Which therapy to start off with

[Wren77]

Hi there,

I'm 51 and experiencing symptoms of perimenopause - insomnia, ++ anxiety, really awful brain fog. I'm also depressed and currently off work.
Its been suggested by the mental health nurse who is supporting me that I may benefit from starting antidepressants, but I also want to start HRT but it looks rather complex!! I am seeing the Dr tmrw to decide whether to start both ADs and HRT together or singly.
Any advice as to what HRT to start - I still have regular heavy periods.
Many thanks 😊

The nurse is possibly a little out of date with her advice or possibly not trained in menopause treatment.

ADs are not for women whose symptoms are caused by peri meno.
This is in the NICE guidance, 2015. They state this very clearly.

https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-of-perimenopause-and-menopause

see 'psychological symptoms'.

Please don't start both as a) ADs are not advised and b) you won't be able to work out what is helping if you use both at the same time.

Your GP would also be ignoring NICE guidance.

Most women now use transdermal estrogen - applied through the skin - and take micronised progesterone for the progesterone part.

if you have time today, have a good read of the website here- and use the search Library for read about ADs, types of HRT, etc.
https://www.balance-menopause.com/menopause-library/

https://www.balance-menopause.com/subject/hrt/

Thanks so much - will take a look at the links.

I have also been under a lot of prolonged stress, so cause of anxiety / depression isn't completely clear cut - I'm assuming perimenopause isn't helping but this is why the nurse has asked me to speak with the Dr to determine what/ how to treat. I am just keen to attack it with everything but can totally see how this would be unwise, especially as a first step.

Thanks so much again - I feel I will be much more prepared for my appointment.

What JinglingSpringbells said ⬆️
GP put me on antidepressants when it should have been HRT! Then, I was on both! Finally ditched the SSRIs when my oestradiol was increased to the max 4 pumps.
I blame the antidepressants for obliterating my libido - it’s finally returning now I’ve added testosterone to my HRT.
Good luck

Thanks so much ☺️

From your description, the lack of sleep is probably your main issue, i would suggest asking for melatonin at first, lack of sleep causes anxiety and brain fog!

Thank you - I keep forgetting I need to mention the sleep!!!

Progesterone will help with your sleep. You take the tablets before bed.

Try HRT first, if it doesn't work you know that's not what is causing your issues and then can try AD's.

Falling estrogen levels play havoc with sleep.

The main reason I started HRT (and am still using it) is for sleep.

(Nothing to do with using Utrogestan as I used Norethisterone for 6 years initially. And I don't use progesterone every day either.)

Asa by the way, is melatonin available on the NHS on prescription? Someone in my family has terrible insomnia and it's never been offered.