HRT or anti depressants

[Ahhhcantthinkofagoodname]

Hello, I am 45 and in the last few weeks my mental health has completely deteriorated, I am feeling very anxious and low. The last year has been extremely tough as our kids have had lots of issues and difficulties and my relationship with my husband has been difficult too (mainly as we disagree about how to manage things with the kids). I have not been able to work for the last few weeks and am currently signed off with acute anxiety.

Before I started really struggling a few weeks ago, I had noticed for a few months brain fog and difficulty concentrating. I feel I have developed ADHD, and flit from one thing to another and get very easily distracted! Also my sleep has been less good, I wake frequently and rely on audiobooks to go back to sleep. Other than that I don’t think I have any signs of peri menopause, my periods are regular (but vary in terms of output) and no hot flushes or anything like that.

GP has offered me HRT or antidepressants and I need to decide which to go for (or both I guess). I am leaning to HRT as I am like the idea of heading off menopause nastiness and think my mental health issues must be partly due to hormones (as I’ve not had any mental health issues up to now despite lots to deal with) but not sure if it is wise to go on it when I must be quite early on in menopause… Very keen to hear any advice. Thank you.

I cannot offer any advice sorry op but I'm watching this thread with interest as I'm similar at the moment and close in age to you op. Funny you should mention the feeling that you've suddenly developed adhd and flitting between things as I've become the same, I can no longer keep up with the house work and my once immaculately tidy home is now a cluttered, untidy mess. I just feel as though I've changed so much. My sleep patterns are not too bad at the moment though. I just no longer feel like the person I once was. Brain fog, unorganised, untidy, I could go on.

Hello , I’m 51 , and am having an awful time mentally at the moment . My son is having mental health difficulties and my mum is in a care home . I’m on the mini pill and ovestin cream , but have wondered about anti depressants. I have considered full hrt , but I think I will try and avoid it , as I don’t want periods again , it’s a tough decision.

NICE menopause guidance says HRT is first line therapy, not ADs.

This is because mood and anxiety that start in peri meno do not necessarily improve on ADs, which also have their own side effects and don't provide any of the other benefits of HRT (bone and heart health.)

@Toomanysquishmallows If your periods have stopped you won't get any on HRT. You'll use the type of HRT that is bleed-free.

I would definitely recommend HRT first. Give it time too. I recommend transdermal oestrogen (patches, gel or spray) starting dose is normally 50 but as you are younger you may need more in a few months. You then (if you have a womb) take micronised progesterone capsules for half of the month to protect your womb lining. Progesterone is also calming (but can at first re route neural pathways and make you quite reflective).

I did Sertraline first and it was amazing but in retrospect it did cause issues I am still dealing with like bruxism.

After about a year if you are in the right nhs catchment you can also add testosterone which will really help with brain fog and give you back assertiveness. However you can only get it if you say your libido has tanked.

Think if it this way, HRT is giving you back natural hormones back you are losing. Anti depressants are medicalising the issue.