Suicide awareness and the impact of Menopause

The questions below were raised during our live event and answers provided by Dr Louise Newson.

Question: As a psychiatrist, I have had a few battles getting GPs to prescribe Hormone Replacement Treatment (HRT) and would be interested to know how GPs are being helped to be more open to HRT possibilities.

Answer: We have developed a free educational programme for any healthcare professional to access at https://www.fourteenfish.com/menopause/subscribe. We have been trying to work with the Royal College of General Practitioners (RGCP) but they do seem resistant to improving education for GPs.

Question: How do you make your GP listen to you when getting an appointment is a total battle, post covid?

Answer: This may help - https://www.themenopausecharity.org/2021/10/21/how-to-ask-your-gp-for-help/

Question: How can we address issues with GPs saying Clinical Commissioning Groups (CCGs) and formulary guidance restrict prescribing when trying to access hormones, particularly testosterone to help with brain fog, libido etc?

Answer: This is an area I am trying to work on with the government menopause task force. Some women find that seeing a different clinician who has been trained in the menopause can be helpful. We are hoping that testosterone will be licensed for women later this year.

Question: How aware are  the panel of the increased risk of suicide associated with autism (often undiagnosed) and menopause? I knew I wasn't experiencing typical mental health issues during menopause (I'm an ex mental health social worker) but no one considered that I might be autistic until I asked to be assessed aged 58. My autism diagnosis and getting treatment for menopause saved my life.  

Answer: I am very aware of this and often symptoms related to autism worsen during the perimenopause and menopause. We are writing information about this to improve awareness further.

Question: In 2019, over four months I became ill. My personality changed, insomnia, rapid weight loss. Asked repeatedly for HRT and was refused as I didn't have flushes. I attempted to end my life three times. I was placed in a psychiatric hospital for 4 months. I returned home in June 2019. Why do we have to struggle to obtain HRT? It took me until June 2021 and only by chance. No help from GPs. A locum had done menopause training and told me I would benefit. I felt improvements within two weeks. They diagnosed me with clinical depression, that I'd never suffered before 56. When will GPs be trained and at least one in a practice have knowledge?

Answer: I am really working hard to try and improve this so more healthcare professionals are educated. You can signpost any healthcare professional you know to our free educational programme - https://www.fourteenfish.com/menopause/subscribe

Question: Why are there not more leaflets available like in GP surgeries to highlight the menopause and the symptoms that are associated with the menopause? Unfortunately, in this day and age the menopause still remains a taboo subject to talk about and there needs to be a greater understanding in the subject.

Answer: I totally agree. On this page there are some posters that can be downloaded and printed off - https://www.balance-menopause.com/balance-for-hcp/

Question: Is HRT medication particularly expensive?  What is the reluctance to prescribe it?  

Answer: No it is very cheap. The reluctance has stemmed from misunderstanding about the safety of HRT and I’m sure it is also because it affects women rather than men.

Question: This was brilliant and very eye opening. I'll encourage colleagues to watch the recording. I am 50, just over 2 years ago I saw my GP to discuss several symptoms - sudden eczema, lack of concentration and very low. I asked if I could be starting the menopause (I hadn't heard the term peri-menopausal at the time), he asked if I was still having periods, when I said yes, he said 'well you're not menopausal are you. Is this response common?

Answer: Sadly it can be common that there is a misunderstanding because HRT is any licence for the menopause. However there is good evidence that women who are perimenopausal also improve from having HRT. It would be worth seeing another doctor.

Question: I've been trained to deliver menopause awareness sessions and the majority of feedback we get relates to pretty awful experiences with their GPs. What can we do to accelerate the re-education of GPs so more women get help?

Answer: It would be worth contacting RCGP to ask them why their education for GPs about the menopause has not improved. You can always signpost any GPs to our free educational programme - https://www.fourteenfish.com/menopause/subscribe

Question: Why is it so difficult to get alternative bio-identical HRT when GPs know it is available but always seem to revert to pharma options?

Answer: Compounded bioidentical HRT is neither licensed or regulated and potentially not safe. Regulated bioidentical hormones or body identical hormones are safest - this may help you - https://balance-menopause.com/uploads/2022/01/Body-Identical-Hormones.pdf

Question: Where is the evidence for bioidentical hormones? NHS endocrinologist do not recognise them. Can a psychiatrist train in prescribing bio identical hormones? Can a psychiatrist prescribe them?

Answer: Prescribing HRT should be possible from any clinician who prescribes. Sadly the training is often not undertaken especially in psychiatrists - they can access this training programme for free though - https://www.fourteenfish.com/menopause/subscribe.

Question: I have induced menopause due to breast cancer treatment. I suffer symptoms but my cancer was hormone related so unable to take HRT. Do you have any other advice on how to cope? (I have been prescribed antidepressants).

Answer: Women who had breast cancer can often still take HRT because there are many benefits that taking HRT gives to women and there have not been good quality studies that shown that women who take HRT following breast cancer have a worse prognosis. It may be worth listening to this podcast - https://www.balance-menopause.com/menopause-library/explaining-what-the-evidence-shows-to-offer-choice-to-women-after-breast-cancer-with-avrum-bluming/ and reading this booklet - https://balance-menopause.com/uploads/2022/01/Breast-cancer-booklet.pdf

What if you have breast cancer in the family? This would be worth reading - https://balance-menopause.com/uploads/2021/09/Family-history-of-breast-cancer-Should-I-take-HRT.pdf

Question: Years ago, the balance question was HRT versus increased risk of breast cancer. Is this still a question?

Answer: The evidence is very clear that most types of HRT do not have the risk of breast cancer associated with them and if there is a risk then the risk is incredibly low. The benefits outweigh the risks for the majority of women. There is plenty of information about this on the www.balance-menopause.com website and also the free balance app.

Question: How can we improve the support given to women in the workplace? I think menopause isn’t discussed within the workplace. We’re seen as not up to the job. I became so ill I couldn’t get out of bed. Five years on I take diazepam and citalopram daily and I dare not come off in case I can’t run my house or work. Such a sad situation more awareness is needed.

Answer: I totally agree that awareness and education really need to urgently improve. You may be interested in this booklet we have recently written - https://balance-menopause.com/uploads/2021/10/Menopause-confident-organisation-booklet-FINAL.pdf

Question: How is it that menopause and suicide are still taboo in western society?

Answer: I wish I could answer this easily. It totally should not be.

Question: I am so sorry to hear of Victoria's story. It is incredibly familiar and I am wondering if the close correlation and similarities between these accounts are being formally researched?

Answer: We are funding a three year PhD student to work with us looking specifically into suicide and menopause.

Question: How many cases have you been aware of since looking into this?

Answer: It is not possible to give numbers but I am sure they are higher than we realise.

Question: Can you feel better without HRT?

Answer: Women who take HRT usually improve their symptoms as it is replacing the missing hormones. It is impossible to replace hormones other than taking HRT. There’s more information about this on my balance-menopause website and also the free balance app.

Question: When should women not need take HRT?

Answer: There are no women who cannot take HRT. Women who take HRT have more health benefits than risks. More information about this on my website and on my free balance app.

Question: I had an epilation due to very heavy periods, so could not gauge my menopause on stopping period, they said my bloods showed I am menopausal how do blood results show where you are in the time line of menopause?

Answer: The tests are often inaccurate and misleading. If your hormone blood tests are showing that you are menopausal then it shows that it is likely that you would benefit from taking HRT.

Question: Are there women in different parts of the world who do not get symptoms? I've heard of so-called 'Blue Zones' where women do not get same levels of symptoms. What does this mean?

Answer: A really healthy lifestyle can reduce symptoms such as vasomotor symptoms and weight gain. However, women without symptoms still have health risks associated with the perimenopause and menopause including increased risk of heart disease, osteoporosis, diabetes and dementia. Oestrogen is a very important hormone to improve future health.

Question: I’m scared of weight gain with HRT.

Answer: Most women do not increase their weight with taking HRT. Many women lose weight because once the body has adequate oestrogen it does not tend to put on weight. You may find this interesting - https://www.balance-menopause.com/menopause-library/will-hrt-make-me-gain-weight/

Question: Why is it so hard to get HRT?

Answer: It is often due to inadequate education for many healthcare professionals. You can signpost this course which is free to them https://www.fourteenfish.com/menopause/subscribe

Question: I am post menopausal and still suffering symptoms, is there anybody that I can discuss this with?

Answer: You should see a doctor who specialises in the menopause. There is plenty of evidence based information on my balance-menopause.com website and also my free balance app.

Question: Why aren't women told more about the Mirena coil to help with peri-menopause?

Answer: There is information about this here - https://balance-menopause.com/uploads/2021/10/The-Mirena-Coil-or-intrauterine-system-IUS.pdf

Question: Can you start HRT even if periods finished five years ago?

Answer: Yes any woman can start taking HRT at any age as the benefits usually outweigh any risks.

Question: Radio 4's Inside Health on Wed 16 Feb 2022 "Can you take HRT forever?" seemed to present old thinking as current evidence. How can the public reconcile these different views? My Dr tells me at 5 years I should come off HRT - how do you know when it is time to reduce or come off hrt?

Answer: This episode on radio four was terrible and not based on good quality evidence. Women can take HRT for ever to replace the missing hormones which is important to improve symptoms but also to improve future health.

Question: I have been referred to a Menopause Clinic next week, what would you suggest my prep should be to get the best from that appointment?

Answer: You should download the free balance app and create a health report. It is also worth reading as much as possible about treatment including HRT.

Question: How do we improve the education for women to understand what menopause is and what it means to them?

Answer: By downloading the free balance app and also reading some of the articles and watching the videos on the balance-menopause.com website

Question: What would be your starting point for areas to take this work forward? Menopause cafes seem a good model for peer to peer support, training and awareness for health professionals and public also seems like a helpful action - anything else?

Answer: Improving training for healthcare professionals and also knowledge for women is pivotal for improving menopause care and also improving the future health of women.

Question: Can difficult menopausal symptoms be offset by helping women to prepare for it in the years prior, during peri-menopause, through hormonal regulating gentle balancing remedies and other alternative approaches?

Answer: Women can start taking HRT during the perimenopause to improve their hormone levels. An important to look at diet and exercise as well as well-being.

Question: I work within the perinatal mental health service and I wonder what support/advice we should be offering to our mums re: relapse prevention?

Answer: This may be useful to share - https://balance-menopause.com/uploads/2022/02/What-is-reproductive-depression.pdf

Question: In many cases Tibolone and other HRT can paradoxically make the mental health symptoms worse? Is that true. Dr Kulkarni whose questionnaire you use says that in her research ( I think).. Is that true?

Answer: Sometimes progesterone can make symptoms worse. It is really important that women have individualised advice and often we give oestrogen and testosterone first and then adding progesterone. If a woman has side-effects with one type of HRT then it is important that she tries another time.

Question: Are there any particular cultural or BAME groups for whom this is an even bigger issue? And if so, how is this being addressed?

Answer: We are trying to address this especially with the free balance app. Women are neglected in so many groups it is awful.

Question: I received talking therapies for my anxiety around that time at the age of 55. How common is this? Are there statistics on medication and suicide among menopausal women?

Answer: Anxiety is a very common symptom of the hormone deficiency related to the menopause. There are not good statistics because this research has not been done but I’m sure the numbers are worse than we realise.

Question: At 59 I feel I would be considered too old it’s too late for help, is this common?

Answer: No one is too old to start HRT. There is plenty of information on my website and on my free balance app.

Question: Is there an age that HRT has to stop? Does NICE reflect this? My GP has said it won’t be prescribed when I get to 60? That is definitely a depressing thought and is causing anxiety.

Answer: This is not accurate information. It is really important that women can take HRT forever because of the many health benefits taking HRT gives women.

Question: What sort of age might a woman not require HRT? I know of someone who is 80 who has long term depression. Is this too mature an age to be possibly linked with hormones?

Answer: Mood changes can occur at any age related to hormones deficiency. The only way of knowing whether it is related to hormones or not is by taking HRT and assessing whether mood improves.

Question: Is there an age limit to going on HRT?

Answer: This may be beneficial https://balance-menopause.com/uploads/2021/09/Starting-or-continuing-HRT-many-years-after-your-menopause.pdf

Question: Do you think HRT could be considered for women who present within older persons mental health, (age 70+) with anxiety and low mood?

Answer: Yes it may help. You may find this leaflet useful https://balance-menopause.com/uploads/2021/09/Starting-or-continuing-HRT-many-years-after-your-menopause.pdf

Question: How would you treat women with perimenopausal/menopausal symptoms alongside historical/current cancer?  For example, gynaecological and breast?

Answer: Women need to receive an individualised consultation. This may be useful - https://www.balance-menopause.com/balance-for-cancer-support/

Question: I have hypothyroidism and am going through the menopause, my hormones are going haywire and feel extremely anxious, feeling quite flat, I would like to know how I proceed, have been to Dr's to check my thyroid levels, would like to see either endochrinologist or menopause Dr to get this looked into, what can I do as I do worry about my mental health?

Answer: Many women find that taking HRT improves thyroid function. It would be worth thing a Dr who specialises in the menopause. This may be useful to read - https://www.balance-menopause.com/menopause-library/thyroid-function-and-menopause/

Question: Is there evidence that birthing people who experience post partum psychosis may experience a psychotic episode during menopause?

Answer: Yes there is some evidence. https://balance-menopause.com/uploads/2022/02/What-is-reproductive-depression.pdf

Question: Is there any link found between menopause and potential worsening of symptoms or more instability for those with pre-diagnosed MH condition- such as bipolar?

Answer: There can be an association. There has been little research into this but certainly we see women who have worsening symptoms during the perimenopause and menopause which is related to their hormone deficiency.

Question: If a woman has lived with clinical depression for many years, should their treatment change if there is now a menopausal component?

Answer: It is important that women are given the right dose and type of HRT which often should include oestrogen and testosterone which can improve depression

Question: What is the understanding of menopause versus fibroids/ovarian cyst issues?

Answer: It would be worth reading this https://www.balance-menopause.com/menopause-library/fibroids-and-the-menopause/

Question: I've got most of the features of perimenopausal depression. I'm 48. The last few weeks I've felt paranoid, anxious, isolated and felt hard to reach out to anyone. I'm fatigued a lot and my sleep is all over the place. Mine is complicated as I also have RA.

Answer: It is likely you would benefit from taking HRT. It would be worth seeing a doctor who specialises in the menopause.

Question: How do you get an appointment with Dr Louise?

Answer: There is currently a waiting list in my clinic. However, we are recruiting many more doctors so it is worth joining the waiting list.

Question: I approached my GP who, like Victoria's GP, prescribed antidepressants and like Victoria, they made me shake. I came off the tablets very quickly. I managed to get an appointment with Dr Newson's clinic and how glad am I? I too was suffering from thoughts of, 'I don't want to be here anymore'. HRT patches have definitely helped. I still have some up and down days but nothing like I did - I can't thank you enough.

Answer: Thank you so much for sharing this.

Question: Could the balance app please have a symptom button for suicidal ideation please? I have been trying to track my thoughts and use the app already but as it’s not an option I’m not really tracking it properly. Thanks for organising this live event with outstanding speakers.

Answer: It would be worth emailing the app team about this - the email is info@balance-app.com.