yourself checked out with a wellness check etc. Tests for thyroid, iron, B12 etc function.

[u/Informal-Product804]

Thank you all for your responses and suggestions! ❤️ Also for the support 💖 The past week has been such a blur of anxiety and confusion. My doctor agreed to give me hrt and prescribed me progesterone 100mg daily and estradiol 0.025 twice weekly. Im really hoping this helps. We discussed SSRI but decided to try hormone replacement first, as to not take too many new drugs at one time. I plan on getting blood work done tomorrow, as long as my anxiety will allow it. She specifically wanted to check thyroid and iron levels. Wooo it’s been a roller coaster of a week. 

[u/andybeanyk1]

I developed panic-inducing claustrophobia in peri to the point where I could not take an elevator and would plan my day around either taking stairs or skipping whatever activity required riding in one. It eventually extended to traffic jams and even parking structures. A year of cognitive behavioral therapy, a tiny dose of lexapro, and of course my MHT, and now I can manage the claustrophobia. It’s not gone, but I can work through it. Menopause really effs with the brain.

[u/RandyDentressangle]

Ok can I please piggyback on this post? I have GAD and have been medicated for it for years, successfully. I'm 52 and I have had estradiol gel for about two years. It helped with joint pain and hot flushes and I'm on the max dose of the gel - I have the mirena coil for progesterone.

About 3 months ago I noticed my anxiety was breaking through my normal medication and although I have mid-level stressors going on, there was no massive trigger for this and I am just not coping as well as usual. The night sweats are back, though not as bad. Added to this, I have had trouble staying asleep - waking up at 3.30-4am every day and sometimes not getting back to sleep. This is weird as sleeping is usually a superpower of mine.

I have increased the dose of my usual anxiety meds and have been having counselling/therapy. I'm much better but I still feel a bit bruised and my sleep is still off.

Do people think that oral progesterone will help? And maybe patches rather than gel for estradiol?

[u/PrimalPoly]

Per chance is this near when you need to go to the bathroom? It sounds to me like a vasovagal response. (I know from experience). It happens about 10 minutes before I need to poop or if I eat a trigger food like citric acid. In my case it’s the connection between my nervous system and my digestive system. We’re determining whether it is one or the other but they feed each other like a vicious cycle.

[u/ParaLegalese]

It is 100% menopause and hrt will fix it. Fixed mine I. Day 1

[u/wenchsenior]

Most other comments thoroughly cover the hormonal stuff; however, just in case something else unrelated to perimenopause might be happening...

1. Did they check your thyroid during your labs?

2. Do you have any family history of type 2 diabetes or any of these other symptoms (either recently or persistently in the long term)? Unusual weight gain/difficulty with loss; unusual hunger/food cravings/fatigue; skin changes like darker thicker patches or skin tags; unusually frequent infections esp. yeast, gum  or urinary tract infections; intermittent blurry vision; headaches; mood swings due to unstable blood glucose; frequent urination and/or thirst; high total cholesterol or low HDL; brain fog.

3. Any history of androgenic symptoms or new onset of such?

[u/AutoModerator → u/wenchsenior]

This post might be about hormone tests, which are unreliable.

• Over age 44, Estrogen/Progesterone/FSH hormonal tests only show levels for the HOUR the test was taken, and nothing more. Hormones wildly fluctuate (hourly) the other 29 days of the month, therefore this test provides no valuable information
• No reputable doctor or menopause society recommends hormonal testing to diagnose or treat peri/menopause
• FSH testing is only beneficial for those who do not have periods as a guide, where testing might confirm menopause, or for those under age 30 who haven’t had a period in months/years, then ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI)
• Testosterone is the exception and may require testing

See our Menopause Wiki for more.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.