Perimenopausal symptoms and GP’s first suggestion was anti-depressants?!

[ureterr1blemuriel]

I’m 44 and am pretty sure that I’m perimenopausal - periods now a bit irregular and super painful, constant fatigue, increased mood swings, some joint ache, not sleeping as well, struggling to deal with the mental & physical busyness of family and work life (12 months ago I could deal with it much better), loss in some confidence and feeling a bit meh a lot of the time.

Due to my age I had lots of blood tests - everything is fine and I’m still ovulating (which I know). Anyway, I had a telephone app today and the first suggestion from my GP was anti depressants. I was quite shocked. I told her at my first appointment that I’m sure that I’m not depressed and that I think I’m just quite sensitive to hormonal changes, so I was surprised that she thought depression rather than perimenopause.

I explained that I didn’t want to go down that route and would prefer something to help with the PM. We agreed on the mini pill, which I’m a bit sceptical about but am happy to give it a try although I don’t think it’ll help with the fatigue. Apparently once I turn 45 she would be happy to try me on HRT.

Sorry for the rant but am just disappointed by the GP.

She's very out of touch. You're 44 so what does a few months matter? Lots of women are on HRT at 44.

Can you see another GP at the same practice?

Or, if you can afford it, see a private GP or a gynaecologist. You can self-refer to all of these now.

I think prescribing ADs as a first stage is fairly common place as they can alleviate some menopausal symptoms. I was offered the same and declined. They then prescribed oestrogen.

It is most definitely not.

NICE said in 2010 (updated menopause guidance at the time) that ADs 'have no place in the treatment of mood etc' and should not be used. The exact words are in the guidance, online. They go on to say that HRT is first line treatment.

@JinglingSpringbells Just because it is not in line with NICE guidelines doesn't mean that this practice is not happening. There was an article in The Independent in 2019 saying that a third of women were incorrectly being prescribed ADs and this is long after the NICE guideline change. https://www.independent.co.uk/news/health/menopause-antidepressants-symptoms-worse-hrt-shortage-a9148951.html

Not all GPs are as up to speed with the NICE guidelines as they should be and it was as recent as 2020 when mine suggested ADs. I explained that I wasn't depressed, she said that ADs can help with hot flushes and I declined.

I didn't say it wasn't happening and I'm sorry your own GP was so out of touch.

That link is now 6 years ago and hopefully most GPs have changed their prescribing.

There's been masses in the media since about this but some GPs also seem to 'not approve of' HRT no matter what the guidance says.

Some are still in the dark ages sadly, but at least there is guidance that women can quote if GPs aren't up to speed.

ADs for flushes is one option available if women can't use HRT for other medical reasons.

I’m so sorry@ureterr1blemuriel Stories like this come up time and time again. I have to zip past posts on IG because I get so cross for women. Keep chipping away. I hope you find someone better really soon.

Ask for a better informed GP, and you know what you need the mini pill is synthetic and won’t do what you need. Thats almost worse than ADs. Also a top tip just tell them you have hot flushes, even if you don’t, it seems to be the only blinking symptom they prescribe for.

Thanks for your replies - I was getting quite excited about not being so tired all
of the time but it looks like I will have to wait a bit longer. 🙄 I’ll give the mini pill a try, however will mention hot flushes at the review meeting so hopefully that might change the GP’s opinion. Luckily I can afford private so might need to consider that.

But the mini pill is 100% synthetic progesterone. Your symptoms are caused by loss of estrogen. I'd make plans now to get another opinion. It's quite ridiculous that your GP is saying that at 44-and a bit you can't have HRT based on age.

I had one telephone conversation with a gp and she offered me hrt.Been on the tablets for 8 months now.

Mine tried this and when I said I wasn’t depressed she patronisingly asked me if I felt there was some stigma attached to it? So infuriating. I put off calling back for a while then went to a different gp there and got hrt, but have ended up going private anyway to get a better range of options and better service where I’m listened to and don’t have to suck up feeling like a zombie for months just to “see if gets better.” Being a woman really sucks sometimes. Hope you get the help you need.

I am sorry this happened OP.

I went on HRT nearly 3 years ago. All over phone, had asked for GP with particular knowledge/ responsibility for menopause. She was very nice, prescribed immediately and off I went on my merry way.

It made me less ‘crazy’ (my words), but still very anxious and flat. Last time I needed a repeat prescription, a message said I needed to come in and see a GP as it had been over 2 years. Trooped in. GP I did not know (big London practice).

He asked how I was getting on with it : and I burst into tears. He offered me anti depressants. I was so shocked, (and to be honest, had been so low for a few weeks), I just said um, ok and took prescription.

But then sat in the car and felt cross with myself. I have not started them: I don’t think I need them. Am a primary teacher in tough inner city school. Behaviour appalling. 2 kids at uni, feeling broke. Parents are both very unwell and 6 hours away: think I am menopausal and might need some testosterone!

As others have suggested, think private GP might be the way forward. Good luck, it’s a frustrating path.

I'm on hrt and I'm 41.

I'm also on antidepressants, prescribed for insomnia. I now think the insomnia may have been due to perimenopause, but I'm stuck on the antidepressants for the forseeable (quite hard to come off, but I do feel good and I am sleeping).

Thankfully the doctor was willing to let me 'try' hrt, after the antidepressants had been prescribed, at my insistence. But I'll then insist that I continue with it. I had to fight my corner a bit though.

Maybe you should try increasing your estrogen and dropping the ADs?
At 41 you will need more estrogen than women in their 50s and 60s on HRT.
Talk to your dr about weaning yourself off them perhaps?

I find this a useful red flag for GPs I’d rather avoid! Would highlight the NICE guidance and seek the HRT

The same thing happened to me at 44. I was prescribed sertraline for a year or so before switching to hrt. I understand all the arguments against it but I have to say it was great for me. I slept very well on it and my energy returned. I could think more clearly and was much less anxious. Hot flushes disappeared. I wasn't depressed beforehand either. I think many of the symptoms of peri happen because the loss of oestrogen affects serotonin production, so there is some logic to prescribing it, even though it isn't treating the root issue.

I'll add, when i went for my hrt consultation, presenting with feelings of melancholy, my doctor asked me if I 'enjoy' what I do for a living.

I answered that 'enjoy' would be a stretch, but it's a good job; I'm good at it; it pays well; I'm grateful to have something stable in this difficult economy; and it's more or less impossibly expensive and difficult to retrain at this age, with a mortgage to pay.

She did a head tilt and said 'Hmmmm, food for thought?'

Erm, no, did you hear what I said? Unless you can fund me retraining, kindly fuck off.

I wouldn't even try the mini pill. I'd go back and tell them you need HRT. I can't believe a GP is still so out of date with their knowledge.

If it had benefits, NICE would not have advised in very strong words that ADs were not to be prescribed. They have side effects, some are addictive and they don't give any of the benefits of HRT.

For younger women with a loss of ovarian function in their early 40s (by that I mean irregular periods) their lower estrogen is a longer term issue- higher risk of bone density loss, heart disease and maybe dementia risk. This is why, for women needing HRT aged under 40, it's standard treatment.

https://www.drlouisenewson.co.uk/knowledge/antidepressants-and-menopause

Worth reading.

Yes I will want to try that. I've just got a lot going on in my personal life currently 😑

Have a look at the link I've just posted above and maybe even discuss with your GP?

I wasn’t offered ADs but I was refused HRT the first time I asked and I was 47. She was worried I would be on it too long 🙄. I agree with the PP that the magic symptom to mention is hot flushes. I’d actually been having them for 5 years or so, but didn’t realise as it was always after dinner and just as I left the house in the morning and I thought I was just hot from cooking / dashing about.
Ask for a different GP. I was given HRT the second time I asked, and I am so annoyed that I had a year without it, when I could have felt better.

As I said, I understand the issues. I was simply sharing my personal experience. They benefitted me and eased my symptoms.

I appreciate that, but I added that link so that anyone reading (and not posting) can read the medical recommendations.

So sorry OP, it is infuriating just how unhelpful GPs can be. In the last few years I have learnt so much about my health and discovered what the issues were without any help from immediate care providers. It meant years of suffering unnecessarily which makes me furious.
Mine also offered antidepressants for what was clearly escalating peri menopause symptoms. I turned it down firmly, then I was offered HRT. The patches helped to some extent, one thing I noticed is I haven't bled at all since on them which meant I have more energy and less breatlesness. Trying the gel next.
I think it is really important to inform yourself as much as possible and pay attention to your body. Some supplements might help such as Primrose Oil capsules and Agnus Cactus, of course if those are safe for you. Ask for blood tests if not already done to test iron levels, Vit B, D, folic acid etc. Sometimes rebalancing a simple deficit can make a huge difference.
Antidepressants are offered like candy, GPs still peddling the lie about taking them for a week or two. Many many people have a very hard time coming off them after a week or two, it is outrageous. Have you watched the Panorama doc made on this topic a few years ago? Not sure if still accessible. Clearly GPs are not paying attention.
Good luck, I hope you get the support you deserve and start feeling better.