This week More Sex Daily is delighted to introduce “Guru and Champion of Women’s Health” Professor John Studd DSc, MD, FRCOG. John is chairman of the British Menopause Society and runs the London PMS & Menopause Clinic. In 2008 he was awarded the Blair Bell Gold Medal of the Royal Society of Medicine which is given every five years for the obstetrician/gynaecologist who has made the greatest lifetime contribution to the field.
Twice as many women as men suffer from depression and there is universal agreement amongst the medical profession that this higher prevalence indicates a biological or hormonal component to the illness, however there has been a surprising lack of investigation into the use of trans-dermal oestrogen as a treatment for hormone responsive depression.
Professor John Studd believes that the “main reason drug companies have not looked at it is that they don’t want to create competition for their own in-licence anti-depressants” and obviously psychiatrists also have a vested interest in depression.
“It’s a scandal” says John “because the evidence is there that pre-menstrual depression, post-natal depression and peri-menopausal depression are eminently treatable with oestrogen, but no one wants to accept it.”
The people that do accept the link between hormones and depression are the women he treats at his clinic. Every week, ten or twelve women seek his help and in the space of four to six weeks he can change their lives. They are usually in their mid forties and desperate. “Some have been on anti depressants for fifteen or twenty years and I am a last resort.”
Unlike the average GP, John considers blood tests to measure hormone levels to be “a complete waste of time because in women of this age range, the levels will always look normal.” John makes his diagnosis by looking carefully at a woman’s history to see if her depression relates to her menstrual cycle. In his experience women who suffer hormone responsive depression usually have ups and downs through their monthly cycle. They generally feel great during pregnancy and terrible afterwards. Things go steadily downhill as they age, and their depression is at its worst when they are about 45.
HRT has been given the all clear in an investigation by a panel of 40 international experts but the public perception of hormone replacement therapy is still quite negative. When questioned about the risks of HRT John is indignant.“There is no evidence of side effects in women who start HRT below the age of 60, particularly if minimal amounts of hormones are given through the skin in the form of cream, patches or implants.” He also believes that “In HRT it is clear that the component that causes the side effects is the progestogen and that women respond really well to oestrogen and testosterone.”
There is no doubt that John’s description fits with the experiences of many women and it is pertinent to sex in long term relationships because women who are depressed are, invariably put on anti-depressants and when this happens to a woman who is actually suffering from hormone responsive depression, it begins a sequence of events which will undermine her relationships in a number of ways.
One of the most well documented side-effects of anti-depressants is low libido which can cause, or add to, existing relationship conflict (depressed women, by their own admission, are not a barrell of laughs to live with). In addition to medication a depressed woman in her mid forties will often seek psychiatric help. This process encourages her to question why she feels the way she does and she may, rightly or wrongly, decide that her relationship is to blame.
If John is right, and if you read Giovanna Forte’s case history below it is hard to conclude anything else, any woman who presents to her GP with depression should be questioned on links between the severity of symptoms and her monthly cycle before anti-depressants are prescribed.
Mid-life female finds happiness
by Giovanna Forte
I am forty-eight and I am smiling. I have a spring in my step, a twinkle in my eye, focus in my day. I’m in control; I have a new drug of choice.
If you’re a woman hurtling inexorably towards middle age (or like me, are in denial about having reached it) you’ll be pretty interested in this apparently innocuous substance that despite having wonderdrug stimuli, is not strictly speaking a drug at all. It’s a common-or-garden hormone. It’s oestrogen.
The onset of the mid-life nightmare commenced a couple of years ago. A naturally sunny person, black days began to punctuate my life; for the first time since post-natal blues distorted early motherhood two decades ago, a tide of tears began to wash regularly over my days and weeks. Mood swings ruled; demons and monsters jumped out from behind the smallest, most innocuous task or engagement. My first morning thought became “can I not cry today please?” The words alone would often make me weep with frustration at this inability to cope with anything. That’s no way to start the day.
The ebb and flow of these episodes was not entirely unpredictable – they were timed to exacerbate the pre-menstrual days. Which turned into weeks. Which took over my life; I’d leaf anxiously through my diary, maniacally counting … trying to anticipate the disruption.
Let me illuminate because, gentle reader, you too may recognise the symptoms in yourself or your partner. Combined, they can threaten not just the individual’s relationship with herself, but with everyone around her. Take heart: the problem is not insuperable.
I can pinpoint the start with disrupted nights. Waking up hot and bothered, my head swimming with stress caused by sleep deprivation, leaving me stunned with fatigue when, too early by half, John Humphries would penetrate my stupefied consciousness. Bless him; most men would have taken those husky, poisoned insults very personally.
Sleep deprivation – two words that surely strike fear into the hearts of all forty-something women. For without sleep, the coping mechanism becomes a fragile, broken thing that no amount of masking will fix. And therein lies the rest of it: tears, anger, frustration, self-doubt, broken confidence, low self-esteem and disrupted relationships.
My doctor was not unsympathetic, or unhelpful; she prescribed anti-depressants, sleeping pills (loved the sleeping pills) and blood tests to check my hormone levels, which were apparently perfectly well balanced. The anti-depressants, however, enveloped me in a rubber bubble, anaesthetising the senses but oddly, not the emotions, which remained unstable. Zopiclone restored sleep patterns, but cannot be taken daily due to addiction risk.
This state of affairs (well, I wasn’t exactly in the right shape for any of those) dragged interminably on for about two years. In utter frustration, and believing that I may be peri-menopausal, I requested HRT, initially rejected out of hand by my doctor, due to a complex and apparently dire web of risks. Conducting my own research and boosted by my findings I returned to my GP and was this time offered a visit to “HRT Clinic” where I would be counselled and, if absolutely necessary, given the appropriate treatment.
I decided, however, to make a rare claim on health insurance, and requested a referral to a consultant gynaecologist of my choice. A friend had recommended Professor John Studd, guru and champion of women’s sexual health.
Professor Studd knew exactly what was coming; he sees women like me, he said, several times a day. The world is apparently brimming with emotionally overcharged women, many of whom are much maligned with well-meant but inappropriate treatment.
“Oestrogen!” he declared, twinkling at me over his bifocals. Oestrogen, is, he explained, a much overlooked method for managing the destabilising mid-life symptoms that characterise the years preceding cessation of periods. This is not menopause and its not even peri-menopause. As well as exacerbating PMT the symptoms are just a normal female response to the ageing process and for those women that experience them, a boost of this naturally occurring hormone can do the trick.
I am testament to the trick. I am a fine example of successful oestrogen treatment. After three short weeks, a tangible relief enveloped me. After five, I feel normal; no, actually, better than normal. I sleep. I smile. The anger has dissipated. I am able to navigate life’s hurdles with logic and calm. I don’t cry. I’m happy.
Women of a certain age, rest assured there is a God (I call him Professor Studd) and there is an elixir for female wellbeing (it is oestrogen). If you’re enduring the sort of symptoms described, read up on hormone treatment, believe that things can be better and take action. Life is good; reclaim it.
At this juncture, I should commence an Oscar-style thank you speech to friends and family who endured two years of hell and helped me through the black stuff. But it would go on far too long. I shall suffice with “You know who you are. Thank you.” And that includes you, Mr Humphries.
Giovanna Forte is Managing Director of Funnelly Enough, the company that developed and now manufactures Peezy, the revolutionary, right-first-time, hygienic mid-stream urine collection system for women. Peezy allows you to deliver the best possible urine sample whilst retaining your dignity. It is available on the NHS; demand it from your doctor.