Hrt patches and ads?

[Baddz]

My go thinks I am in menopause/peri menopause.
I am 42 and am having lots of troubling symptoms, and my periods are now slightly irregular and only last 2/3 days (instead of 7)
I am getting horrendous hot flushes.
Headaches, nausea, need to wee all the time, almost psychotic rage the week before my period, hugely sore boobs, palpitations....it's really really affecting the quality of my life.
I have had a blood test and an ecg andI am hoping to see her again on weds.
Has anyone used patches and ads together?
That's her suggestion.
I am all for anything that could make me feel better tbh :(

sorry you feel so rotten.

I'm only quoting here what is in the latest NICE guidelines- out 1 June this year. There is a thread about it further down the forum.

The gist of it is that ADs should not be prescribed for menopause (and especially for early menopause ) when oestrogen is what is needed. There is a lot of concern amongst meno consultants that women are prescribed ADs when they are not depressed.

Hmmmm
Interesting
Thank you

This is from page 11 of the draft guidelines. This is linked to on the forum here- near the end of this page..

vasomotor symptoms

13 1.3.2 Offer hormone replacement therapy (HRT) for vasomotor
14 symptoms after discussing the short-term (up to 5 years) and
15 longer-term benefits and risks. Offer a choice of oral or transdermal
16 preparations as follows:
17 ? oestrogen and progestogen to women with a uterus
18 ? oestrogen alone to women without a uterus.
19 1.3.3 Do not routinely offer selective serotonin reuptake inhibitors
20 (SSRIs) or serotonin and norepinephrine reuptake inhibitors
21 (SNRIs) as first-line treatment for vasomotor symptoms alone.

see points 19, 20 and 21.
Do not offer SSRIs routinely as first line treatments.....

Hello. I'm hoping the HRT may help with my face twitching/tingling & bladder/pelvic pain. I am still considering an AD as I feel depleted after an awful 9 months & I am unsure if I will feel better without having extra support. I will try the HRT for a month & then see my GP. Our mental health needs looking after as much as our physical health. I'm hoping I won't have to but it is an option. The anxiety of how I have been feeling is taking its toll. If all is good & the physical symptoms ease I'll be happy as Larry. I think we have to do what we feel is right to stay healthy physically & emotionally. I hope you feel better soon.

Peter- all drs who know anything about menopause say you must give HRT 3 months- not one month.

HRT is not a cure-all for mental health.
Your face twitching and tingling is a classic sign of stress - are you maybe an anxious person anyway? This won't be cured by drugs- you need to continue with your counselling etc to help that. Drs have been told to cut back on ADs because the evidence is that except for severe depression they don't really work.

This article contains advice from NICE about how other therapies work better and how drs are told not to offer ADs when there are other options.

www.telegraph.co.uk/news/health/news/11550766/Mindfulness-as-good-as-anti-depressants-for-tackling-depression.html

Peter...that sounds awful
I hope the hrt helps you
But I would agree - you need to give it 3 months
I will update tomorrow after I have seen the gp x

I agree with all said. I am in menopause & taking the HRT (only 1 week & yes 3 months is a much better timespan) & I am not coping with the anxiety, face pressure & pelvic pain. That is where I have to make a judgement if it is better for me to include an AD with the HRT to help me at the moment. I realise that is not for everybody & it isn't a cure all. Good luck at the doctors tomorrow :)

Gosh can we just stop right there! I agree that ADs shouldn't be prescribed for menopause, of course they shouldn't. But I really don't agree that ADs "only work for severe depression". That's not a good thing to be putting about and might put people off visiting a Dr when ADs may be exactly what they need.
I'm on ADs and have also had counselling, I'm not and never have been depressed, I take them for anxiety and whilst CBT has helped me it hasn't worked on it own. It's the combination of ADs and CBT that have helped enormously.

Baddz, I do hope things go well at the Drs.

Peter- trying to put this gently- but it's not actually your decision whether you take ADs or any other mind-altering meds. That's down to your GP. There are increasingly strict guidelines about the use of ADs and your GP will make a clinical decision. You aren't depressed though you are pretty fed up with your symptoms. As shown in that link NICE ias asking drs to reduce the number of ADs prescribed. There have been other articles like that- no time to find them- that say ADs ought to be reserved for people with moderate to severe depression only.

I know you are finding your symptoms tough- I had a severe and disabling health problem for years and years so understand that completely. But damping down your emotions is not always the answer. Talking therapies will help you far better in the long term.

Bake I was referring to articles that I read ( research by scientists) in the press a few months ago- this is not something that I made up or was my own opinion- it was the conclusion they reached from research trials on thousands of people.

pink I think you need to re read the Telegraph article you linked to. The study really isn't as conclusive as you are trying to suggest. In fact there's a warning at the bottom of that article about "not reading too much into the survey".

Ads do have their place, not in helping the menopause, but for anxiety and depression. There's enough stigma associated with taking Ads as it is but they can and do help some people enormously.

Well said, Bakeoffcake.

Far too much stigma, when it comes to Ads!

There's also far too much 'selective quoting' to prove a point on MN, with regard to stuff on the internet. Before you know it, a selective quote soon becomes fact and is repeated as such. Dangerous in the extreme.

Thank you Elliotsmam I very much agree with you.

Bake I think you should do some more research.
I don't need to read anything more carefully, thank you. Not quite sure why you are being so snipey either- trying to have a sensible discussion but you appear to want to make it personal
Fully aware of the ending of the article, but I did point out more than once in my post that this was one of only several announcements about the over-use of ADs.
Yes, some people like you might benefit from a combo of treatments. But the overall trend is to get GPs to stop handing out Ads as if they are Smarties and address the underlying issues through counselling, CBT etc.

What on earth is a 'selective quote'? If anyone wants to disprove something then they ought to link to another article, research paper or whatever which shows the opposite.

If you don't like the message, don't shoot the messenger!

In answer to the OP's question, I am on ADs and patches.

I have been on AD's for over 20 years as I have suffered from severe depression since the age of 15 - it runs in my family. When I started to get menopausal symptoms, my anxiety levels rocketed so I had a very good idea that it was my hormones. The HRT has eliminated the anxiety completely. I would try the HRT and see if it helps you - if you're still feeling the anxiety, then try an AD as well.

Sorry if I come across as snipey.

I'm only responding to your post so I'm not sure how I can NOT make things personel to you and your post

This part of your post is incorrect too...

"Your face twitching and tingling is a classic sign of stress - are you maybe an anxious person anyway? This won't be cured by drugs"

Are you a Dr? I am not but I am allowed to point out misinformation on a public forum.

Yes it is true Drs have been told not to give ADs out like smarties. No it is not true that anxiety or depression cannot be helped by drugs.

Hello, my anxiety stems from having the twitching face/pressure and being told it was a brain virus which sent my anxiety to an extreme level. It was a misdiagnosis & it has been diagnosed as TMD which is muscle spasm in my face which is causing horrible sensations. It isn't very nice. I was sort of getting through & then the pelvic pain has come back & I am finding it difficult to cope. When I had the pelvic pain before it was 6 years and 11 ops/Exploratories and it almost broke me. I was prescribed the ADs a month ago but I haven't taken them hoping the physical things would ease. There is a huge element of anxiety adding to my face symptoms. I am in menopause & it was the gynaecologist who said the HRT may have a relationship to my anxiety & muscle spasms and possibly the bladder/pelvic pain. There is an element of feeling like a failure not to cope but I shouldn't feel like that. HRT is for missing hormones but the ADs could be for low Seretinon. My GP wants me to take the ADs. I wish I wasn't in this situation as it is horrible.

Facial twitches can be caused by low potassium levels.

'The messenger' often quotes about hrt protecting the heart, and you can find countless articles etc on the research that 'proves' the connection. If you pop over to the British Heart Foundation you find that they warn about the risks of hrt rather than promoting it. Many others say there is not enough evidence to prove the findings of the research.

The 'messenger' often quotes about hrt protecting the bones, and yes you will find confirmation of that, but the messenger fails to include the full picture by simply using.... 'selective quotes'.

The National Osteoporosis Society says this.

'As recently as two decades ago, HRT was the only treatment available for osteoporosis and was prescribed for post-menopausal women to raise the level of the hormone oestrogen after the menopause. However, over the last twenty years, the range of treatments for osteoporosis has greatly increased and we have a far better understanding of the effects of the long-term use of HRT. These can include a risk of breast cancer, strokes, other blood clots and an increased risk of cardiovascular disease. Because of these risk factors, HRT is not generally used as a treatment for osteoporosis.

Menopausal women under the age of 60, at high risk of breaking a bone, this treatment may be considered provided that the benefit, in terms of reducing fracture risk, outweighs any adverse risks for that individual. HRT would not be considered suitable for women who had risk factors for breast cancer, heart disease, stroke or blood clots.

HRT is still prescribed to relieve menopausal symptoms, and women who are taking it for this reason can be assured they are also taking an effective treatment that will protect them against broken bones.

HRT also has a role to play in replacing hormones in women who have had an early menopause, until they reach the age of 50'.

I get sick of reading 'selective quotes' which are used to prove an unqualified individual's opinion. Quotes which are taken as proof, and then repeated as such.

HRT may help reduce the risk by 20-33%, but it does not guarantee it, it MAY help.

Hrt is one way to deal with the menopause, but not the only way.

I wonder how many women are having trouble sleeping at night, not because of the menopause, but because they are terrified they will die of heart disease or broken bones if they don't listen to 'the messenger' and take hrt! they might get so anxious that they do need Ads, but better not take them because that's wrong too!!

Have a read of this www.wisegeekhealth.com/what-are-the-effects-of-potassium-deficiency.htm

I get sick of reading 'selective quotes' which are used to prove an unqualified individual's opinion. Quotes which are taken as proof, and then repeated as such

Quotes, by their very nature, are not 'an unqualified person's opinion'.

The NOS is a wonderful organisation. But if you took those quotes- (as an unqualified person using selective quotes, perhaps? ) then there is just a chance that they are not as up to date as they could be.

This is what NICE has to say- page 177 of the new guidelines for menopause published June 1 2015.

OSTEOPOROSIS
8.2 Consideration of clinical benefits and harms

Consistent evidence from both randomised and cohort studies demonstrated that the risk of any fragility fracture and non-vertebral fracture was significantly lower for women currently taking HRT (either oestrogen alone or for the combination of oestrogen plus progestogen) compared to non-users.

The risk of hip fracture was also found to be significantly lower for those women on HRT treatment compared to the no treatment group but this finding was only supported by the prospective cohort studies.

The effect of duration of HRT use on the risk of fractures was investigated in both randomised and observational data. No change in the direction of observed protective effect of HRT on the risk of any fracture was found when different HRT durations were examined (short term duration of less than a year, up to 5 years, 5 to 10 or more than 10 years) in RCTs. However, the observational evidence on non-vertebral and hip fracture showed that the effect of HRT on lowering the risk of this type of fracture was only apparent for HRT durations more than 10 years.
Subgroup analysis was undertaken on the role of different age profile when the risk of osteoporosis was examined in relation to HRT use; randomised evidence did not support any differences in the direction of effects based on age. Evidence from cohort studies also showed that the protective effect of HRT on the risk of fractures is not influenced by the time since stopping HRT implying that protection may be preserved after HRT is stopped.

The GDG concluded that the evidence was robust and showed a lower risk of fracture associated with current HRT use that persists after HRT is discontinued. The GDG discussed whether women should be given information about this conclusion as a long term consequence of HRT, to be considered.

if you are to plough through the document you will similar sound evidence about heart disease but of course sometimes a short-cut is to have information posted by a 'messenger'.

PeterSpots you made a very valid point earlier, when you said 'Our mental health needs looking after as much as our physical health'.

You've got a lot of stuff causing you problems, so it's no wonder you're fed up. I'm sure I also read that you have thyroid problems too, which are a pain on their own.

I'm a firm believer that mental health and physical health are equally important, and being in a good place mentally often helps us handle our physical problems better. Hope things improve for you soon.

Not sure where that quote from the NOS was found.

This is from their website. Take note that the risks they refer to are based on the 2002 -2003 research and that this has now been discounted, as flawed ( see BMS and various other sites for that.)

This is from the NOS online leaflet on drugs for bone density.

www.nos.org.uk/document.doc?id=1362

"However in post menopausal
women under the age of 60, at high risk
of breaking a bone, this treatment may be
considered provided that the benefit, in terms
of reducing fracture risk, outweighs any adverse
risks for that individual. HRT would not be
considered suitable for women who had risk
factors for breast cancer, heart disease, stroke or
blood clots"

Not sure why there has been a resurgence from some posters who like to chip in and criticise the use of HRT, at any opportunity they can.