The triad of postnatal depression,
premenstrual syndrome and severe menopausal symptoms
It has been established for many years that there is a clinical relationship between these 3 different gynaecological problems which can cause extreme misery and result in depression.
It is vital that the clinician is able to diagnose whether the patient has this condition or has a severe depressive illness.
Sadly 20% of women with postnatal depression are not appropriately managed and develop unnecessary chronic depressive illness.
Postnatal depression can be successfully treated with the use of topical oestrogens (transdermal or oestrogen gels). Oestrogen is effective since it is a natural antidepressant and derived from a steroid hormone.
Topical oestrogens are also effective in the treatment of premenstrual tension (pmt) and menopausal symptoms. Topical oestrogens and the insertion of a Mirena coil (a coil which contains the hormone progesterone) are very effective in the management of pmt. The Mirena coil can be inserted relatively pain free in the outpatient clinic. It is also an effective contraception, and is the most potent non surgical treatment of heavy periods. It has very few side effects because very little is absorbed into the circulation.
The use of HRT has recently become controversial and worrying. This is based on the Women’s health Initiative studies which showed an increased risk of breast cancer and heart disease in women using one particular type of HRT (premique – a preparation containing a mixture of oestrogens and medroxyprogesterone acetate). However this study failed to look at any other preparations. It was no surprise that medroxyprogesterone acetate was associated with an increased risk of heart and blood vessel disease since there is evidence that this particular progesterone stops the well established benefits of oestrogen on blood vessel function. The study showed the risk of breast cancer is not increased in women using oestrogen alone.
More recently a UK based study has shown that women attending for mammography were at higher risk of being diagnosed with breast cancer if they were using a combined HRT preparation (oestrogen and progesterone).
I believe that there is a definite role for HRT agents in treating menopause symptom relief. This is the role of HRT. It is also protective against bone loss. Topical oestrogens have a lower risk of causing thrombosis in the veins and pulmonary embolism. Drinking more than 3 units of alcohol a day, and being overweight increase the risk of developing breast cancer and heart disease compared to HRT.
I offer women HRT counseling and advice on their breast cancer and heart disease risk. I can carry out specific tests for inherited thrombosis risks which are common in Northern Europeans and Ashkenazi Jews. I feel that there are real benefits in using topical oestrogens in combination with a Mirena coil, which minimizes the exposure to progesterone.