I was nervous about Hormone Replacement Therapy (HRT), but at 44 years old, I thought I was years away from needing to worry about it. I didn’t know what an impact hormonal changes would make on my life, far earlier than I expected.
It’s been obvious I’m in perimenopause for several months now. Compared to some women, my symptoms have been mild, but the low mood and brain fog of perimenopause affected both my work and my personal life.
My brain felt sluggish and fuzzy, and even after a good night’s sleep, I was almost constantly tired. My work suffered, and on far too many days, I felt an aching sadness that wouldn’t budge.
In perimenopause, our hormones fluctuate, and it’s common for women to have psychological symptoms–concentration becomes difficult, and you have trouble with your memory and your mood.
Antidepressants often don’t work for women when hormones are the root cause of their depressed feelings. On the other hand, hormone replacement therapy is effective at treating depression in perimenopause, but like many women, I was reluctant to try.
I talked with Dr. Linda Dear, a GP and menopause specialist, and she explained why women and doctors have been fearful of HRT for the past 20 years.
In 2002, a study called the Women’s Health Initiative (WHI) announced it was stopping early because they’d found that HRT increased the risk of breast cancer. After the study, women stopped taking HRT, and doctors stopped prescribing it. Antidepressants became the first line of treatment for menopause symptoms.
“Yet as the rates of HRT use plummeted overnight and stayed that way for the next two decades,” explains Linda Dear, “the rates of breast cancer continued to rise because the actual increased risk they found in that study was small. So small in fact, it was not statistically significant. It was an extra 8 cases per 10,000 women per year.”
We now know the risk of getting breast cancer from HRT is lower than from drinking two or more alcoholic drinks per day and much lower than from being overweight. We also have different types of HRT available than when the study was done.
“The benefits of HRT far outweigh any small increased breast cancer risks for the vast majority of women,” says Dear. “Not only is it the most effective treatment for all perimenopausal and menopausal symptoms; if started before the age of 60, it also reduces a woman’s risk of heart disease, osteoporosis, and fractures, and there is emerging evidence it can reduce her risk of dementia too.”
During my low mood days, I started becoming problematic enough to talk to my doctor about it. I knew I was perimenopausal, and after researching HRT, it seemed like the best option. There was no harm in trying and seeing if it worked.
My doctor agreed and prescribed me Estradot and Utrogestan: a tiny clear patch to place on my stomach twice a week and a daily pill for half of every month. These are two of the options women have for Menopausal Hormone Treatment (MHT) or HRT, but not the only ones.
The day before I started HRT, my thoughts were spiraling into dark places: “What’s the point?” and “I wish this could all just be over with.” I’m an under-sharer with my feelings, and it wasn’t easy to own up to these thoughts. I managed to tell my doctor something along the lines of “I’m feeling low a lot lately, and my thoughts are starting to scare me.”
Still, I sat on my prescription for two weeks, unsure if I wanted to collect it from the pharmacy. Even after all the research I’ve done and the talks with experts, HRT still felt like a big deal. I’m hormonally sensitive and have had bad reactions to hormone medications in the past (like the contraception pill), so I was worried about what version of me might appear on HRT. Would it switch my mood from sad to angry? Would it make things worse?
The day before starting, I felt like garbage. The day after, the malaise lifted, and I felt fantastic. All the gray fog clouding my brain for the last year had vanished. My mind felt full of warmth and lightness: that feeling you get with a surprise day off, lying in the sun on a beach with your favorite book. What a relief!
I wondered if it was a placebo effect–maybe I felt good because I so desperately wanted the HRT to make me feel good. I’ve been on HRT (MHT) for four weeks now and progesterone for two. Initially, I wouldn’t say I liked the Utrogestan. It made me dizzy and completely messed with my balance. Dr. Linda Dear suggested I take it at night, which fixed the issue.
Importantly, the tortured sadness in my chest is gone, and my mind is sharp, clear, and at peace for the first time in a long time. My mood matches my day–sad only when things happen– and that feels like a miracle.
I smile more. I smile when I’m alone for no reason. Just because life is good and I feel good in myself. I’m sure my family is enjoying it, too. I tried not to mope before, but it’s hard to fake it when you think low constantly. Dangerous even. Instead of crying about being lonely and dragging myself through the day, I bounce into a room, feel excited about life, and even laugh at the silly videos my husband shows me. It’s not like I didn’t laugh before; I did, but I could feel the underlying sadness even laughing. Now that’s gone.
We watched a funny show in bed last night, my head against his shoulder, snuggled into each other and giggling like children. And all I felt was joy and gratitude for this moment, this life, and HRT.
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