How to know when it's not perimenopause but depression

[Delling]

I have been on HRT for perimenopause symptoms for 12 months now but my anxiety and feelings of hopelessness and sadness seem to be creeping up. The last six months have been very difficult, there have been some objective 'reasons' for me to feel sad but I feel like my reaction to these is hugely dialled up compared to normal or rational reaction. My sleep is awful and I regularly go through periods of very little sleep which makes everything more difficult. I don't know whether all of this is because of general menopausal anxiety related reasons, or whether I am actually depressed and need some further medical help. How do I know the difference?

I think you need to sort out sleep first. Have you tried promethazine? Only thing that works for me. Consultant recommended it when even zopiclone didn’t help me sleep. Doesn’t need a prescription but I don’t say I’m using it for sleep aid.

After a lifetime of coping with the impact of childhood trauma by myself, I ended up falling off a cliff when perimenopause hit. I did pop to GP a couple of times but in hindsight I undercomplained about the impact of what I was feeling. I ended up not being able to sleep or eat and was hospitalised and sectioned with episode of hypomania. Diagnosed with bipolar and with some time and hard work (and the aid of a mood stabiliser medication), I’m feeling the best I have for decades. Lack of sleep and stress are the biggest risk factors for a relapse and it did take some time to work out what works for me to get a full night’s sleep. Promethazine works a treat. It’s only an antihistamine so doesn’t have the addictive risks of sleeping tablets. I take two tablets and it’s enough to dull the anxiety that makes it hard to drop off to sleep and stay asleep. I’ve got from little or no sleep and feeling awful, to a guaranteed 8 hours a night. Can’t tell you what an impact that’s had.

So I would recommend getting your sleep sorted first if you can.

Menopause is known to worse pre-existing mental health issues like anxiety and depression so that’s worth exploring too. But get sleep sorted. Sleep deprivation is used as a form of torture for a reason.

All the best.

Can you get some help with your sleep from your doctor? You're spot on that everything seems 10 times worse when you're not physically or mentally able to deal with it.

I just watched this video on the biological processes of the menopause, and found it very interesting. It could be hormone changes from the menopause effecting mood:

It is worth watching as it does offer some solutions to common menopause symptoms like mood changes.

Best wishes.

Thank you both. I have used promethazine and it works well but apparently it is only recommended for very occasional use as can damage your liver (?) so I only take it when I am desperate and unable to function due to prolonged lack of sleep. You are right though, in the periods when I sleep better I can manage the bad feelings much more effectively using CBT techniques.

My understanding is liver issues are rare, usually mild and reversible - but I’m not a medic so I can’t offer advice on that. You certainly shouldn’t take it if you’ve had or have liver issues. Piriton is another antihistamine they mentioned but that doesn’t make me sleepy. My mood stabiliser can cause kidney issues and I have to have regular blood tests to check kidneys, liver and other markers so I guess I’m in the take the medication now to make today good and deal with any consequences if they happen category. My friend was given low dose PPI medication and told she couldn’t have it for longer than 3 months because of possible side effects from long term use. However, for my stress-related (no h pylori bacteria found) stomach ulcers and resulting gastritis, I’m taking a high dose for the rest of my life.

I would pop back to your GP for a chat about options. It’s very individual what people need and what works. Can take some trial and error.

A couple of little tips for racing thoughts at night. Firstly imagine that's a car windscreen in your head and that every new thought is a rain drop that gets swept away by the wipers. Concentrate on watching them going back and forth.

Secondly (and similar) imagine a thick layer of perspex and every though smacks into it before reaching your mind and slides harmlessly away. And finally repeat the 'mantra' "no thoughts" over and over (in your head) so that there's no room for anything else.

I take magnesium glycinate 20 mins before sleep. My adhd coach recommended it. Works well.

What dose of HRT are you on? If lower than 100 / 4 pumps - it might be worth considering an increase.

Thanks. I have tried magnesium (and other sleep supplements) and they don't seem to have much effect for me unfortunately.

I have also tried meditation, yoga, relaxation, white noise, listening to podcasts... Nothing seems to work.

I'm on 75 which my doctor said was as high as they want to go at the moment. Plus progesterone which is supposed to help with sleep (just not for me it seems).