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[kris.s]

I have been reading the (rather harrowing, so sending love this morning) posts on depression & anxiety brought on by menopause.   My challenge is that I have always suffered from depression & anxiety and have a medication problem/question.

I started HRT fully post meno with Premique low dose.  it was wonderful for 3 months and my mood was both better and more even.  Absolutely loved it!  Then came the problems with supply- just could not get the product, so I was put on Femoston.  Immediately started heavy bleeding and return of familiar levels of depression & anxiety.  Went to the doctor, sent for series of scans and long story short, had polyps removed (benign) and a mirena coil inserted. Then put on Premarin .625mg.   I asked a lot of questions about depression and confirmed how well the Premique worked for me.  GP and specialists were, unfortunately, completely clueless. 

I am now 4.5 months post the Mirena + Premarin and the spotting has been constant (which is very irritating after not bleeding for several years).  Anxiety & depression bad but familiar levels.   We are now 9 months after going off the Premique.  After having something that worked after so many years of suffering then to be back in the same place, and bleeding, is...well...depressing 

Is there a London or UK resource that actually cares and has any expertise in depression & menopause?  I see recommendations for estrogel but wondering if any other thoughts given the success with Premique?

[Hurdity]

Hi kris.s

I think it depends on the cause of your depression? If you've had it all your life do you know whether it was hormonal in origin and related to your cycle and have you taken other medication for it - throughout your life? If it is not hormonal and you've taken medication for depression throughout your life, then HRT won't necessarily help with this, although it should help with the mood changes associated with menopause - if you see what I mean? If you know it is hormonally based then it is what is known as reproductive depression (and I'm not talking about anxiety which lots of woman experience to a greater or lesser extent). That being the case Studd's work on this might be of interest here:

http://www.studd.co.uk/reproductivedepression.php

There are lots of tabs about hormones and depression down the left hand side and sub-sections on the right so do have a read. In a nutshell hormonal depression is treated with very high levels of oestrogen (maybe a small amount of testosterone) - but this doesn't work for all women.

If you are in or near London then you can ask to be referred to a menopause clinic (there might be a bit of a wait) - they are listed under Specialists on this website - and there will be several in London ( NHS Clinics). The Chelsea and Westminster is a good one - Nick Panay's team - there are women on here who have been.

The bleeding with a Mirena should clear eventually (if you are post-menopausal) but usually it takes between 6-9 months especially with higher doses of oestrogen. I was tempted to suggest you might want a higher dose but it seems there is only 0.625 and 1.25 with nothing in between. An increased dose may well increase the amount of spotting and delay the time it takes to settle - but might well help your mood! However it is strange that you did so well on the low dose but less well on the higher dose - but some women find they need a higher dose of oestrogen when on the Mirena because of the negative effects of the progestogen ( only some women feel this).

I hope I haven't confused you by just giving my thoughts here?

Hurdity x

[paisley]

Hi Kris
It sounds like premique suited you
The manufacturer of Premique, Pfizer, had two Premique products: Premique (which contained 0.625mg conjugated oestrogen (a mixture of naturally occurring oestrogens) and 5mg of Medroxyprogesterone (a type of progesterone) and Premique low dose.
As the names suggest, the difference between the two products was dosage. Premique low dose contains 0.3mg of conjugated oestrogen and 1.5mg of Medroxyprogesterone.
In November 2016 they say they stopped producing the higher dose & now only produce the 0.625mg/5mg
Apparently stocks are low & so you have to order it a week or 2 before you need it. Have you tried online to order it?
 Indivina is the closest to Premique, in terms of the progesterone content because it contains the Medroxyprogesterone acetate 5mg.
Or you could try Tibolone . Tibolone tablets contain a synthetic molecule with oestrogen, progestogen and androgenic Properties.
I hope this helps a bit

[racjen]

Hi  kris.s, I'd have thought that if Premique helped then that's surely proof that your depression has a hormonal basis? I'm so so fed up of mental health professionals giving me that sceptical look and the 'how can you be sure your problems are hormonal' thing, when it's now been confirmed by numerous professionals that they are. And yet I seem to have to keep proving it over and over again - especially the anxiety thing, why have no health professionals heard of this as a menopausal symptom? Yes, I suffered childhood bereavement and an eating disorder as a result, but I never ever felt anxiety, fear and dread the way I do now until I reached perimenopause. But it seems that once you have any kind of history they just write you off as a neurotic woman... I think Hurdity is right, you need to keep researching with this and insist on a referral, don't let them get away with fobbing you off x

[CLKD]

Could you contact the Company directly?

[Ladybt28]

Premique was always listed as the alternative to some of our ladies beloved Prempak C and I Premique was discontinued April 17 and stocks ran down.  I was advised Indivina but I hadn't heard of it and I don't see much about it on the forum.  Maybe someone on Indivina will see this post and be kind enough to tell us their experiences.

By the way how are you racjen - I wrote you a big long post the other day but it disappeared into cyberspace.  I didnt have time at that moment to do it again and now the moment has passed.  How are you doing?

[kris.s]

Thank you for the replies!  Detail is indeed super helpful, Hurdity, so thank you for taking the time to type it.   

[Hurdity]

No problem - but it was paisley who gave all the detail about the different types so don't want to take the credit for that  - hope you get it sorted anyway - whichever product or dose you decide to try.

Hurdity x