I'm a 37-year-old Caucasian female, and I recently (3 weeks ago) started experiencing heart palpitations in the middle of the night. Then I started getting the palpitations during the day, and then they were accompanied by a general feeling of anxiety and dread. The anxiety has since gotten much, much worse (I have developed a phobia of scary world events on the news), coupled with some depressive thoughts when the anxiety is at its peak. I have no prior history of anxiety (or heart palpitations), no family history of anxiety, and nothing going on in my life that could feasibly explain where this anxiety has come from so suddenly and powerfully. I am also experiencing nausea and aversion to food (I've lost about 8 pounds in the last two weeks), and I often feel a sensation of heat in the middle of my chest when the anxiety sets in. I also experience what seem to be mild panic attacks. In the last 4 or 5 days, the anxiety has been constant, to the point where it feels like my body is constantly being flooded with cortisol--my body feels constantly mobilized and never relaxed. It is much worse at night; once I lay down, my heart starts pounding and the anxious thoughts start racing into overdrive. I went two nights without sleep before finally taking some diphenhydramine to knock me out for a few hours.

Further history: Ever since my last child was born 3 years old patientago, I have not had a regular period. After I had my daughter, I took the minipill for about a year, then Generess for about a year, and since then I have been taking Loestrin 1.5/3/0 (a low-estrogen birth control pill). My last period was 6 months ago, and before that, I had been getting my period only every 4 or 5 months or so (and my periods were very light). I have not yet had hormone testing done to see if I'm in perimenopause. The nurse explained that as long as I'm on birth control pills, they could not get an accurate reading of my hormone levels. There is no history of early menopause in my family.

The anxiety has been severe enough to send me to the ER. I have had a complete cardiac workup (my heart is fine; no evidence of disease or arrhythmia), as well as blood work, which confirms that my thyroid function is fine. I had an "upper GI" (barium swallow), which revealed "mild acid reflux."

So, basically, my question is this: could this anxiety be related to the changing hormones of perimenopause? Or possibly to the Loestrin? I understand that decreasing progesterone levels in perimenopause could cause anxiety, but because I am on a progesterone birth control pill, is this not a possible explanation?

The nurse I have been seeing has just prescribed a birth control pill with more estrogen to see if it makes a difference in my anxiety. But would I be better off stopping birth control altogether? Or would that send my hormones all haywire and possibly worsen my anxiety?

I'm also somewhat afraid I may have some kind of pituitary or adrenal tumor that's causing this constant fight-or-flight sensation, but I don't get headaches and I don't sweat too much. It's just that this constant, unremitting anxiety is so out of character and so out of the blue that I feel like there must be a medical explanation for it.

Thanks for your help,

Alyson Smith