A perimenopausal woman struggles with her mood and irritability and wonders whether she should needs hormone replacement therapy or antidepressants during perimenopause. Jessica explains why a doctor might encourage antidepressants over Hormone Replacement Therapy and how to respond, depending on symptoms and feelings about one’s doctor.
Ask Jessica is an advice column for women in midlife. We cover all things related to midlife from changing bodies to career transitions to parenting teens to sandwich generation challenges to shifts in marital or life partnerships and everything in between. My hope is that in sharing these questions and answers I can women as we face the midlife journey together. Got a question or challenge you would like me to address? Fill out this form to submit your issue! Want to see the answers to other questions, check out our archive here.
Hormone Replacement Therapy or Antidepressants During Perimenopause
HEY JESSICA: My mood has gotten really bad. I get irritated super easily and can fly into a rage at the drop of a hat. I recently went to the doctor to discuss whether or not I was having perimenopausal symptoms because I heard that rage can be a big one and I’ve heard that Hormone Replacement Therapy can help. At the appointment, she asked me about how my periods have been (different, but still regular), whether I am experiencing hot flashes (no) or night sweats (sometimes when I drink alcohol), and a few other things. She then said I wasn’t a candidate for hormones because I don’t have enough symptoms. Instead, she thought that I should try an antidepressant. I have heard all these horror stories about doctors not taking women seriously when it comes to perimenopause. Is that what I am experiencing with my doctor or does this mean I have depression? And how do I know if I should be on Hormone Replacement Therapy or antidepressants during perimenopause? ~Confused AND Moody
DEAR CONFUSED:
First, I want to be clear that I am not a doctor or psychiatrist and so I cannot give you medical advice, but I can hopefully put this situation into perspective so that you can feel more secure moving forward, no matter what you decide.
One of the things that is tricky about perimenopause is that there is no test you can take in order to diagnose it. The only way that doctors can get close to making a diagnosis is by asking about symptoms. The thing is, though, the list of perimenopausal symptoms is very long and each woman’s version of perimenopause shows up differently. As a result, figuring out whether or not you are actually in perimenopause can be a real challenge.
Another factor here is that while Hormone Replacement Therapy (HRT) can be a game-changer for many women and can do a lot to improve the long-term health of postmenopausal women, it isn’t actually effective at managing all perimenopausal symptoms.
Hence, what many doctors try to do is assess (1) whether they think you are actually in perimenopause, based on your reported symptoms, and (2) determine whether HRT could help with those symptoms.
It sounds to me as if your doctor was trying to screen you for perimenopause by asking about some of the most common symptoms, and especially those that can be helped by HRT. And it also sounds as if you reported that those symptoms have not become an issue for you (they may never become an issue for you or they may show up later). And my guess here is that your doctor may have determined that while you may be experiencing perimenopause, you don’t have enough of the classic symptoms to warrant HRT.
So where do you go from here? To make the decision of whether you need Hormone Replacement Therapy or antidepressants during perimenopause, I think you have three choices: (1) if you like and trust your doctor and feel open to trying an antidepressant, then perhaps you give it a try for a few weeks (antidepressants can take a while to kick in) and see if it helps with what you have been experiencing; (2) you could decide that you aren’t comfortable with antidepressants and that you’ll try some different potential remedies (mindfulness work, exercise, coaching with me, working with a therapist, etc.) for a while to see if they help; or (3) you could track down a doctor who is well-versed in the menopausal transition and get a second opinion.
I will say that while it can be scary to think that you need to start taking medication to regulate your mood, the other side of the coin is that it could bring you great relief. As someone wisely told me once, antidepressants don’t stop you from feeling emotions, they just help you to raise the bottom of those low feelings so that it no longer feels like a bottomless pit of sadness/anger/rage, but rather a mood that you can climb back out from.
No matter what you decide, Confused, I hope you can remember that you deserve to find peace from this unhappiness you are feeling.