What helped your mental health during perimenopause/menopause?

[Teaandtoastfortwo]

What has helped your mental health symptoms during perimenopause?

I’ve been struggling with peri symptoms for the past couple of years and I’m 40. I had my HRT regime changed about 5 months ago because although it was helping with the physical symptoms, it wasn’t really helping with the mental health side of things.
I’m now on Utrogestan continuously taken vaginally and a 75mcg Everol patch, but I’m still really struggling with feeling lost and flat. I have no motivation and just feel like a shadow of my former self. I don’t recognise myself anymore.

It’s started to affect my relationship with my partner too. I constantly question whether he loves me or wants to be with me, even though he’s amazing and has done absolutely nothing to make me feel this way. I know these thoughts aren’t really me, but I can’t seem to switch them off. I just miss who I used to be.

I feel like I’m doing everything I possibly can. I walk for an hour every day, do a weights class twice a week, eat well and avoid UPFs, don’t smoke or drink, take vitamins, read the books and listen to the podcasts… and yet I still feel like this.
Has anyone found the magic dose/type of HRT that finally made a difference to their mental health symptoms? Or is there anything else that has genuinely helped you?
I’d really love to hear from anyone who has been through this and come out the other side, because right now I’m struggling to see how I get back to feeling like myself again.

I don’t want to take SSRIs so that’s not an option and I’ve had counselling and CBT.

I resisted the SSRIs, too - I knew my symptoms were a result of my hormones dropping so wanted to treat the cause and not the results. I’m afraid that for me it was being on the right dose of HRT which made the depression, severe anxiety and paranoia go away. I first had those symptoms before I started HRT at all, alongside the usual night sweats, brain fog etc, but it improved when I started on Evorel 25. Then after about a year my own oestrogen production must have taken a downturn because it all came back, and my dose was upped to Evorel 50. It all went away again until about another year later, when I was upped to 75 (I recognised what was happening at that point and so got help sooner). I’ve been stable since then, though I had a total hysterectomy a few weeks ago and lost my ovaries, so when things have settled, if I start feeling that way again, I might need that final step to 100 if they were still producing any oestrogen of my own.

I’d persist with trying to see if your dose needs increasing. As you’re post-menopausal it’s reasonable to assume that your own ovaries aren’t producing much any more so you might just need a higher dose - Evorel goes up to 100 so you might need that last step too.

In my experience I would try to get Testosterone prescribed as it can really help get the zest for life back in a way that the rest of HRT can’t

Duloxetine. Sorry.

I should have mentioned that since the change in my HRt dose, I now bleed for most of the time. The longest I’ve not bled for is about 5 days!

That can be from the high dose of progesterone. I hope you’ve had an ultrasound and biopsy to rule out endometrial cancer, as any post-menopausal bleeding should trigger this?

My hysterectomy was because I was having the same, almost continuous heavy post-menopausal bleeding which couldn’t be controlled medically. I also have a number of extra risk factors for uterine cancer so all round it was the best solution for me.

Can you get a referral to a gynaecologist or HRT specialist? GPs are very by-the -book with HRT and a specialist might be able to be more creative.

I’m not post menopausal. Still in perimenopause. I’ve recently had an ultrasound which was normal.

Good news on the ultrasound - that’s reassuring.

If your periods haven’t stopped, why are you taking progesterone continuously? You should be having it two weeks on/two weeks off so you get a withdrawal bleed like a regular period. Why was it changed?

It does sound like you need some better advice on it all.

They changed it because my mood was very low the two weeks on progesterone and they said the sudden drops of taking it sequentially weren’t helping.

I wonder if ‘fighting’ your natural cycle is making it worse, then. I think you need a new GP appt to discuss. Ask if there’s an HRT specialist at the practice, or failing that go for one of the younger GPs - they are often better informed.

You possibly need to increase the estrogen and maybe change the type of progesterone or how often you use it.

I presume you have been diagnosed with early menopause?
Had your periods stopped or almost stopped at 38?
Have you seen a menopause specialist or just a GP?

There are far more variations on HRT than most GPs are aware of.

The first is to increase the patch to 100. You're very young and it will take more to replace your own estrogen.

You might also want to consider swapping to gel as you can easily adjust that yourself- 3 pumps = 75 patch, 4 pumps= 100 patch.
You may not even be absorbing well from a patch.

The second option is to adjust the progesterone.
I know utrogestan is popular but when I started on HRT almost 20 years ago it wasn't at all. The usual one was Norethisterone. This is in most patches but mine was a tablet. (prescribed by a consultant privately.)

You might find it makes you less 'flat'.

The other option is to take whichever progesterone sequentially, if you don't mind having a bleed on it. My own experience is daily progesterone does't work for me and I'm still using sequential.This is not usually part of what GPs would suggest but it is possible for all women, even post meno.

There is also the option of using progesterone less often, such as every other month, but this tends to be monitored by a specialist.

I should have mentioned that since the change in my HRt dose, I now bleed for most of the time. The longest I’ve not bled for is about 5 days!

Edit having see this- you should not be on continuous HRT if you're constantly bleeding although it can take 6 months to settle. OR the Utrogestan needs to be 200mgs a day (not 100).

Can you afford to see a specialist privately?

My main symptom has been low mood, hrt has helped but I was already on an anti depresent. The two combined seem to be working so far. If you don't want anti Ds then perhaps higher does hrt is the way forward.

When this happened to me my gyno said it was likely my progesterone dose was too low. I’ve swapped from continuous combined patches to oestrogen patches and cyclic oral progesterone so that my dose can be adjusted if it happens again. Just waiting to see what happens now…

My mental health went in the toilet and stayed there for at least two years. I didn't take any HRT or anything else. It was pretty awful at times. I think for me what helped was having work colleagues who had just been through it or were the same as me.
One day things just seemed easier. I had some turbulence in both professional and personal life in the decade this all happened but nothing I could affect myself. Bereavement and so on. I would say it was the toughest time of my life.
My neice is just about to go to University and I read so many articles and advice pieces aimed at her cohort or the parents and it has made me realise just how little there was to help me in menopause in comparison.
The upside though was that I really couldnt care less what others think about me anymore. And young men on my commute offered me a seat on the train! I think because I always looked on the edge of explosive anger, which I was, to be fair.

This is really helpful thank you.

I started getting very irregular cycles from 38. My mother, grandmother and aunt had all gone through menopause by 42!

Ive been paying privately to see a specialist at menopause care.

I can really relate! I could give zero f’s about most things these days and certainly don’t hold back saying what’s on my mind. I used to be such a people pleaser, brimming with toxic positivity.

I recently went back to a city I’d visited 3 years ago. It was so nostalgic and I kept having flashbacks of the happy, carefree person I was on that trip compared to the anxious, neurotic mess I am now.

That's run by a good doctor - do you see anyone there in person?
Do you see/ consult the same dr each time?

Has a doctor ever suggested the Mirena coil? For someone your age who needs a high dose of estrogen it's probably the first choice - not to say it's what you want but I'd be surprised if it had not been offered.
It's the progesterone part of hrt and you only need estrogen on top.

Yep I understand the weird dislocation feeling when you went to your old home town. One day I just felt a lot more me again though. I hope this will happen for you.
Also I lost the ability to drink alcohol and I developed migraines, however the alcohol is no loss and the migraines are at least something that other people including the medical profession are comfortable dealing with. I take a newish drug for them which makes me special as well!

I’ve seen two different doctors via online appointments. The mirena was discussed but because they think I’m progesterone sensitive it wasn’t a first option.

I think if you can it's best to form a relationship with one doctor and stick with them until you get it sorted. There are so many subtle variations with HRT (and what they suggest can be very subjective) and moving between doctors means you sometimes aren't getting continuity and they aren't getting to know you as a person.

The advice against the Mirena isn't logical IF you use progesterone continuously. It's only relevant if you prefer sequential .

You need progesterone. If you're taking it orally, vaginally, as a patch OR as the Mirena you're getting progesterone. Micronised progesterone is infamous for low mood as a side effect.

Maybe talk to them again about all of this? Is there no one on their team or locally you can see face to face?

I have a Mirena and the advice I was given was that the dose was low (and delivered locally rather than roaming about your whole body) and consistent, so a good option if you are sensitive to progesterone. I found fitting it very unpleasant, but I have not had children, and it took a couple of months to settle, but it’s been great.

Is it any anti-ds or just SSRIs?

I take mirtazapine which is a different type as had severe side effects with an SSRI.

Plus gel oestrogen and Utrogestan capsules. You could try taking these vaginally if you’re sensitive - you still get the protection but less impact to your mood (in a good way!)

Yes I take utrogestan vaginally now.

It’s all antidepressants I’m afraid of!

No one medical should suggest ADs for someone your age with early menopause. They are not 1st line treatment (NICE guidance for over 10 years.) The guidance is get the HRT dose, optimised.

I have another appointment with menopause care tomorrow. Really hoping they offer some useful advice as my anxiety is awful

@Teaandtoastfortwo , ten years ago when I was at the lowest point in my life and it was pretty low, my husband bought me ten dance classes (Latin and ballroom) as a Christmas present. We still go every Thursday evening. 😃
Suddenly in the darkness of my existence there was a light and I have followed that light with ever increasing joy since.
Those classes gave me an hour in my week to look forward to, an hour where I could forget about everything which was negative and just have a beautiful time.
I know that perhaps you were more thinking about medication but dance is the most effective medicine I have ever encountered. Find your thing the one that you can’t wait to do again and see if that helps you too.
You might also want to add some fermented foods into your diet if you don’t eat them already, there is excellent scientific evidence for the impact on our gut microbiome to our mental health. Good luck!