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HRT instead of anti-depressants

For some women depression in their 40s can be hormonal as Ursula Hirschkorn – writing in The Telegraph, 30 June 2015 – found out, and since being treated with tailored Hormone Replacement Therapy her quality of life has vastly improved.

“I never saw it coming. Though I’d suffered some postnatal depression years earlier, I’d always considered myself a pretty even-tempered, upbeat sort of person, not one to wallow or mope about. Then I turned 41, and almost overnight my life imploded.”

The number of women suffering from depression linked to hormonal fluctuations is unknown since the condition often goes undiagnosed, according to Dr Mike Savvas, consultant gynaecologist at Kings College Hospital, London.

“Very often, depression and anxiety in women of all ages can have a hormonal basis,” he says. “This type of depression often fluctuates according to the menstrual cycle. It includes both premenstrual syndrome, postnatal depression and depression leading up to menopause and it tends to get worse in the 30s and 40s. But it often goes unrecognised, or is treated with antidepressants.”

Nor is it known why hormonal fluctuations cause these symptoms, says Dr Savvas. But Hormone Replacement Therapy (HRT) with oestrogen (plus a progestogen for women who still have their wombs), normally prescribed for menopausal symptoms such as hot flushes and vaginal dryness, can be highly effective in treating younger women with cyclical depression and is safer and more effective than anti-depressants. “Of course,” he adds, “you need to assess the patient to ensure the depression has a hormonal basis.”

The anxieties raised about the risks of HRT from previous studies have for the most part been shown to be unfounded, he argues. Current NHS advice is that combined HRT is linked to a slight increase in the risk of breast and some other cancers, deep vein thrombosis and pulmonary embolism (blockage in the pulmonary artery). In women who start it more than 10 years after menopause, it can increase the risk of heart disease and stroke. HRT is not suitable for everyone but for most women taking it for five years or less, the benefits outweigh the risks, says the guidance.

Testosterone therapy may help improve a flagging libido, meanwhile, but is usually only prescribed by specialists and is no longer available in the UK in a form licensed for women. British Menopause Society Guidelines advise doctors to use instead a very low dose of the gel licensed for testosterone deficiency in men. Very high doses can cause masculine characteristics such as facial hair growth, and little is known about the long-term effects, says Dr Savvas, “although given at levels within a woman’s normal range it is unlikely to cause problems.”

Read Ursula’s story on The Telegraph website.

9 Comments

  1. Ros Barnes 12 August 2015 at 4:23 pm - Reply

    I am not a person with any medical training, but I am in the throws of peri-menopause – maybe even post. I am 51 years old and have been on HRT for five years. I believe my peri-menopause began ten years ago, though the GPs I saw all told me I was too young. Being told that there are no magic potions and that we should accept it as being a normal state, doesn’t make sense to me. I am one of the unfortunate women who hasn’t had a good experience so far. I feel the ‘take it on the chin’ attitude can only apply when your mental state is not affected. I turned down anti-depressants for years, as knew I wasn’t depressed. Depression wouldn’t make my head fill with sad and suicidal thoughts every time I needed to trot for a pee in the night. I would wake up okay, but by the time I reached the toilet I would feel the depths of despair of a grieving mother – life wasn’t worth living. A low dose of HRT meant the thoughts came but didn’t go deeper, the higher dose, which I am on now, took them away completely. So, sleeping better meant I wasn’t so tired during the day; another symptom eased. Tired people are snappy, moaning and non-productive – in my case anyway.

    My dilemma now however, is that I don’t feel I should be having the ‘monthly bleeds’ my HRT causes. I believe that my periods have stopped; both my sisters had stopped by 51, my mother sadly, was dead by then (strokes). I’m not worried about flushes; I strangely find the urge to strip to the waist wherever I may be, rather amusing (fortunately it’s never actually happened). The bit I am worried about is the feeling that I’ve lost the plot; a forgetful, hazy and meaningless me will return. The occasional wrong word may come out of my mouth but I don’t lose the plot mid sentence like I used to; watching the person I’m having a conversation with wonder what’s happening. It is as alarming for them as it is me. It’s an unemployable state. I’ve agreed this morning with the GP that I will try a lower dose HRT again, just to test the water (I currently take Prempak C 1.25mg).

    I do feel that vitamin deficiency has a part to play in all this. If I take magnesium my skin glows and my nails strengthen and grow like never before. I started taking probiotics five weeks ago (a potion bought on line not yogurts) my nails once again started to grow. Obviously, nails and skin aren’t my concern here, but I do think that other vitamins such as the B’s in high doses may be more useful to women than any anti-depressants and HRT. I don’t think it’s fair on women to be classified as a statistic for depression, when we are an oestrogen deficient or vitamin deficient one (I think this applies to men too).

    The health service and medical centres would be making huge strides and saving millions of pounds if it offered nurse specialists, nutritionists and support groups to women and men of all ages. As communities we are generally more isolated than in years gone by. Once upon a time families would live in the same village, town or even street. Even if a name wasn’t given to what aunty was going through, you’d be aware of how she was affected and how she was or wasn’t dealing with it. I feel that being menopausal is viewed as a failing: you need to toughen up or it’s all in your head (sort of actually). Support, understanding and progress really does help, believe me – oh and in HRT.

  2. Julie Mills 11 November 2016 at 2:57 pm - Reply

    My gp refused point blank hrt, been offered anti depressants instead. I am Not depressed though! Was told menopause is a natural occurance. Then why do I feel SO bad?

  3. Sue 13 November 2016 at 11:00 am - Reply

    I so agree about the attitude of people regarding women in the menopause. Toughen up and its all in your head . Ive suffered all my life with pmts , thinking i was horrible and alwsys sad , unlike some of my friends. Now at 52 im in the menopause and the symptoms are the same.

  4. Sue 13 November 2016 at 11:06 am - Reply

    I resently lost my mum and the two years before she died were horrific. I have no close family. But a few wonderful friends. Two children. A teenager 15 going through his own hormones. I feel tearful so often . Thoughts through my head are annoying . Some sweats at night and day. Coincidence issues and feeling not good enough. Im single and do believe a good person . Ive spoken to my doctor and she has suggested anti depressants or hrt . Im terrified. I dont no which to try although hrt is up first .

  5. jeanette 30 April 2017 at 10:49 pm - Reply

    I am a single 48 yr old, my periods stopped 4 yrs ago. I have suffered depression & anxiety for several years, which I am currently taking medication for.I’ve recently become so agitated with my thoughts & feelings, hot flushes and extreme itching, that I have had tests done for menopause and or thyroid. My worry now is that my hormones were at the root of this all along and that my life which has been dramatically disrupted by my behaviour. I am hopeful having read this website that HRT could be the answer.

    • Dr Heather Currie 4 May 2017 at 3:06 pm - Reply

      We are aware that many women have been offered antidepressants in the past when HRT may have been more appropriate. Indeed the NICE guideline on Menopause, diagnosis and management, recommends that HRT should be offered for both vasomotor symptoms (flushes and sweats) and menopausal psychological changes. It would certtainly be worth discussing a trial of HRT with your doctor.

  6. Bernice 6 May 2017 at 3:35 pm - Reply

    Understanding your body and your own mental health and well-being are the key, – mind, body and spirit- is not new age it’s ageless.
    I just wish some health professionals would actually listen to, study,and educate women better.
    After years of mis-diagnosis, and treatments for anxiety and depression, ( I had several mis-carriages, the fibrio including drug treatments- anti- depressants, talking therapies and an Endometrial Ablation a few years ago, I fought on to understand my conditions.

    I have come to the conclusion that I do understand my body and I know my own mind – but I am not listened to effectively, by differing G.P’s which is a major flaw in General Practice itself, the fact that it was governed by the now defunct Family Practitoner Committee tells you all you need to know there – abolished but now morphed into Primary Care Trusts!

    Primary Care Trusts where arrogant G.P.’s seem to ignore the specialists or more realistically do not have the time to read case notes.

    Following Kirsty Warks excellent documentary and a recent diagnosis of Fibromyalgia, I have decided to try HRT again to combat my unbearable daytime, vasomotor symptoms ( flushes and sweats).

    I am on patch 2 after refusing anti-depressants yet again, and insisting that it is the vasomotor symptoms which are the hardest to deal with when at work!
    I was also patronisingly told I did not need my Vitamin D as prescribed by the Specialist, until i insisted the G.P. read the notes only then did he agree.
    What I would like to know is if it is ok to take the H.R.T. ? Dr Heather Currie?

    • Dr Heather Currie 10 May 2017 at 9:26 am - Reply

      We are delighted that the Kirsty Wark programme has led to better understanding of menopause and treatment options and we are aware that many women who have suffered from menopausal symptoms for several years are now considering taking, or restarting HRT. If there has been a gap of several years since periods stopped, or since stopping HRT, then the safest route is through the skin, starting with a low dose. I notice that you mention that you are taking a patch which is great.

      Detailed answer without all the details is not possible but in general, for women with menopausal symptoms, HRT provides more benefits than risks.

    • Webmaster 10 May 2017 at 9:43 am - Reply

      For more detailed advice you may be interested in our email or telephone advisory services (details in the Help and advice section).

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