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[Aurelia]

I first went on HRT in February. It was Evorel 50 Sequi patches. I started getting depressed in April so the doctor upped my HRT to Evorel 75 patches and Utrogestan 100mg capsules in July. My depression has got worse. I've been prone to depression and anxiety since I was a teenager but this is the worst I've ever felt. Is it possible that the HRT is causing it? I've searched online for advice but there's not much. There's a Telegraph article about HRT causing someone's depression but it's behind a paywall. Does anyone have any experience of HRT causing depression? Thanks.

[Limpy]

It's rotten you feel so bad Aurelia.
When you started feeling down on the Sequi. Was it when taking the Conti patches that is started or was it with both the patch types?
BTW Welcome to the forum

[CLKD]

Morning.

How were your moods during your menstruating years?  I would sob uncontrollably the night before a bleed began, even if a period wasn't due.  I knew that it was hormones.

Think why you went on HRT, what symptom did you want to ease?  Some don't do well on the progesterone part of a regime, is the depression worse when using the Utrogestan?

[Flossieteacake]

Hello Aurelia. Welcome to the forum. I am wondering if the progesterone part of the HRT is making you feel depressed. You said you felt worse after trying Ultrogestan and this can cause depression. Some say they feel okay taking it vaginally rather then oral.

[joziel]

Like Flossie says there, usually it's the progesterone causing this problem (if it is HRT). You can often get around it by taking the progesterone vaginally rather than orally. The same capsule that you take orally, you can insert as far up into the vagina as possible before bed. This means that less of it gets into your blood and affects the rest of your body, it just gets to the uterus where it needs to be. So you could try that and see...

Or you could try not taking progesterone for just 3 days or so, to see if that improves your mood - so you can figure that out.

When you were on the Sequi, did you feel worse on the days you were taking the progesterone combined patches? And better on the estrogen only days?

[Aurelia]

Thanks for your replies.

My depression started when I was 13, which was also the year that puberty began for me. I've always thought my mental health problems are connected to hormones. I get anxiety and depression on and off but am wary of taking anti depressants because of the weight gain I always get from them. I'm getting depressed now though so I might have to go back on them.

I haven't noticed it being worse when I took the Utrogestan capsules. It's just been getting progressively worse over the months. I've been crying in front of my 8 year old daughter which makes me feel ashamed.

If I thought just taking the patch off and stopping the hrt would alleviate the depression I would do that.

[joziel]

Have you noticed that the depression is worse at certain times in your cycle? Like for example, the week leading up to a period? That is very classic if it is hormonal...

Has your GP checked your blood estrogen levels? Usually this isn't recommended unless you need to go over 100, but perhaps you are not absorbing the estrogen in the patches very well (some women are poor absorbers) in which case you could be very progesterone heavy and not be getting the estrogen - so it might be worth asking for a blood test for estrogen levels. If your GP refuses you can order one yourself which you do at home with Medichecks. It's about £45 and you just **** your finger and squeeze the blood into a little tube and post it off...

Lastly, some women with depression can need really high estrogen levels to feel okay (according to Dr Louise Newson) - sometimes they need serum levels of 800pmol to feel alright. And most doctors would consider that too high and freak out a bit. So it could be worth seeing a menopause specialist.

There are some SSRIs which can also help with menopause symptoms (ie venlafaxine) so it might help more than your depression to go back on them.

[Aurelia]

Have you noticed that the depression is worse at certain times in your cycle? Like for example, the week leading up to a period? That is very classic if it is hormonal...

Has your GP checked your blood estrogen levels? Usually this isn't recommended unless you need to go over 100, but perhaps you are not absorbing the estrogen in the patches very well (some women are poor absorbers) in which case you could be very progesterone heavy and not be getting the estrogen - so it might be worth asking for a blood test for estrogen levels. If your GP refuses you can order one yourself which you do at home with Medichecks. It's about £45 and you just **** your finger and squeeze the blood into a little tube and post it off...

Lastly, some women with depression can need really high estrogen levels to feel okay (according to Dr Louise Newson) - sometimes they need serum levels of 800pmol to feel alright. And most doctors would consider that too high and freak out a bit. So it could be worth seeing a menopause specialist.

There are some SSRIs which can also help with menopause symptoms (ie venlafaxine) so it might help more than your depression to go back on them.

I never had PMS when I was younger.

I haven't had my estrogen levels checked either. I am 50 so they wouldn't check.

I have been on 3 different SSRIs in the past: Paroxetine, Sertraline and Prozac. I haven't been on any for 5 years because they make me put on weight and that scares me. I was thinking of asking for Citalopram because I haven't tried that one. I didn't know Venlafaxine helped with menopause symptoms.

[Perinowpost]

Oestrogen is the feel good hormone. As the others have said progesterone is the likely culprit. The only way to know is to have some progesterone free days/oestrogen only and see how you feel. I minimise prog for this very reason x

[Fruitcake]

Have you noticed that the depression is worse at certain times in your cycle? Like for example, the week leading up to a period? That is very classic if it is hormonal...

Has your GP checked your blood estrogen levels? Usually this isn't recommended unless you need to go over 100, but perhaps you are not absorbing the estrogen in the patches very well (some women are poor absorbers) in which case you could be very progesterone heavy and not be getting the estrogen - so it might be worth asking for a blood test for estrogen levels. If your GP refuses you can order one yourself which you do at home with Medichecks. It's about £45 and you just **** your finger and squeeze the blood into a little tube and post it off...

Lastly, some women with depression can need really high estrogen levels to feel okay (according to Dr Louise Newson) - sometimes they need serum levels of 800pmol to feel alright. And most doctors would consider that too high and freak out a bit. So it could be worth seeing a menopause specialist.

There are some SSRIs which can also help with menopause symptoms (ie venlafaxine) so it might help more than your depression to go back on them.

I never had PMS when I was younger.

I haven't had my estrogen levels checked either. I am 50 so they wouldn't check.

I have been on 3 different SSRIs in the past: Paroxetine, Sertraline and Prozac. I haven't been on any for 5 years because they make me put on weight and that scares me. I was thinking of asking for Citalopram because I haven't tried that one. I didn't know Venlafaxine helped with menopause symptoms.

Sorry to be the bearer of bad news but I don't think there is an SSRI available that doesn't have weight gain as a side effect of the medication. Probably the nature of the way they work on the chemicals in your brain that then make you crave more of the 'bad' foods etc.

From personal experience Citalopram caused weight gain. Whether you could counter act this by being really conscious of what you eat and how much you eat I'm not sure, especially when you may not be feeling in a good place to start with.

I hope you find some relief to how you are feeling at the moment.

[Flossieteacake]

I think everybody reacts differently to antidepressants and not all will have weight gain. I understand weight gain is not nice but I would personally think of your mental well being first. If you were to feel less depressed that would be wonderful. I know it can take time to find one that suits. I think it took me about 8 years to find one that suited me.

[jillydoll]

If I have too much HRT, I feel down and depressed.
When experimenting before, I found too much made me down and depressed.
I’ve found my level now. 2mg Femoston conti. Xx

[chucklesista]

HI Aurelia (like your Forum handle!),

It does sound possible that hrt could be bringing out the depression. I have underlying depression too and take fluoxetine (prozac). Based on my own personal experience, there could be a few tweaks to try. I started on Evorel Conti 50 (I am postmenopausal) in April and got more and more tearful and angry over the 3 months I stuck it out. Not more depressed though. You say you were crying in front of your daughter - would that have been something your depression might have caused previously, or does the tearfulness seem to be linked to starting HRT? I didn't get PMT of tearfulness either.

I asked my gp to swap me to Utrogestan for progesterone component to try and reduce side effects. He suggested reducing the estrogen element too so I am now on Estradot 25 (ie half the level I was getting on the Evorel patch) and Utrogestan 100 mg 24 days from 28. I have just switched to taking Utrogestan vaginally last week (after 6 weeks orally) and it has made a big difference already - less bloating and I am much less angry/tearful. It is a wee bit of a performance (I have 2 wombs ) but worth it for the result.

The BMS seems to suggest starting on the lowest estrogen dose poss, trialling it for 3 months, then going up if symptoms not resolved. If you were started on 50, which seems to be fairly standard NHS practice, it's not the lowest dose. Some folk can be sensitive to estrogen too and only need half of a 25 patch to make them feel better. I personally felt a load better in the 4 days when I had taken the Evorel patch off altogether so wasn't getting either estrogen or progesterone. But I am only changing one element of my hrt at a time as otherwise I won't know what is making me feel better (hopefully!).

I really feel for you as we all want our lives back and having to be faffing around increasing and decreasing doses is a right pain. I am also keeping a mood diary and a food diary to see if any patterns emerge (will be a thrilling read for future generations  )

Really hope you feel better soon, Chucklesista x

[CLKD]

Having taken ADs since the 1980s and never having put on weight  ......... we have a healthy diet (when I am well) with lots of fresh fruit and veg as well as chocolate for pudding.

I have taken escitalopram for 12 years without problems. 

[Aurelia]

Thanks for all your replies. I have decided to ask the doctor for antidepressants. I have avoided it for long enough but I can't continue to feel this bad for any longer. I'll just have to put up with weight gain if it happens.