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[Knockmany]

Hello,

I am newbie (but lurking for a while!). I am 47 and fairly sure am peri. I am still having periods but have night sweats, dryness, lack of libido, sensitive bladder, mood swings, anxiety etc. These symptoms all started about 2 years ago. The mood swings and low mood started to get very bad after the summer, noticeably before my period. I have always been prone to hormones, had bad PMT when younger and had post natal depression with both children. Eventually I went to the doctor and told her, she said that she didn't believe there was a link between menopause and depression and told me I was seratonin deficient and gave me anti depressants. I was really floored by the appointment, felt quite dismissed. She was really nice about it, and told me she knew her stuff as she came from a psychiatry background. I have been taking the anti depressants for a month now and do feel better but all the other peri symptoms are still there. The lack of libido aspect is really upsetting me as well! I am due to see her for a follow up on Monday but I don't know whether to mention the peri stuff again. I don't know if she would even consider HRT for me. They did the usual blood test which of course showed nothing. I have been doing so much research into it and see that the guidelines now say that HRT should be the first thing tried in depression in women over 45. My GP is quite forthright in her manner, a bit scary even! I am nervous about saying anything to her. She is the fourth female GP I have seen about this at my practice. The first did blood test and told me I was not menopausal and I should be careful with my contraception! The second gave me vagifem which then she wouldn't repeat. The third told me to come back in a year and see if there was any change in my blood tests as "they can't prescribe HRT without knowing what is lacking according to blood tests." I am at my wits end. Thank you for listening!

[Perinowpost]

Your GP is wrong.  Hormones are precursors to our moods and it's no coincidence many women struggle in peri menopause as levels drop off or are all over the place. The symptoms you describe are also classic peri meno symptoms, a good GP would go on symptoms not blood tests which are notoriously unreliable anyway.

Have you looked at Prof Studd's website he makes the link between hormones and depression. That said you don't have to go private to get his regime. I educated myself via this forum and got everything from the nhs (my GP's are excellent).

Knockmany you allowed to advocate for yourself and I don't think you've been given the best advice. It depends how you want to play it though, especially if you're GP is scary I understand your dilemma. You could print off the NICE Guidelines and say you want to try hrt. Also, and I don't know if you're aware but anti-depressants are notorious for quashing libido.

Keep posting , I'm sure others will be along to help soon, and don't give up x

[SueLW]

You are absolutely Mrs Average for menopause.  47.  You are peri.  Your symptoms need hormones to resolve them. 

Did you see Dr Newson on Lorraine last week?  She had a call from a lady also 47 who had a similar experience to you and it was Dr Newson who said 47 is absolutely average for menopause and that over the age of 45 blood tests are not necessary, symptoms alone should be used according to the NICE guidelines.

Your doctor is wrong.  She was wrong to start you on the AD, but if you feel better on them, stick with them while you get the rest sorted out.  Some women need a combo.  Others won't need them when the HRT is right.

Here she is, talking about it. 
https://www.itv.com/lorraine/health/menopause-expert-dr-louise-newson-answers-your-questions-and-dispels-myths-about-hrt?fbclid=IwAR2VX1u-Yk0Gf4wurCiYRkMJ0HsdRxhkx7pY-9xvs8uYIBR-Kqo6xX-9UUI

[suzysunday]

Poor you being given the run around by the gp's. It sounds a real pain and it's hard to get the point across to the docs at the best of times.  Yes antidepressants will nobble your libido and if that is going to be a problem for you then perhaps you need to re think. Also, if you take them long term you may find it hard to come off them.  Vagifem takes a while to improve dryness and is safe, so don't know why it was short term. It will improve the bladder with time.  I know
 it's not easy, but if you want hrt then as previous post said, print off the guidelines and stick to your guns.  It's you living with your symptoms and flaming GP should understand this.  All the best.

[CLKD]

Your GP Practice is way behind and should be reported to Dr Currie on here!

Does she not relate PND with hormones ?  Wonder if she suffers up hormonal ups and downs with her periods?  However, what ever the cause of depression and anxiety, appropriate medication will enable you to see the wood for the trees.  Also, having been on Anti-Depressant meds since 1988, they have never affected my libedo that was purely hormonal  . 

Anyway.  You are in the right place now.  Go back and ask for appropriate vaginal atrophy treatment which should be used for ever.  It plumps up vaginal tissues as oestrogen levels drop off.  Maybe get a copy of Mary Jane's book to take to your next appt. 

Browse round.  Could you keep a mood/food/symptom diary to chart your journey.  What are you going to the GP 4 on Monday, maybe postpone the appt. until you have more knowledge to take along?   I thought that I could tackle any GP but 12 months' ago one I saw was insistent that I start statins, she wouldn't consider dropping my apparent high cholesterol levels by diet.  I went to see our usual GP who explained properly about statins so I decided to take them.   So don't worry about her 'scaring' you  .

GPs will tell you 'NICE are only guidelines'.  Maybe put off the appt. for a couple of weeks and speak with a local Pharmacist, they have private rooms now.  Take a list, i.e. about treatment for atrophy and see what they say, it should be clear in the leaflet in the box.  Ask if they have surgeries that support menopause in your area. 

Let us know how you get on! 

[Dancing Queen]

Can you see another GP at your practice? I saw one in mine who wouldn`t give me hrt only AD`s which didn`t agree with me so I made an appointment with another one who agreed to let me try hrt. Which has helped my low mood enormously. Not to mention the flushes etc! Keep persevering x

[CLKD]

I think Knock has already seen 4 with little success 

[Knockmany]

Aw thanks all for your replies, I know, it's madness. I wonder does she not equate post natal depression with hormones! I am a keen follower of Dr Louise on Instagram and she is amazing. In fact it is her, and here, that has given me so much decent information and I know now that my GP is wrong. I read the Dr Studd report on Reproductive Depression which is excellent, it is me to a tee. I'm going back to see her on Monday for a review appointment, she only gave me a month supply of anti depressants so thats why she wants me back, to see how I am doing. If I put it off I won't get another prescription and I don't want to be left without anything. I am going to tackle her about perimenopause and see what her response is. I am not too hopeful though! There is a menopause advice clinic run in our local well woman centre on a monthly basis. I am going to see if I can get an appointment there. Failing that there is a private specialist in Belfast (I'm in N Ireland) that I would go to if nothing else could help. I'll let you all know what the result is!
Thanks again,
Knock

[NaturalMystic]

Well of course, its one of the 34 symptoms, of which I have 24 myself.

What it is to be women 😵

[CLKD]

.... but a female GP that has no idea! who pays for their training .........

Let us know how you get on.  We shouldn't have to fight for what we require 

[Autumn27]

Hi Knockmany,

I had the same problem as you, my GP flat out refused to give me HRT or discuss it, when I was 47. I was also seeing a liver specialist for benign liver cysts who also refused to allow it.

I did a lot of research and decided to go and see a specialist privately, paying for just one session, so they could write to my GP with recommendations. The GP always takes a letter from a consultant seriously. The specialist asked my GP to refer me to the menopause clinic, because of the liver issue, so that I could be monitored.

Whenever my newly menopausal, or perimenopausal friends face negative responses from GPs re HRT, which is all my friends and every single one of their GPs, I advise them either what bio identical HRT to ask for, and failing that, to go the route of seeing a specialist for just one consultation to get the ball rolling.

Best of luck! You have to fight your own way forward in this Menopause business.

[Hurdity]

Hi Knockmany

 

Sorry to hear about your unsympathetic treatment from your GP. Someone mentioned reporting the doc - this would not be to Dr Currie but if you have a complaint then this should be done through your GP practice and the normal channels.

My first question would be what are you periods doing? Are they regular, or has your cycle started lengthening or shortening, and are your bleeds heavy or light etc? This combined with your age and symptoms will determine whether you are peri-menopausal. As the others have said blood tests should not be carried out - FSH levels vary daily and depending when in the cycle the bloods were taken. Do you know when this was in your case?

Unfortunately as you will have read on Prof Studd's site psychiatrists can be notoriously blinkered when it comes to depression - and will not entertain a hormonal link - shocking really. What a pity you saw someone like this. After all the evidence is there.

As you will have read, Studd's approach is to treat women with reproductive depression with high doses of oestrogen to suppress the cycle (of ovulation) but you may have difficulty persuading your GPs (defo not the psych one!) to go along with this. The cycle can also be suppressed through the combined contraceptive pill and there are a couple that are especially for menopausal women as they contain estradiol - the same oestrogen as in our bodies and in most HRT. These are called QLAIRA and ZOELY. Qlairai has only 2 tablet free days so the oestrogen crash does not happen to the same extent as with the normal CCP. However oral oestrogen can also depress libido so maybe not ideal for you?

No - you shouldn't have been given the ADs - too mamny docs are just dishing these out willy nilly. In your position I would want to get my hormones right first - but perhaps has SueLW says stay with them for the time being but only while you get going with the right hormonal treatment and then hopefully wean off them - as has been said these won't be helping your libido either.

Hurdity x

[CLKD]

My libedo has never been affected by anti-depressant medication in all the years I have been taking them.  Also, regardless of whether depression and anxiety are/not hormone triggered, if treatment works, don't knock it.  Regardless of the recommendations, unless those writing the guidelines have been depressed or anxious, they have no knowledge of how it feels.  ADs usually take less time to provide benefit than HRT might do, including getting a GP to recognise that a lady requires HRT.

[Perinowpost]

That all depends on the anti-depressant medication though. The older generation meds don't tend to suppress libido but GP's don't like to prescribe them so much these days, whereas the new generation SSRI's definitely do (been there tried them all).

Also, having been in the position of trying both (anti-d's & hrt) I've got to say hrt worked much quicker and without the nasty side effects associated with anti-d's.

I think the pertinent point which we've all discussed many times before is whether the anxiety/depression is triggered by peri OR long term deep seated which of course requires appropriate treatment.  There is a difference.

Personally though (from experience) and if possible I'd go the hrt route as it is replacing declining hormones and has many benefits (heart, bones, mood, etc) rather than medicating myself x

[CLKD]

I've been on SSRIs for years and my libedo has never been affected.  Depression however can affect libedo.  When my libedo dipped 17 months after being married (1979) I knew it was hormonal because of the 'urge' 5-6 days prior to each bleed.  But GPs wouldn't believe me, blamed depression  .  I also knew that the intense weepyness each night B4 a bleed even if a period wasn't due was hormonal ...... so GPs sometimes haven't a clue 

It really can be Trial and Error.  Which is SO tiring.