Alternative Medication to HRT - Depression and Anxiety.

[Daphnesmate01]

Anyone take anything as an alternative to hrt for depression and anxiety and insomnia in relation to perimeno? I have beta blockers which are great, amitriptyline to sleep...now for low mood? I have tried HRT for a short while but it does not seem to agree with me (I ended up with very heavy periods) and currently having a cyst examined, though not thought to be sinister. I have never had a good reaction to any type of hormonal pill.
Anyone?

Have you tried having non-oral HRT? I have gel for the oestrogen and a progesterone pessary every other day. I had to go to a private practice to get this combination, but it has really, really helped my insomnia and a flat feeling I had all the time, a sense that nothing in life was worth looking forward to. I also had a weird sudden adrenaline rush when i was dropping off to sleep each night, which would jolt me awake and very alert. That's now gone. So have the night sweats.

I got oestrogel and Utrogestan prescribed by my GP. I think it might be easier to get on the NHS now due to supply problems with other forms.

It's the non-oral Utrogestan delivery method I use which GPs aren't happy with doing sometimes because it's off-licence in the UK (though widely used on the Continent).

I just insert a capsule as if it were a pessary, @Abraid2, as suggested by Dr Louise Newson on menopausedoctor. The private doctor I saw also said this was fine.

That’s exactly what I do too. sparkling

But NHS gps don’t usually prescribe like this. I go to the same clinic as you.

I went to a private doctor years ago for advice (not Dr Newson), but got the most useful advice re oestrogel/Utrogestan on MenopauseMatters and MenopauseDoctor, then asked my NHS GP to prescribe. She was fine about it. We didn’t discuss where I was going to stick the Utrogestan

Doesn’t she notice that you only get through half as many utrogestan tablets as she’d expect? 😆Assuming like me you do them once every other night?

That menopausematters forum is really useful.

Haha! I only started properly a month ago. GP prescribed them originally in 2016 but I got cold feet about HRT. Then I got desperate and asked for another prescription. So it’s early days for me yet. I guess I can tell pharmacist I don’t need every other pack. Can I ask how much oestrogel you take? My hot flushes have gone but my moods and energy are horrific. But it’s early days so 🤞🏽

Sorry, @Daphnesmate01, have rather taken over...

Don't worry Sparkling, it makes for interesting read, especially the flat feeling described and the nothing to look forward to really resonated.

At the moment I am still under investigation re cyst (initial exam and blood test didn't flag up anything sinister, so fingers crossed), but not wanting to take anything until then - including dhea the expensive micronized stuff from America. Periods have moved slightly further apart and seem heavier too (I thought it was the hrt that might have caused this but perhaps not). Just feel very uncomfortable taking the hrt and wondered if an anti-d might provide a pick me up.

@Abraid2 Just a couple of comments - using Utrogestan on alternate days is very much 'off label' and it's not mainstream.

There is some evidence that it's safe this way if used vaginally as absorption is supposed to be better, but it's not widely recognised. I think there is only one research paper on it.

If you are using 100mgs capsule this is the same as the oral ones- exactly the same product. I use it too vaginally, which my consultant prefers to reduce side effects etc, but use 200mgs for 10-12 days on a long cycle. I insert 2 x 100 mg capsules. GPs won't tell anyone to use it vaginally, but that doesn't mean you can't :)

@Daphnesmate01 It's really important that you give other types of HRT a go. ADs are definitely not the way to go and NICE menopause guidance (top of page here) says they are not to be used.

It's very common to have some problems with hrt at first and the heavy bleeding could well be because you are in peri and have lots of your own estrogen still sloshing about. It's also worth knowing that HRT is made from yams, it's natural and it's NOT the same as the Pill- totally different. The Pill is synthetic chemicals , HRT is putting back 'your own' estrogen.

Your cyst sounds like a normal, benign cyst and they are SO common. I had one which was monitored for 2 years as I was post meno by then and my consultant wanted me to have regular scans but all that time I was on HRT and they never ever suggested it was the issue.

I agree with the other posters that you ought not to dismiss HRT until you have tried other types. what were you on?

Thanks, jingling. It was Louise Newson herself who prescribed it. I did make the point upthread that it wasn’t mainstream.🙂

Thanks Jingling. If I have two much oestrogen sloshing about, why am I getting several other symptoms...is it progesterone related? I am confused as to whether my symptoms are peri related but I suspect they are. I think there is another pill you can take to ease heavy bleeding - was going to speak to my GP about this. Any advice gratefully received because it seems as if in trying to ease some symptoms, other things like heavy bleeding is created.

too much, not two much. Although it might be twice as much!

@Daphnesmate01 The issues during peri are that you can produce estrogen erratically, and also flooding/ heavy periods occur when there is no ovulation; you get the womb lining building but not shedding each time, or just building up too much.

I'm surprised to be honest that you are using beta blockers and ami, as these ought to be replaced with HRT- that is Nice guidance. Beta blockers are for what? High BP? Erratic heart rate? Palpitations? Anxiety?
Hrt is the recommended treatment and your GP needs to know this.
You don't need a cocktail of all those things. It'sin the Nice guidance.
Hrt is the first line of treatment. The other drugs have side effects as much as if not more than estrogen.

Beta blockers for anxiety. And I'm currently not taking them but really do need them, they are one thing that has made a difference. I have a history of anxiety, so it isn't just peri.

Is there anything that can be done about heavy periods? It doesn't seem so bad this month (still a bit heavy). I am reluctant to stop using the amitriptyline because a good nights sleep feels a relief.

Hopefully, further down the line, I can make some life changes which might make me less dependent on tablets but I'm not going to stop taking something that makes my quality of life better.

Heavy periods are usually treated with the Mirena coil.

It might be useful to read the brilliant website of Dr Louise Newson- menopause doctor. Loads on there.
www.menopausedoctor.co.uk/menopause/topics/hrt

6th topic down is ADs and menopause. There are also other articles under Medical on PMS and treatments.

I hear what you are saying, but maybe hear what I and menopause doctors are saying too and keep an open mind rather than relying on incorrect / outdated/advice/ treatment.

Hormone-related anxiety, peri, and all the symptoms you have are treated with HRT. This is the advice from NICE.

Betablockers are not without risks and side effects.

Has your GP suggested you are referred for something like CBT or counselling to help control anxiety?

ADs and betablockers are used only for women who have had cancer or one of the few health issues that prevent using HRT.

HRT will protect your heart, bones and brain. Betablockers don't do that. They are primarily for treating high BP.

Acupuncture sorted my heavy periods and made them come once a month.
Sorted anxiety and sleeplessness too. Also frequently needing to pee during the night.
Sorted me being too hot at night.
Basically it sorts anything! Without hormones pills or side effects.

I can’t wait to get back.

It just makes me the best me.

I think the problem is, distinguishing between situational depression and hormonal depression. I suspect I might have both going on (awaiting psychotherapy after covid eases) plus CBT next year. I'm a bit dubious about trying the hrt (had hrt patches) because heavy period seemed to develop after this = too much estrogen?

Because it isn't clear, I might be adding to my problems. I am not getting hot flushes but I am experiencing insomnia, low libido, irritability which again may or may not be situational. Perhaps gel might be better - lower dose?

I have some micronised dhea but I don't want to use it just yet, until more information is provided about cyst. Beta blockers seem to be doing the trick in reducing adrenaline and shakiness I can experience with anxiety (and the old cycle of becoming anxious about being anxious). No history of high bp. Just too much adrenaline?

I experienced both pmt and pnd so quite possibly will be affected by peri/meno. The fact is I don't have concrete facts to act on. I wish things would improve in relation to hormonal testing.

Do things settle down after the menopause? HRT can't be taken forever can it.

I have the mirena coil which I gather provides the progesterone, wonder if oestrogen gel would help me?
Anyone got an idea How much it costs from a private clinic?

I've had the coil to stop heavy periods which it has done but my mood is badly affected.

@Elieza, Im really interested in the results you had from acupuncture.
Did you have many sessions?
Do the place the needles in the abdomen?

Not keen on the coil, I've heard lots of negative things. isthiswalter - I think the GP has recently prescribed oestrogen gel for me (NHS) -still with the pharmacy, so unable to check.

This is the thing...there are no definitive tests are there what with fluctuations etc. - so it seems a lot of it is guesswork. It would be wonderful if our hormones could be measured and an individualistic prescription given.

@isthiswalter you get oestrogen gel on the NHS from your GP.

@Daphnesmate01 It's good that you have some talking therapy lined up but Covid doesn't help, does it?

Being honest, you sound as if you want 'guarantees' , or have some negative mind blocks, before trying anything and it doesn't work like that.

For instance, we've all heard of bad experiences with the Mirena, but there are 1000s women happy with it - they just don't come to forums! You might get on great with it- who knows?

Hormone tests aren't reliable. That's why they aren't done. Hormones change daily. I've used HRT for 12 years and never had a hormone test except at the very first appt which was for something else (not hrt.) and that gave a wrong result- said I was post meno when I wasn't!
My consultant says they are a waste of time.

There is no such thing as too much adrenaline- this is a kind of myth that people talk about. Obviously, you are an anxious person and your fight-flight response kicks in fast. Trick is to get to the bottom of why you react that way- what's going on in your head to kick off that reaction. You can do CBT online- lots of free or almost-free courses that might help.

You didn't say what kind of hrt you were on, or what dose, but certainly with gel it's easy to use a low dose and build up.
Medical advice is to give any hrt 3 months trial before stopping.
And there is no time limit on it. You can use it forever.
Hope you find a way forward, but you've got to be willing to try stuff and have a positive attitude rather than believing there will be problems. Good luck!

Thanks Jingling. I hear what you're saying. Can I ask you one thing? If there is no such thing as adrenaline, then what is it that causes someone to become shaky/palpitations etc. (not hormone related)?

I see you have said you are waiting for pyschotherapy when Covid eases.

Are you planning to do this privately? Just to say most of the therapists and counsellors I know have continued seeing clients throughout lockdown via Zoom or other virtual means so don't make Covid a reason to wait.

Also there are a lot of CBT resources on line for no or minimal costs.