Depression or perimenopause?

[midlifeish]

Wasn't sure where to post this but would love to hear others experiences. I'll try to keep it brief.

Lost my Dad almost two years ago and it hit me hard. The grief in the beginning was brutal but I've pushed through with the help of my husband and weekly therapy but I'm just not right about 50% of the time. I have spoken to the gp who suggested considering HRT but unsure if I should just try antidepressants first. A few details/symptoms:

• I'm 42
• periods still regular
• less alcohol tolerance recently / wine drys me out and wakes me in the night with a bit of a fever
• zero libido between post ovulation and next period (this is taking its toll on my relationship)
• snappy/ragey with the family but not consistently
• low mood, sometimes out of the blue having been fine an hour earlier.
• headaches across forehead which I often attribute to teeth grinding which I do a lot
• waking more than once in the night but mostly able to go back to sleep
• stiff joints after sitting for long, easing with movement
• tired more often
• I walk daily with the dog but need to get back in to exercise properly.

What would you do in this situation? HRT or antidepressants? I feel so up and down I feel like I need to do something to help. Thanks for reading

Hey there,
If you have the time take a look at Georgia Ede on YouTube, she is an American psychiatrist who takes the view that some mental health issues can be caused or exacerbated by inadequate diet.
It is worth considering. Anti depressants work on the assumption that there is a hormone imbalance or insufficiency in the brain, so for example SSRI inhibit the re uptake of serotonin in the brain. But this does not address why there is insufficient serotonin.
HRT also works on the assumption that body can not or does not produce enough of the right hormones, and replaces them. Ok, but we can also think about how can diet help the body produce hormones.

Anyway, I found it interesting.
Best of luck,

Your GP has (most unusually) suggested that HRT might help. Most of them brush off raging peri symptoms with 'oh you are depressed, here, take these' so if I were you I'd try the HRT asap and see what difference it makes.

There is the possibility that you are also depressed, but treating your peri symptoms will at least mean you won't feel so rough all the time.

OP give the hrt a try, it's refreshing to read that a Dr has suggested it as most would be prescribing anti depressants! Some of your symptoms do point towards peri even though your periods are still regular. Do try hrt, you might find it makes a big difference and if not then you can consider anti depressants.

These are many of the symptoms I experienced when I first started going through perimenopause at the same age as you are now. My periods were still regular for a while but I had pretty much all the symptoms you are experiencing so I would definitely go for the HRT first before the antidepressants.

How did you find the HRT? Was it useful? And how long did it take before you noticed a difference?

How long does it take to see the impact of HRT? I still have a bit of the old school hangover from my own mum saying HRT was bad for you and caused cancer etc so I think I'm talking myself out of it.

Yes, she was very good and really listened but it's still a little like feeling around in the dark!

Thanks, I will take a look. I know lifestyle and nutrition also have an impact so it would be no bad thing to have an overhaul

I felt a big difference. The waking up in the night with a racing heart and feeling feverish and anxious stopped immediately, as did the low moods and mood swings. The raging temper was the next thing to improve within about 2 weeks. The joint pain took about a month then I suddenly noticed it was much better which has meant I can now walk further and for longer and no longer hurt! All other symptoms I had just started improving and getting better the more time that passed. But many of the symptoms started improving within a week.

How many of those issues were applicable to your life at age 20? Things like teeth grinding you probably did since childhood. My experiene is that Some tiredness, grumpiness, laziness, moodiness is normal in every human. I am immensely jealous if you never had any of that before 2 years ago. If it isn't incredibly different & fairly new, I wouldn't blame it on aspects of aging (so HRT not so indicated). Sitting still for long periods makes everyone feel stiff potentially. The less exercise you do the more tired you'll feel the rest of the time.

You won't know what works for you before you try it. There are A LOT of different combos of antiDs or HRT options, so I'd try the one that is supposed to work fastest (according to doctor advice, not according to internet randoms). You might end up wanting versions of both or neither.

Op while I’d go with what everyone else says especially re the physical symptoms I’d also remind you that the depression might just be sadness and grief at your dad. I was years ‘getting over’ my dad and was thinking I was doing fine for my kids but I wasn’t really, add to this how life is just tougher at our age physically and stress wise- it might just all be hitting you but then see above advice because hopefully that will help if you know what I mean x

Yes, I know what you mean but it feels like such a shift that I'm not sure I can put it down to just getting a bit older. The stiffness/tiredness/low libido etc are all things I never experienced in my 20s. Of all of them, the teeth grinding was the only one I've had long term so you're right on that score. I was always sceptical about perimenopause and all the information around it. Guess I always had the ‘it will never be me’ attitude but now I feel like it might be happening and I have had to have another look at all the things I rolled my eyes at before 😅 Im also worried about hrt and the risks that were always mentioned in the press back in the day - part of the reason my own mother didn't take it. Looking back, we all would have been better off if she had!

Yes, hard to know which way is up where grief of concerned. How long does it have to go in for before I can admit there's something else up. Perhaps long term grief is simply depression. Who knows?! Sorry for your loss xx

Try the HRT for 3 months. See if it helps with your symptoms.

@nessiesnotreal that’s really helpful and good to know, thanks. Is you're heavier in testosterone? I've heard that's a good place to start

I've booked a gp appointment and hope to discuss options. Anyone on a testosterone based hrt?

@midlifeish Testosterone is an extra. They'll put you on it if you have low libido. You also need to get your hormones in check first.

@midlifeish l was suffering with hot flushes (as well as other symptoms) and for me the hrt worked on the hot flushes almost instantly, which was a big relief. Other aspects, tiredness, low mood etc took a while longer.

I feel like you've had a terrible loss and needing some stability to regain equilibrium - anti depressants could help you achieve that but alongside them you need to also do the work to heal if that makes sense. The reason I say that is they IME come with side effects of varying degrees like some tiredness, gastro upset, so you need to try and help yourself so that the side effects are less noticeable e..g following a routine, nutrition. Antidepressants may not help libido.

There is also CBT which can be helpful for establishing routines, and grief counselling may also be beneficial.

I had a stint on the progesterone only pill which made me feel incredibly calm but almost too calm.

I can't take HRT so have had to just resort to being more mindful of my moods, knowing they will pass etc., but I know there are positive and small risks with HRT so maybe do some reading and around these and decide if you want to give it a try.

Thanks. I have been in therapy for 18 months and though it has helped with the grief, some weeks I can't help but feeling like its going over old ground and that puts me back. All of my symptoms feels cyclical so I'm erring on the side of perimenopause but it could easily be depression. I just don't know how to differentiate! So hard x