Antidepressants? Or HRT?

[LatentPhase]

Wise women, what do you think...

My anxiety is horrendous and out of control. There’s a different quality to it and I’ve had it for a year, since my cycles became shorter. My hair is like straw, I’m hot all the time. Sweat at night.

Been managing by taking care of diet, exercise, alcohol, caffeine.

The confounder is: life since September has gone to the dogs a bit. Am 47 with dependent teens. Big issues with dd’s MH, exH’s house at risk, and current relationship problems (DP and lack of boundaries with his ex, would have liked to move in with him but am fed up).

I’m in counselling. Which is making me feel even worse (shining a light on all the above).

I have crushing anxiety. Work (I love my job) is becoming awful and I am sometimes paralysed at work by the anxiety.

Given I’m afraid of HRT (mum died of breast cancer aged 54) at the mercy of life AND hormones.

Shall I try antidepressants? Or if the major problem is oestrogen - will the antidepressants not work?

I’m speaking to my GP this week but opinions or words of experience would be very helpful.

My own opinion is that most meno specialists would advice HRT using body identical types- so that's estrogen patches or gel, with micronised progesterone. This type is progesterone is - it's thought- less risky for breast cancer and the research shows no added risk if taken for 5 years ( at least.)

Breast cancer and HRT is still a controversial issue; there are many experts who think it does not cause BC at all. (Dr called Bluming - US expert- has written a book Estrogen Matters - and explains why both his wife and daughter who have had BC are using HRT.)

In the UK most specialists think that HRT may in some women accelerate the growth of a cancer but not cause it.

Anti Ds won't work for your symptoms if you need estrogen.

If you want to see a meno specialist privately to discuss this, there are names I can share, mainly London and you could be referred on the NHS to the Chelsea and Westminster meno clinic by your GP. They work with women who may have increased risk of BC or who have had it.

That’s amazing advice, thank you. I would be interested in those names, please. As I can’t go on like this. I think I’ll feel better knowing there are specialists I can consult. Thankyou.

For names, look at the British Menopause Society website and they have a tab at the top - Specialists. Bear in mind that there are specialists and specialists. I'm kind of 'in the know' as I am a health writer and talk to drs as well as having had my own consultant for years.

I hear you re: ‘specialists’ (I work in the NHS!)

Agreed that if your anxiety is caused by hormones then HRT is needed as antidepressants wont work.
@JinglingHellsBells advice is spot on!

I don't know if this helps. I gave up HRT due to family members getting breast cancer. I suffered the sweats, flushes and anxiety for 1 year and have recently started on a low dose of Venlafaxine (75mg) antidepressant for the menopausal symptoms. It took a couple of weeks for side effects to fade but the flushes etc have reduced enormously.

user1463815082 It really depends on what you mean by family history.

My own consultant who is a top meno expert, has a 'rule' that there have to be 2 close family members with BC for it to be a consideration. That would be a mum and sister with BC at an early age.

And even then, it's not a no-no.

All the research shows that for women under 50, who use HRT for 5 years, there is no added risk of BC.

It's your personal choice, of course, but specialists would not refuse you HRT.

Latentphase I have been where you are for 2 1\2 years.
I didn't know the symptoms of perimenopause and put my symptoms down to grief and stress.
The gp never mentioned HRT just ADs!! Also with ovarian cancer(dm)and cancer in the family awaiting BRCA testing I was reluctant to take anything.
I was.given advice and percentages regarding my risk and decided to have hrt.
It has changed my life back to where I was ages ago.Anxiety almost gone sleep has improved arthritis pains gone completely.Please ask G p about the risk factors.
I was also told there were alternatives like the previous poster.

I'm 60 and was on HRT for 7 years but I chose to come off having been risk assessed due to my sister being diagnosed with BC. My grandmother died of early onset BC and my elderly mother has it too.

I wasn't aware until recently that some anti depressants at low doses can help with some menopausal symptoms. I just wanted to put that out there.

ADs for menopause are not first line therapy- this is clearly set out in the NICE menopause guidelines.

They will help with hot flushes but they are not recommended for mood/ anxiety where the cause is loss of estrogen.

For women like you who choose not to take or carry on with HRT, there are options as you have found. I guess if ADs work for you and stop symptoms and you have no side effects from them, that's good.

So I managed to get an appt this morning with GP.

She steered the convo away from HRT. She wanted to steer it towards ‘everything that’s going on’ for me. I felt that’s because she feels on safer ground there.

She offered me two weeks off sick (which I don’t want, it’s not going to be useful). The offered me diazepam and zopiclone! I declined both, on the basis that there are fundamental reasons behind my horrible insomnia and my anxiety so that’s no good to me, with the risk of becoming dependent.

I’ve come out with a prescription for 10mg citalopram, blood tests for the usual (thyroid, got D, iron - all done this time last year). And got to go back in two weeks.

What I really want is someone to discuss the ins and outs of HRT so I can make an informed decision about the hormonal aspect.

Think I might look now for an appointment with private specialist.

vit D not got D

OP what you need to understand (and I'm being 'light' here) is that most GPs know bugger all about menopause. I've been writing on it for years as well as having my own 'meno journey' with an expert.

NICE has already done the hard work for you which is why they state very firmly that for women with symptoms like yours, HRT is the first line of treatment, not ADs. Their statement says 'use of ADs...'has no place' in the treatment of women with...' blah blah.

The research shows that for women with vasomotor symptoms and low mood, HRT has more benefits than risks for women up to the age of 60.

Have a good read of the articles on the website of Dr Louise Newson. Put ADs into the search box and read all the terrible experiences of women like you who were given ADs when it ought to have been HRT.

There is a place for ADs like with the PP where she is worried about BC etc but she is 60 now.

Honestly, you need to ditch your GP and see someone more experienced in menopause. If you want to make a short list of clinics or people in your area from the BMS list I am happy to give you any info (if I can) on names by private messaging.

I asked for a gynaecologist referral and got a bank look and steered back to antidepressants. I’ve GOT to do something so have taken the citalopram but need to go elsewhere as it’s clear the GP is out of her depth.
I’ll PM you, thank you.

I am so glad I found this thread. I am 54 and recently ...in November..had the Mirena Coil removed due to bleeding. Since I had it removed I have suffered from very hot flashes....I don't go red (or get the prickly heat flush...which I used to get occasionally a year or 2 ago. the doctor tested me and said I was through the menopause...BUT said the tests weren't very reliable and FSH etc can vary .
I get a LOT more anxious than I used to and worry a lot and this has been the case for a few years. I also wake up sometimes feeling so very sad and upset. I get on with life but sometimes I wonder if I'll enjoy it properly again. Sometimes I feel I have nothing to look forward to...which is ridiculous as I have a part time job with teenagers , husband has recently retired and is helpful in the house, 3 lovely girls, one of whom is still at home (not so lovely all the time it has to be said!)
I also get the dreaded brain fog and forget words etc and my hair had gone a lot thinner
I try to eat healthily, exercise and am not overweight. However I am absolutely terrified about taking HRT, which the doctor has prescribed for me (patch and pill) as my sis in law died at 45 of breast cancer and I have friends with womens cancer both alive and sadly not with us anymore,
The more I research the more worried I become.....!
Any advise...doctor seemed keen to get me on HRT rather than anti dep?

Feeble, I can relate, every time I google about hrt, my health anxiety is on the roof!
Some days I am convinced that I will definitely get breast cancer, other times I feel more secure. It depends on what I read and how I perceive the information.
Taking hrt is an absolutely individual decision and if your quality of life is seriously infected maybe you can give to hrt a try.