How to start convo with doc re potential depression

[chocolatesaltyballs22]

I'm not coping at all at the moment. Been on HRT for over a year but clearly not on the right one yet. Have had severe insomnia for over a year and I think it's leading to depression. Have had no enthusiasm for Christmas at all which is not like me. Can't be arsed with my job any more, which I used to love. Can't really be arsed with anything much any more and feeling no enthusiasm for life. Did a depression/anxiety questionnaire online and scored 14 out of 24. Husband thinks I need help; it's affecting our marriage. I just don't even know how to begin to explain this to a GP - I feel so overwhelmed. But I need to be taken seriously as I just want to feel better.

Any advice from people who have been in a similar position would be much appreciated. Need to make an appointment in the morning and just the thought of doing that is worrying me.

Isn't the best way to get the right HRT?
Depression that starts only when hormones shift does usually respond to HRT.

Maybe it would help if you told us which hrt you had used then we can suggest others?

Re telling your GP, you need to say that you feel low and are maybe depressed BUT you understand the NICE guidelines say treat with HRT as first line treatment, not ADs, so you want to try other types.

The type at the moment that is most popular with menopause specialists is Estrogen gel and micronised progsterone.

I was on Kliovance, then switched to Kliofem. I just feel like they're throwing whatever is easiest my way. I've had enough - I can't wait more months feeling like this while they get it right. The doctors seem clueless. Last time I was there they threatened to take me off HRT because of one high BP reading.

Are you on continuous combined hrt? ( no bleed sort?)

To be honest, if you are, that is likely to be the cause of your low moods.

You will be taking Norethisterone daily. This is known to give women low mood.

You need to switch to a sequential type - where you use a progestin for only 10-12 days each month on a cycle. If you are one of those women who suffer low mood and progestin intolerance, you can, under medical guidance, even extend your cycle to 6 weeks instead of 4, so you have 4 weeks of estrogen-only before the 12 days of progestin.

Can you afford to see a private meno consultant? If your GP is useless, that's one option or you simply have to go and talk to your GP and ask to change to a sequential type- gel and Utrogestan- and say that's what most meno consultants are prescribing now.

Yes - continuous. But my periods had all but stopped prior to taking it anyway. I have private healthcare but don't know if Meno related issues are included.

You've responded to me before so thankyou. Have been putting off going back to the doctor's but things are just getting worse.

Sadly, meno is not covered under private health care although you could try asking for a referral to a gynaecologist (who specialises in meno) to discuss your low mood and see if it's hormonal- some insurers might allow that.

On the other hand you could pay £250 for a consultation, get advice and a letter for your GP advising them of the right type of HRT.

My advice is you stop the HRT now until you see someone else and get another type or your GP agrees to prescribe another type- but you need to be assertive and say what you want to try- your body!

ps you don't HAVE to use continuous hrt, ever. It's mainly prescribed as most women prefer it. I have been on sequential for over 10 years and in my 60s as I don't like the effects of continuous.

Feels a bit drastic to stop taking it, I worry I'll be even worse and go back to horrendous hot flushes. My plan is to see doc asap.

Final question, you don't happen to know whether some kinds of HRT can cause facial rashes do you?

I've never heard of facial rashes though some women do develop rosacea as part of menopause- and if you do have issues, it's worth asking to see a dermatologist.

Right I FINALLY have an appointment for later on this afternoon. I have to set out what I'm going to say as I'm dreading it and this is the conversation I'm planning on having:-

Been on HRT for well over a year, switched types about 4 months ago. Still don't feel it's the best type for me as I haven't had a decent night's sleep in well over a year - I have severe insomnia and think I am borderline depressed. Finding it hard to function at work and it's impacting on my marriage. I am short tempered with everyone and over-think things. I can't go on like this as it's impacting on my life massively.

Anything to add? I don't know how I can cope with quite challenging work situations but find the thought of speaking with a doctor about this stuff terrifying.

You've go to start by understanding that most GPs know very little about HRT- huge movement by the BMS to try to get them trained and up to date.

So you have to decide what you want and ask for it.

My advice as earlier is you switch to a sequential type because taking progestins daily can make moods worse- I certainly don't want to take them daily and have used sequi for 10+ years.

The best meno specialists at the moment are prescribing Estrogen gel (not Sandrena) and micronised progesterone (100mg capsules, 2 a day for 12 days per 28. (You can drop to 10 days if you get bad side effects.)

At least if you go onto a sequi regime you can see if that helps and you can also use Utrogestan vaginally, same dose, just slip them in at bedtime, which reduces the side effects.

OK thankyou. Previous GP told me that only these types were available to me as my periods had stopped completely. But that could be lack of knowledge as well.

There is no rule about using conti or sequi types.
Many women use sequi well past menopause.

Some GPs are a bit ignorant about this.

The lack of bleed with conti is more for convenience for the woman, but the downside is that daily progestins can affect mood.

There is also- according to research - a 1.2% higher risk of breast cancer with conti types compared to sequi though not many GPs know this as they are not experts, but it's in all the research.

Thanks...having been doing lots of reading up this afternoon. Hope I'm a bit better armed with knowledge now.

@JinglingHellsBells thanks to you I think I've got what I need - went with your recommendation. Will see how I get on but thanks for your advice, it's really appreciated. The doc did try to push Setraline on me as it's 'safer' but we'll see how I get on with what I've got.

That's great! Hope it works for you.

Did she explain how to start the r egime?

You start the Utrogestan on the same day each month to make it easier- so women often choose the 1st or the 15th.

You could in theory start the gel today (or when you have it) and start Utrogestan on 1 Feb- estrogen only for a bit more than 2 weeks won't be an issue. Or go for the 15th/ 16th if you want.

I'm on Sertraline because I can't have HRT because of my blood pressure medication.

I don't really care, I just want to be able to sleep. Not really the cure all I wanted it to be but still in the first 2 weeks of use.

I've lost interest in things but I put that down to general malaise of life in general presently.

Yes all explained, have started both today and will note 25 days in my diary then have a 3 day break.

Hope the Setraline works for you PP. (Sorry, forgot your user name. Brain fog)

Reading with interest.

I take oestrogel and utragestan 100 Mungo every day without break and no problems with low mood. The progesterone actually helps my sleep, making me nicely sleepy. Good luck, OP.

100mg! 😆

Thankyou. I have to say this site has been an absolute lifesaver since I started with menopause symptoms. There's so much knowledge on here and quite often the GP's are just winging it. It's best to go into the conversation armed with information

I'm on Sertraline because I can't have HRT because of my blood pressure medication.

High BP medication and HRT are not contraindicated.
The medical advice is women with high BP can use HRT as long as their BP is normal, even if controlled my medication.

Who told you otherwise?

@chocolatesaltyballs22

I think you've got the wrong end of the stick :)

Taking it for 25 days is in fact the continuous regime. (25 days out of 28 counts as continuous.)

The sequi regime is 12 days per 28.

I really do advise based on my own experience with this combo and your moods, that you use it as a sequential type.

That was the whole point of my advice- get off continuous.

Ok, so how many days should I be skipping?

Sorry, you said 12 days out of 28. That's not what the Dr advised me. Hmmm