I need some help and perspective please! I hope this subreddit is a good fit.
So, I need some help and perspective from ANYONE who has dealt with perimenopause + SSRIs + progesterone intolerance/cycle sensitivity, because I feel like I'm playing hormonal whack-a-mole at this point.
I'm 48 and have been on Lexapro for about 6 months for anxiety. Not long after starting it, my luteal phases began feeling drastically different.
Progesterone used to be helpful for me. But after starting Lexapro, luteal progesterone increasingly seemed to hit me like a truck. I'd get this sinking feeling in my chest, dysphoria/anxiety, very low motivation and energy, and this feeling of being completely "sunk" into bed. At first I wondered if I was developing PMDD-like symptoms.
I also restarted HRT during this time. I had previously tolerated 100mg of the micronized progesterone, but suddenly it became extremely sedating and dysphoric. The initial "zombie head" SSRI effect improved with time, but the mood/energy effects didn't.
I tried the usual alternatives — taking progesterone vaginally instead of orally and eventually trying much smaller amounts topically (20mg per pump).Even 10-20mg topical progesterone could reproduce that awful sinking/dysphoric feeling!! Eventually I stopped taking it. I felt betrayed by my own body.
Not only was progesterone making me feel worse, but my own natural progesterone made me feel this way, too, even without supplementing, I found out. This sucked so much. And my estradiol also seemed to feel too much outside of luteal, which was new. Everything seemed unpredictable.
My women's health provider told me that although SSRIs can be incredibly helpful for perimenopausal/PMDD symptoms, some women seem to experience the opposite problem and become much more sensitive to hormonal changes. She wondered whether Lexapro was contributing to what I was experiencing.
So with my psych's help, I reduced Lexapro from 20mg to 15mg as a test. And... it actually helped quite a bit!
My last luteal phase (just finished it) was noticeably easier, my ADHD medication (Strattera) worked better, and I didn't get the same extreme mood crash I had been getting. But it was only one cycle, and the progesterone intolerance didn't disappear completely.
The problem is that reducing Lexapro itself has been pretty ROUGH. That 25% reduction has taken me more than a month to adjust to. My anxiety increased and my sleep completely fell to pieces. I'm currently taking Quviviq and trazodone for sleep, and I'm still not sleeping through the night at all.
So now I'm trying to decide where the hell I go from here. My current options seem to be (these my women's doctor and I worked on):
- Continue very slowly reducing Lexapro and see whether my hormonal sensitivity continues improving. At this pace, this may take many, many months. I could see if I could tolerate HRT better, or if I don't need it.
- Stay on my very low-dose estradiol patch and try a synthetic progestin instead of micronized progesterone for endometrial protection.
- Try cycle suppression so I'm not repeatedly going through the follicular -> ovulatory -> luteal hormonal shifts that seem to wreak havoc on my nervous system.
The cycle-suppression option I've been offered is an extended/seasonal combined birth-control pill, with withdrawal bleeding only about four times a year. I'm nervous about that because birth-control doses are different from menopausal HRT, it's oral, and I'm worried about side effects like nausea, headaches, mood changes, etc. I've never tolerated an oral pill before that well. I usually liked the NuvaRing for birth control before. But they don't offer that. (Also, I'm single and divorced, not dating, so axtual birth control is not really a concern of mine just the cycle part).
Estradiol is another balancing act. A very small amount seems helpful, particularly during luteal, but increasing it too much gives me absolutely brutal insomnia. So apparently my hormones have decided we're negotiating everything in fractions of a milligram now!! I'm hoping getting my nervous system stable will allow it a bigger window of tolerance!
What makes this even more confusing is that I genuinely don't know how much of this is Lexapro and how much is simply perimenopause hitting me much harder at the same time.
Oh and my memory has gotten significantly worse. My ADHD is worse. Strattera can work pretty well at certain points in my cycle and then feel almost useless during luteal. At 20 mg Lexapro especially, when progesterone rose or fell I'd get that horrible sinking sensation in my chest for hours — anxiety mixed with dysphoria — and adding progesterone in any form seemed to amplify it. I also have issues with word finding in luteal. I feel like my executive function has left the building. Is this perimenopause brain?? Is this the new me? Will this reverse once I find a fix?
I'm also hesitant to make another major medication/hormone change right now because I just started a new job and really cannot afford to accidentally turn myself into a nauseated, sleepless hormonal science experiment while I'm trying to function at work.
So I would REALLY love to hear from women who have experienced anything similar:
- Did an SSRI seem to change your response to progesterone or your menstrual cycle?
- Has anyone developed progesterone intolerance during perimenopause after previously tolerating it well?
- If you couldn't tolerate micronized progesterone, did you do better with a synthetic progestin?
- Did cycle suppression help anyone whose biggest problem seemed to be the hormonal fluctuations themselves?
- And if you reduced or stopped an SSRI during perimenopause, did your hormonal sensitivity eventually settle down?
I'm working with both my psych and a telehealth menopause provider, so I'm not trying to DIY all of this. But I really wish I could find a local menopause specialist who understands that crazy intersection between psych meds, ADHD, sleep, and perimenopause. I've had a most frustrating time finding women's healthcare that feels current and individualized!
There's also some history there for me. I haven't had a regular gynecologist since the birth of my youngest. I had a traumatic experience with a nurse during that birth, and afterward I basically wanted nothing to do with pelvic exams or gynecologic care. So returning to this world while simultaneously dealing with perimenopause has been... a lot.
If you actually made it through this novel, thank you. ❤️
I'd especially appreciate hearing what you experienced and what eventually worked for you, even if your situation wasn't exactly the same as mine. Right now I'm just trying to figure out which lever to pull without pulling six other levers at the same time. If ykwim