HRT or anti-depressants?

[FigleafX]

I have been to GP to ask about HRT due to hot flushes/poor sleep. She suggested that HRT carries small risk of Stroke/Heart Attack. She said anti-depressants could be a safer alternative. Does anyone have any thoughts on this?

Have you done all the usually stuff, cutting out caffeine, alcohol etc. Relaxation techniques. Herbal supplements. Sorry if you've already done this.

Vitalogy. Thank you for your reply. No I haven't. I didn't realise that the things you have mentioned would help. Don't drink much alcohol in any case but my caffeine consumption is probably sky high. I will look at trying to cut down. Relaxation techniques is an interesting idea too. Thank you!

I am new to all this. I thought that I would just ride out the hot flushes but am getting a bit sick of them now.

There’s a good forum called menopause matters, also look at the NICE guidelines pinned to this board which states hrt should usually br given rather than antidepressants. Your gp knows your history but the increased risk is small.

Your mood is probably being caused by a fall in oestrogen....

Yeah I cut out the coffee to try and stop the heart palpitations, frightened me they did. I don't get them as bad but I also get them if I've had a load of sugar too. I'm finding that hard to cut out, not that I'm trying very hard on that matter. I still have alcohol very rarely, more so because I seemed to have gone off it , then I can't have much without it making me fee rotten. I was thinking of the relaxion for the sleeping isssue. Is the problem the amount of sleep or the falling a sleep and waking up problem you're having? I sleep less these days but try not to stress about it.

GP wasn't suggesting antidepressants for low mood, just for reducing hot flushes only. I was surprised as I haven't heard of anti-ds being used for this before. I don't have any problems falling asleep when I go to bed. Problem is waking up at about 3 - 4am. So annoying! I can usually get back to sleep by listening to a Radio 4 Podcast.

For goodness sake. She is out of date. Show her the NICE guidelines that are posted my Mumsnet at the top of the forum. You need HRT.

Thank you! I will read the NICE guidelines.

Waking up at 3-4am, that's not so bad. I used to do that and still do, way before the peri meno started, need a wee anyway
Hope you get some relief from the hot flushes soon.

Wool duvet helped me at night. As can be prescribed for hot flushes there seems to have been studies suggesting they are as good as HRT. But I don't know how credible they were. I seem to remember reading that HRT isn't that great for night sweats but mine reduced when I went on it. Mabye a coincidence.

The NICE guidelines are pinned at the top of this forum. If you read them you will find the part which says that SSRIs and other ADs are NOT to be offered to women instead of HRT unless they are clinically depressed and diagnosed as such.

HRT has many benefits which ADs do not .

Transdermal HRT does not alter your baseline risk of stroke. New research out yesterday showed using HRT for 3 years cuts heart failure / heart disease.

Your GP is out of touch and out of date. Is she a dinosaur?

The GP was quite young so no excuse for her to be out of date! Thank you for the advice everyone. I will go back and ask for HRT. The GP did give me the choice of HRT or ADs and said for me to go away and think about it and come back with a decision.

This is so interesting. I have just been prescribed Fluoxidine anti depressants for hot flushes. I can't find the link to NICE which is referred to in this conversation. Are you able to send it to me please? Much appreciated.

www.nice.org.uk/guidance/NG23/chapter/Recommendations#managing-short-term-menopausal-symptoms

Hrt is the main indication for hit flushes, anti depressants might be the appropriate treatment if non issue is dépression, anxiety and/or sleep issues.

Do you have heath issues that puts more at risk, ie. history of breast cancer, high blood pressure or a combination including smoking?

I think we've been here before with these 'contraindications'!
High blood pressure is not contraindicated for HRT and neither is smoking. If the estrogen is transdermal (not pills) there is no increase in risks if you have high BP or smoke. Obviously you should stop smoking anyway! And high BP has to be treated.

Thanks very much for sending me the link. Very helpful.
I went to the doctor with hot flushes keeping me awake at night, I have also been feeling down (probably as I am not sleeping), feel foggy headed, indecisive, down in the dumps and generally not myself. I'm 53! I have had blood tests done and they confirm I am definitely peri-menapausal. I still get regular periods though! I do not have and health issues, I'm generally fit and well, and do not have any history of breast cancer in my family. When I saw the doctor after having all my tests etc. her advise was to prescribe me antidepressants as she said they help with night sweats and do not carry the risks associated with HRT!
I was a bit surprised to be prescribed this and have not yet started taking them! It's been good to read this forum.

read the website of Dr Louise Newson website is My Menopause Doctor- and all she has to say on Ads / HRT.

She is spitting blood tbh at these useless GPs who dish out ADs willy nilly - mind altering drugs with side effects- rather than replacing estrogen which is the cause of the meno symptoms.

There is a HUGE campaign amongst the meno specialists to educate GPs on not using ADs with women like you.

ADs have risks. They have side effects. They do not give you any fo the GOOD things that HRT can help with- heart, bones, brain, pelvic health, lower risk of colon cancer.......

Oh Queen here we go again. Both AD are strong drugs and both come with benefits AND risks. HRT as a whole is a more risky treatment than no treatment at all however small the risks are. Yes you can take hrt if smoking of with high blood pressure but that will increase the risks that are associated with hrt.

HRT shouldn't be dismissed for women smoking/with high BP but they still need to make the decision as to whether the albeit small increase risks are worth the benefits of hrt and that only the patient can decide.

I agree that prescribing anti-depressant for hot flashes doesn't make sense medically. GPs do need educating but that's where it should stop. Antidepressant might be the better treatment than hrt for some menopausal women because not all depression/anxiety symptoms will be solely hormonal, in other cases, hrt will be more appropriate and yet in other women, psychological support might work best. GPs should not persuading patients that one treatment is always better than an other.

There is no need to be rude.

Here I go again- what? Reiterating medical advice that is published by NICE?

The difference between your posts and mine is you are stating your opinion and it's confusing people because it's your opinion and it's not backed up by medical evidence.

What's been quoted by me are the medical guidelines.

The latest poster does not have high BP or smoke as far as we know.

Yes, high BP and smoking are health risks but they do not raise risks of HRT ANY MORE than risks of

Being overweight
Being sedentary
Drinking more than one unit a day.

We ALL need to be aware of these risks whether we use HRT or not.

The guidelines are very clear and if you are not familiar with them, please have a read. ADs are NOT for women who do not have a history of depression before menopause, or who have not seen a psychiatrist/ specialist who has diagnosed depression. That is the guidance and it's reiterated by all the top UK meno specialists.

It's wrong to suggest women should have the choice because their drs ought to know the facts and be offering proper treatment.

@swingofgthings

Another poster left this link above- NICE guidelines

www.nice.org.uk/guidance/NG23/chapter/Recommendations#managing-short-term-menopausal-symptoms

Dr Louise Newson on ADs/HRT- video

www.menopausedoctor.co.uk/menopause/anti-depressants-and-the-menopause

HRT as a whole is a more risky treatment than no treatment at all however small the risks are.

@swingofthings
You aren't doing women any favours by posting things like this because it's not actually true and it's scaremongering. If you want to make the statements, back it up with the stats and research papers?

HRT has risks and benefits. The information we have shows that for women under 60, the benefits outweigh risk. (There is a graph on the site Menopause Matters on this.) From 60-70 the risks and benefits are equal BUT it also depends on the type of HRT as transdermal does not carry the same risks re clots.

The facts are that HRT protects against many diseases and can prevent killer diseases like:
osteoporosis
heart disease
colon cancer
possibly dementia

Did you know that more women die from osteoporosis than cancer each year?

There is possibly a link with breast cancer with some types of progestogens, BUT there is also increasing evidence, ie the KEEPS report, and the French EN3 research, that micronised progesterone does not add to the risk, nor does a sequential regime.

It's not helpful to make statements about risks when it's not actually the whole picture and will scare women who may already have worries about HRT.

Antidepressants have got loads of side effects
I havent had a single side effect since going on HRT 5 weeks ago. I just feel so much more normal.

I think antidepressants are cheaper for the GPs though, so theyre one of the things they push first

ADs are not recommended for meno symptoms but for clinical depression.
GPs prescribe ADs because they are poor informed!!!
Depression due to hormonal instability is treated with hrt and not with other medication.

Queen I agree with you, creating fear is not the best for the women who use hrt.
The forum offers me a huge help for handling my fear for using hrt and you offer medical knowledge that I really appreciate.

Thanks for all your replies. I think I will go back to the doctor and request I go onto HRT for my symptoms, instead of taking the prescribed anti-depressants Fluoxetine, which she gave me!
It seems that from this thread, and from the information on the links sent; that for someone like me, who is 53 and has had no previous depression, does not smoke, does not have high blood pressure, does not take any other medication, but for the past 3 years has been tolerating menopausal symptoms - that the best thing to do is just go onto HRT!!
Obviously, no one wants to put ANYTHING with any associated risks into their bodies if they can help it! I myself have never wanted to take drugs if I can help it, and have been lucky enough not to need them much. But if taking HRT has a very low risk, and is especially designed to help us women through this stage in our lives - then the benefits will hopefully help me get back to my normal self again.

I really hope it will work as after three years of tolerating my symptoms (night sweats, feeling low, no confidence etc. etc.) and trying different natural remedies, I feel succumbed into asking for HRT.
Thanks all for your advise - it's been very helpful.