Antidepressants Blog

- Can HRT help depression?

It may, particularly if the depressed mood is caused by sleeplessness due to night sweats. However, oestrogen therapy used to treat severe depressive illness has variable results and, when there is severe depressive illness, psychiatric intervention and antidepressant medications are usually needed.

- I am taking oestrogen and progestogen, but I believe the progestogen component is having a depressing effect on my moods and libido. I feel better when I just take the oestrogen. Is this OK? Yes, you could consider this as an option, particularly if your withdrawal bleeds are light. However, there is no data to prove that oestrogen without some progestogen is safe for women with a uterus. In the long term you could be increasing your risk of developing cancer of the endometrium by five to ten times, that is, from around one in noo to around one in 200. To minimise this possibility, you will need a hysteroscopy and endometrial biopsy every six to twelve months or when any bleeding or spotting occurs.

- Can HRT help depression?

It may, particularly if the depressed mood is caused by sleeplessness due to night sweats. However, oestrogen therapy used to treat severe depressive illness has variable results and, when there is severe depressive illness, psychiatric intervention and antidepressant medications are usually needed.

- I am taking oestrogen and progestogen, but I believe the progestogen component is having a depressing effect on my moods and libido. I feel better when I just take the oestrogen. Is this OK? Yes, you could consider this as an option, particularly if your withdrawal bleeds are light. However, there is no data to prove that oestrogen without some progestogen is safe for women with a uterus. In the long term you could be increasing your risk of developing cancer of the endometrium by five to ten times, that is, from around one in noo to around one in 200. To minimise this possibility, you will need a hysteroscopy and endometrial biopsy every six to twelve months or when any bleeding or spotting occurs.

*112\38\8*

In addition to the possible interaction between HRT and existing medical conditions, there may be a range of unwanted symptoms caused by HRT itself. You may be bothered by one or other of the following.

BREAST TENDERNESS, FLUID RETENTION AND NAUSEA

These symptoms are more likely in women who start on HRT some years after menopause. If nausea persists with the therapy in pill form, a different route should be considered, such as skin patches or implants. Breast tenderness often settles after a few months of HRT. If it persists, consideration should be given to a reduced dose of oestrogen, to a different way of administering it, and to complementary naturopathic remedies such as evening primrose oil tablets.

IRRITABILITY AND MOODINESS A common short-term side effect of the progestogen component of HRT is irritability and moodiness reminiscent of the symptoms of premenstrual syndrome. Sometimes these side effects last longer, and very occasionally they persist despite trying various progestogens. If you are affected in this way, you may elect to stop HRT, or take oestrogen alone – accepting that hysteroscopy and biopsy will be necessary every six to twelve months.

VAGINAL DISCHARGE Women can expect their normal vaginal lubrication to return while on HRT. Some women think they have developed a vaginal infection when it is simply a return of the natural mucus, which should make intercourse more comfortable.

*78\38\8*

It usually takes six months for side effects associated with HRT to settle. A doctor will normally start with an ‘off-the-shelf hormone format and then make adjustments to suit your particular responses. Two months after starting on HRT you should be reviewed by your doctor, with a follow-up three months later. Once-yearly checks are appropriate from then on, unless side effects or other concerns like irregular bleeding occur, in which case prompt investigation is in order. Also make sure you ask your doctor to check your breasts and to confirm that you are not overdue for a mammogram.

Once a format and dosage of hormones that suit your individual needs are found, it is usual to stay with this formula for as long as HRT is required.

Duration of HRT

The length of time for a woman to have HRT remains a matter of debate. Most doctors advise patients to continue the therapy until a break from their hormone format no longer results in troublesome symptoms. This generally occurs in one to three years, but sometimes five, ten or even fifteen years.

If HRT is given solely to reduce a perceived risk of osteoporosis or heart disease, current evidence suggests that the longer the use, the greater the benefit. It seems that at least five years of HRT are needed to obtain a statistically significant benefit for the bones or heart, and to get maximum benefit you need from fifteen years to lifetime therapy. Bone density measurements (see chapter 3) may give helpful information when the question arises of whether or not to continue with HRT. If the bone density is excellent and menopausal symptoms are no longer troubling, you may wish to stop HRT pending a review of your situation (including another bone density measurement) in two to three years time. If the bone density is of concern and there are no compelling reasons to discontinue HRT, staying on the therapy is the best course.

If the main consideration prompting HRT was abnormal blood fat levels, an improvement to normal in cholesterol and triglyceride levels does not provide a convincing reason for stopping it. Indeed, it may be an argument for persisting with the therapy as it is doing the job required.

*43\38\8*

You may notice your periods becoming irregular in your late forties, although this can occur quite naturally some years earlier or later. As periods become less frequent, your fertility declines. Women of fifty-five have become pregnant, however, and one Californian woman gave birth at the ripe old age of fifty-seven years! The changing output of sex hormones by the ovaries, as the menopause approaches, is responsible for this menstrual irregularity. For most women, irregular periods last between two and seven years, though the range is a,few months to eleven years. If you are irregular for many months, this can be a confusing and stressful time because of both the bleeding and the risk of an unplanned pregnancy.

In order to meet contraceptive needs in their forties and fifties, some women use the Pill or long-acting contraceptives like Norplant, a hormone-containing pellet that is implanted under the skin. These tend to mask changes in menstrual bleeding that indicate the approach of menopause.

This was the case for Janet, a Pill-user since having an IUD removed ten years previously. When she was fifty-three and, with no change in her Pill-induced bleeds, experienced a few hot flushes, she asked her doctor if these could be menopause-related. Her doctor recommended that she use a non-hormonal form of contraception for a while to see if her menstrual periods occurred, thus allowing an assessment of what was happening to Janet’s own hormone production. After she and her partner had been using condoms for a few months she had a menstrual bleed. She then faced further choices — whether to continue using condoms until her bleeding disappeared for a full year, or to resume the Pill for another year before repeating the same sort of Pill-free ‘trial’. Janet chose the first of these options, and what turned out to be her final period occurred four months later. According to a recent Australian study, an increasing number of couples choose sterilisation of one or other partner – at this stage of life another option again.

It is important to point out that the Pill is not a suitable choice for any woman over thirty-five who has a substantial risk of heart and blood vessel disease. Indications of high risk include smoking, high blood pressure, unacceptable blood fat levels, and a family history of heart and blood vessel disease mainly associated with the early death of a relative. If you fall into any of these categories, your risk of suffering a heart attack, a serious blood clot disorder or a stroke markedly increases.

Both HRT and the Pill typically include the hormones oestrogen and progestogen, a synthetic form of progesterone, but the hormone doses in HRT tend to be considerably lower than in low-dose Pills. While women on the Pill who smoke have a measurable increase in their risk of heart disease, the heart health of smokers on HRT does not seem to be jeopardised. In fact, for such women, HRT may confer important health benefits.

*9\38\8*