SSRI and HRT - can I ask for both?

[Tamfs]

I have an appointment with a GP specialising in menopause next week and I just wondered about others experiences. I have not been on anything for menopause before, I'm 45 and my periods are still regular but heavier than they used to be and I get more cramps. I am getting hot flushes now (I have never been more grateful for the icy weather arriving and could be found in a vest in the garden for a bit yesterday!) and a bit of sleep disturbance.

But it's the mood swings that are really getting me. I have a history of anxiety disorder episodes right back to my teens (when I started my periods incidentally) and have had SSRIs at times although I try not to take anything. But my moods are now quite scary, and I can suddenly feel totally removed from everyone and everything, that everything is totally pointless, that I just want to crawl into bed and never leave it, or even some quite dark thoughts. I'm as anxious as I ever was but I think I'm catastophising even more and it's quite hard to deal with. And then suddenly, it lifts and I feel almost hyper. I haven't had anything quite like that before.

I want to try HRT but I'm nervous of it, having not had good experiences of hormonal contraception. I am now at the stage where the low times are worrying me so much I would like some SSRIs again. Will the GP give me both? Or will I have to try one then the other? I just want the dark clouds to lift or to just feel more stable. I'm not bothered about the physical symptoms as much.

Awww that’s great! Sounds like a really good outcome!

Glad your appointment went well. 😊

To add - do you feel like your mood changes are cyclical? When you describe the crushing anxiety and depression that very suddenly lifts, is this related to your cycle? Because I have this and it’s PMDD. Which has gotten much worse during peri.

I am on both an SSRI and now HRT too. A lot of people don’t know this, but new research has shown that SSRIs have a method of action of moderating the progesterone during the luteal phase, so in a way they are treating the root cause!!

That sounds reasonable but just to add, @Tamfs medical advice (NICE) on this is to give HRT 3 months (not one) and if it's not helping, increase the dose of estrogen.

Or you may need to change the delivery (ie patches to gel or vice versa.) And there is also guidance on the type of progesterone if you feel one lowers mood.

Good luck!

@retrophone I hadn't really considered that, I will look back at my tracking app.

Thank you @JinglingSpringbells , I have appreciated your advice on this thread, so I will bear that all in mind going forward. I'm still not totally against SSRIs too, but whatever works, and I know I need to give it a fair chance too.

Which type of HRT has she given you?
The easiest to vary the dose is gel. You can start with a tiny blob (less than 1 pump) and work upwards to the average 2 pumps but some women need more.

Most women now are given Utrogestan (micronised progesterone).
This can sometimes lower mood but if it does there are other options, such as inserting it vaginally to avoid the side effects.

Or you could try tablet form HRT or patches.

See how you go. One cycle is definitely not enough- the guidance is all types and doses need 3 months to settle down, although with estrogen gel you can easily tweak up or down after a few weeks.

Good luck!

I have Evorel 50 patches and then 200mg Utrogestan for 15 days per cycle. Hoping for a better 2026!

The dose for Utrogestan is 12 days (written by a consultant gynae but it's also on the leaflet in the box of tablets.)

https://www.menopausematters.co.uk/perimeno.php

15 days is a long slog and you may find you get more side effects.
Some women have the option of 14 days if they have a heavier withdrawal bleed.

Maybe your GP isn't experienced in HRT because going straight in with 50mcg patch can be too much for some women. I'm not trying to pour cold water on it but it is better to start on a lower dose and build up.

Did your Dr give you the choice of gel or patch?

She is supposed to be the menopause specialist for a large city centre GP (not that I think that is a guarantee!). I'll double check the Utrogesterone because I might have misremembered the days. She did offer gel or patch, I chose the patch due to sensory preference as gels give me the ick! I'll keep a close eye on everything

I'm only advising you from my own experience with a menopause gynaecologist (one of the top handful in the UK) who trains other drs .

I started gel with half a pump ( a 1/4 of the usual dose) as advised.

I was advised to build up over a few weeks. Eventually in around 6 weeks I reached the same dose as a 50mcg patch.

See how it goes.

@Tamfs your starting dose was similar to mine. Good luck with it, I hope it helps. For me progesterone was a huge help mood wise. Some women struggle with it, others find it great. This is the start of a journey, but you're on the right path.

@SparkFinder thank you, I'm actually having a lovely day today, even at work, it's like some spiky gloopy thing has lifted off my back after only a few days. And my sleep last night was absolutely wonderful, so I'm feeling positive about it today.