Mental health and the menopause

[Happiestonthebeach]

This is going to be a long one, so apologies in advance and thank you to anyone who manages to read through. I really do appreciate it.

I am 43 years old and I have dd16 and ds11. For the past 10 years.I’ve been on the contraceptive implant and for the last two or three years haven’t had any periods while I’ve been on it, this hasn’t been unusual, because for the last 10 years my periods have been really on and off. Before this I’ve never really struggled with periods, always regular and manageable,

All my adult life I’ve struggled at times with depression, anxiety and stress, this hasn’t been debilitating but has been something I’ve learnt to control through lifestyle and from short courses of antidepressants at various times. This has always then gone away on its own.

In 2019, I had a particularly stressful year when lots of things in my life came to a head in a very stressful way (at the time I had caring responsibilities for a relative who has since died, then another family member abroad needed care, and I was trying to juggle a demanding job and you d children) I went to the doctor and was prescribed antidepressants, however, since then my mental health has remained poor even though the underlying reasons for the stress at the time have now been resolved and no longer remain. During this time. I’ve been on a number of different antidepressants and medication and my symptoms have continue to worsen, then plateau during this time. Last year I ended up having a mental health crisis and being placed under the crisis team. Though the crisis resolved, the ongoing trend has been worsening mental health. I have had to session 2 sets of counselling under the NHS IAPT scheme in my area and neither of them have made any discernible difference in my mental health. These were two different sorts of counselling, and I engaged and liked my counsellors but made no difference to my mental state. My GP has said that I have exhausted all the drugs that they are able to prescribe for me in primary care, and said I would need to be referred to a consultant who would have more drugs at their disposal to be able to prescribe she sent a numerous referrals and the community mental health team kept getting sent back as I didn’t reach the threshold for secondary care. My gp thought I needed mood stabilisers. This has contributed to my worsening mental health as I have felt like I would always be like this.

Finally, I’ve had an appointment with a secondary care mental health nurse and my case has been discussed with the panel of Doctors at the community mental health team interdisciplinary team meeting last week, they have advised that I go back to primary care and discuss possible menopause with my gp. The GP has mentioned this to me previously, done blood tests and because there were no obvious hormonal factors discounted it. The community mental health team also suggested I self refer to IAPT for another course of counselling (bear in mind I’ve already had two courses which haven’t helped)

I’m booked in for a week on Monday with my gp and I’m wondering whether such severe and ongoing symptoms may be related to the menopause or whether I need to push for the community mental health team to see me (all appointments up to this point has been over the phone)

As I don’t have periods, I’m not sure what the state of them would be if I wasn’t on the implant?

Other possibly relevant information :
I sometimes get period type pains for a day or two but no period.
Since 2019 I have put on around 4 stone in weight which I’m finding very difficult to lose- probably as I have also begun to binge eat, especially sugary food.
My mental health is really impacted by my lack of sleep- I can’t get to sleep and also struggle to stay asleep.
When I go to sleep I’m often cold but then wake up hot and agitated. At times I have experienced sleep paralysis on waking.
I feel old and achy which I have put down to weight gain.
I feel sad, worthless and hopeless with no external reason to feel like that.
I just want to hide away from everything and everyone.
I feel like I can’t think clearly or rationally. I honestly feel like I’m going mad,

It is becoming increasingly difficult for me to maintain social relationships and this week, I was in a meeting and it was gently suggested I needed to do something and I burst into tears, said I was doing my best and was basically a complete mess. My relationship with my dh is already very strained and I fear this could be the nail in the coffin.

I’m sorry this is all so jumbled- I can’t see the wood for the trees, I desperately want to get better but cannot seem to advocate for myself and I don’t even know what I want to happen now.

I am sorry can’t carry on like this for much longer. Any support, advice etc would be much appreciated.

Sorry you are feeling this way.
I was wondering if you have had blood tests for thyroid levels. I don't know about testing for menopause are there more tests your GP could do regarding this? It's relatively unusual at your age but definitely not impossible. Are you tempted to take out the implant and see how it affects a) your periods and b) your mood?

Mood stabilisers are most often prescribed for bipolar disorder. There is nothing you have mentioned that is suggestive of bipolar disorder or any other severe enduring condition, so my guess is that is why you have not been taken on by CMHT or offered a psychiatric review. It is very frustrating navigating mental health services. IAPT might eventually turn you down and refer you to CMHT themselves in which case they may be a bit more likely to take you on.

Thank you so much for replying.

Nothing about bipolar has ever been mentioned- the only thing I’ve been diagnosed with or that has been mentioned, is generalised anxiety disorder with depression.

Honestly I feel so bad and it’s affecting me so much, I really can’t go on like this anc don’t want to ‘waste my chance’ with the mental health team.

I have previously had tests which suggested my thyroid wasn’t of concern and it’s never been mentioned again by my gp (don’t remember exactly what the tests and results were(

Discussing whether it would be helpful to take out the implant is a good way to go, thank you.

It would be a very simple step to try hrt and see if it works.
There is a sad history of millions of women being prescribed ADs for MH in their 40, 50s and beyond when often it's a hormonal issue.

The implant will skew blood tests so it's pointless.

My suggestion would be remove the implant and start hrt.

If it works, that was what you needed- no one has a crystal ball, it's trial and error! But it's worth trying isn't it?

I agree, try a 6 month trial of HRT and see if it works.
You can also try supplements to help your individual complaints, like giving up alcohol and taking magnesium for sleep, and a good quality omega 3 for joints.

This is a good plan - I agree with the above. Also - it probably sounds incredibly patronising but have you tried to keep a routine of exercise like swimming or yoga - or whatever makes you feel good ( what ever feels manageable with an aching body). I know it's not going to fix everything but it can definitely play a part and help you to feel stronger. Research has shown that physical activity can be as effective as antidepressants.

Can relate to a lot of your story. No experience of implant but did have mirena coil fitted in mid 40s and really helped.
symptoms do sound like menopause I’m sure if your were over/closer to 50 doctors would agree. Similarly I’m not maintaining social relationships, had a rare evening out and a friend said she’d been worried about me and I burst into tears. I have appointment with GP in two weeks for advice/poss of HRT I’m 54.

Have you heard of the Balance app? Or look up the Menopause Dr; she covers a lot about MH and peri. I’m 43 and been on HRT for 3 years, symptoms started for me at 39. I too struggled with physical symptoms as well as MH. Good luck.

It all sounds like menopause to me.

Getting HRT can be hard, so find and complete the Louise Newton menopause symptom checklist and have it ready to present at your appointment.

I’m in full blown menopause now and HRT helps. But I also take an LOT of supplements too. I recommend: magnesium glycinate at bedtime, it really helps you sleep. And ashwanganda for mood swings. And Menopace Original vitamins are AMAZING.

are you waking up at 3am? That suggests your cortisol levels are high, which would explain the weight gain. Berberine and Milk Thistle are good for that.

Thank you so much to everyone who has commented.
i am pretty sure my gp will be supportive- especially if the community mental health team suggest this.
Could I just ask- can I keep the implant and start hrt or is that not possible? Sorry I’m new to all this so not sure how it all works.
I feel at the moment like my mental health can’t get much worse- and so I’m willing to give anything a go.

to answer some of the questions, I have done literally everything that’s been suggested to me as I’m so desperate to get well. I have all but stopped drinking, caffeine only before midday, trying to exercise (mainly yoga and mindfulness)

yes I do wake up in the night around 3am- is the time particularly significant?

im taking the bio kult mind supplements as I feel like it helps my thinking but will try some of the other recommendations too.

Thanks again, I’ve found all the kindness and support to be quite overwhelming

Apparently waking up at 3am suggests your cortisol levels are too high.

I thin you can keep the implant but am not 100% sure. A better combo might be the coil and hrt as the coil can be used as the progesterone element of the HRT.

I started meno at 38/39 and it has had a huge impact mentally. You’re not alone OP and I hope you get it sorted.

Try reading the book Menopocalypse by Amanda Thebe - British lady living in Canada - she says she thought she was going mad but it was meno all along. HRT didn’t ultimately work for her but she did try it - I would agree with pp saying it’s worth a try.
Also agree with others saying to be much stricter on lifestyle - it matters much more now than before.
Ive found I can’t drink any more (maybe 1 glass on special occasions otherwise I don’t sleep), I have to walk or exercise or I won’t sleep that night, have cut sugar right down (weight gain and joint pain), have to do much more mobility and flexibility work or I pull something going for a run. It’s no fun but if you stick to those things then physical symptoms and mood do improve.

thsnk you so much for all your advice and help.
I honestly can’t go on like this any more and whatever the root cause if how I am feeling, I need to get to the bottom of it so I can get better.
I have an appointment next Monday so will keep you updated. I feel like I’ll be much more prepared though.

Agree with the above. May be menopause and HRT may help. But also - especially if the hormonal approach doesn’t work - make a bit of a fuss about the CMHT bouncing you and ask for a review again at that point. Mood stabilisers aren’t just for bipolar we use them as augmentation (ie added on to antidepressants) for treatment resistant depression too and it sounds like that’s a possibility if you’ve tried a couple of different antidepressants without success. It isn’t fair that you can’t access them if you need them. Good luck and take care of yourself.

Just wanted to add my 2p worth here. So I’ve always been suffering from bad PMT I think. But was diagnosed with an underactive thyroid at 37 and on meds for that.

Perimenopause was a bit of a nightmare and now at 52 for past 6 months I’m on Evorel Conti. This has helped a lot but recently I’m getting anxiety and not sleeping which could be tied into HRT. I’ve not been properly anxious etc since my teens/early 20s.

Quite a few of my friends including one who’s on HRT say hormones play tricks on your mind and feelings and I 100% agree. What I could cope with before I can’t now!

I’d say definitely return to your GP with your issues. I’m off there this week!

I found answers to my mental health problems by looking into ADHD which I have now been diagnosed with.

It was the underlying cause to everything I’ve struggled with. It often gets overlooked in women, but for me it explains all my menopause and mental health symptoms.

https://www.theminiadhdcoach.com/ I found this website very helpful in seeing how ADHD presents in adults and women.

@Happiestonthebeach I could have written a lot of your post. I have spent nearly 2 years in 'crisis'. Have been suicidal, sectioned, under a psychiatrist (NHS then private after private inpatient care, luckily covered by insurance). I've been on 3 different antidepressants, an antipsychotic (I'm not psychotic), tranquillisers. I have always had depression and been on an antidepressant but never like this, except when I was pregnant and antenatally. Long story short, I'm now on HRT and I have felt more stable and generally happier than I have in a long time. I'm off the diazapam (was on up to 20mg a day, which is a lot!), off the antipsychotic, off 1 of the antidepressants. I seem to have an intolerance of progesterone, so am on oestrogen only temporarily while waiting to discuss a hysterectomy with a gynaecologist (also private, except not covered by insurance now, so huge cost). I'm so angry that I've gone from a slim, fit (ran 5k most days) happy person with a good career to 3 stone overweight (thanks to the antipsychotic), unemployed, suffering from loads of side effects from pills. HRT still not perfect, and I'm worried about the hysterectomy and HRT after that, but it's definitely been the missing part of the puzzle for me. Anyway that's my experience, DM me if you want to know any more!

Thank you again to everyone who replied.I felt better than I had in ages before I saw the GP because I felt like you all understood!

I went this morning- dr says that the latest bloods I had didn’t suggest menopause but explained it was a snapshot and you can’t just go on blood test results. She said that the contraceptive implant may also effect the results.

As I’m not getting anywhere with CMHT and the symptoms all started around 2019 but have gradually got worse, she said it was worth investigating the menopause. She has prescribed me the evorel conti patches, she also has suggested I have the implant out and a mirena coil put in so has referred me to gynae at a local private hospital for this. (I tried to have a coil fitted before but another gp couldn’t get it in as my cervix tilted in the wrong direction)
So that’s the plan for now and she wants to see me after 3 months or after I’ve had the coil in.

Has anyone got any opinions on what has been suggested? If it’s going to work, how soon could I expect to see some difference in sleep, mood etc.

anything I should be aware of with the patches?

Don’t know OP as not on HRT but bumping for traffic.