‘Menopausal depression’: there is an answer

6 minute read

UK GP Dr Louise Newson has attracted controversy for her treatment of menopausal women’s mental health.

Controversial UK GP and menopause specialist Dr Louise Newson has arrived in Australia and is giving a keynote address at the Inaugural Asia-Pacific Conference on Women’s Mental Health today.

Dr Newson is a passionate proponent of MHT to treat the symptoms of menopause, in particular mental health issues – an approach that has attracted a good deal of criticism.

Earlier this year she hit the headlines in the UK, accused of putting women’s health at risk with high doses of MHT for dubious benefit. She defends the practice, saying higher doses are sometimes required to treat serious mental health issues associated with menopause.

Speaking to The Medical Republic on the eve of her visit, Dr Newson said the link between mental health and menopause was controversial, but there was a growing body of evidence supporting it.

“We see a huge amount – 90% of women who come to the clinic have psychological symptoms,” she said.

“We see a lot of women who have been under mental health teams, psychiatrists, they’ve been on more than one antidepressant; we see quite a few who’ve been given drugs such as pregabalin and gabapentin, lithium mood stabilisers and quite a few now that have had ECT; and then a small number who have been given ketamine infusions.

“No one has asked these women about their hormones. And so even if their hormones are not the only cause – because obviously lots of mental health issues are multifactorial – they’re just missing a huge part of the puzzle.

“Lots of people have milder degrees, obviously, but they still have anxiety, low mood, low self-esteem, feelings of reduced self-worth, [which are] really having a detrimental effect on their home, their families, their work as well.”

Dr Newson said there was still a lot of “aversion” to MHT from medical professionals and “a lot of pushback” about the dosing of hormone therapy.

“There’s a sort of unfounded fear, really, which seems to be increasing again,” she told TMR.

“I think a lot of what we do as clinicians is about patient choice. I’m not here saying everyone has to take [MHT], or everyone has to take testosterone. Not everyone has to run or jog as their form of exercise, they can choose what they want to do.

“But what saddens me is that women are being denied an evidence-based treatment, which not only often improve symptoms, but can improve future health and reduce risk of disease.”

Dr Newson established the London-based Newson Health Menopause and Wellbeing Centre in 2018 with colleague Dr Rebecca Lewis, and they now have more than 100 health professionals, including doctors, nurses, pharmacists and healthcare assistants working in clinics across the UK.

They have reinvested a portion of the profits from the clinic into menopause research projects, free resources for patients and a free app and website known as Balance which is available to people all over the world. Her Dr Louise Newson Podcast series has been downloaded some five million times.

Dr Newson said she had perimenopausal and menopausal patients with mental health issues who had not responded to traditional treatments but seen massive benefits from MHT. Weighing up the risks of using MHT against the benefits was no different to the use of any other drug, she said.

She highlighted a case going back a few years, involving a woman who came to her after having a hysterectomy. She had previously been on MHT “mainly for her psychological symptoms”, but when she was diagnosed with breast cancer she was advised to stop the hormones.

“Her anxiety and depression became a lot worse, she had to give up her job as a teacher and she was housebound, she couldn’t go out because of her anxiety,” said Dr Newson.

“I gave her a bit of oestrogen gel to start at a low dose and increase. She had tried lots of alternatives and they hadn’t helped. And she was prepared to take this uncertain risk, because we haven’t got good quality studies. But her GPs refused point blank to prescribe it for her.

“When I spoke to them, they said, ‘we’re really worried about this risk of [breast cancer] recurrence’. And I said, ‘yes, but her risk of death from suicide is 100%’.

The GP agreed to continue the patient’s HRT, and “she’s living a really fantastic life a few years later”, Dr Newson said.

Australian psychiatrist Professor Jayashri Kulkarni, director of the Health Education and Research (HER) Centre Australia at Monash University and part of the scientific organising committee for the Inaugural Asia-Pacific Conference on Women’s Mental Health, described Dr Newson as a “pioneer and a crusader” for women’s mental health in menopause and perimenopause.

“I think what she’s doing is fantastic,” Professor Kulkarni told TMR.

Professor Kulkarni is also no stranger to criticism for her stance on the link between menopause and mental health conditions like depression.

“It’s a really fraught field, but nobody is trying to medicalise menopause and make out that every woman [suffers from mental health issues during menopause],” she said.

“We know that a significant proportion of women go through it and have no problem. All we’re trying to do is help the women who really struggle.”

Professor Kulkarni said she had seen the benefits of using hormone therapy to treat menopausal and perimenopausal women with mental health issues.

“The problem I have is [that] being a psychiatrist, I cannot convince my colleagues. I can convince some but there’s still an absolute dogma that this is not part of the DSM-5, or any DSM system – there is no diagnosis of ‘menopausal depression’,” she said.

“The problem is when a woman hits mid-life and she gets depressed, she will get standardised antidepressant treatment, which doesn’t really hit the target very well.”

Professor Kulkarni is determined to continue to push for research, even though her attempts to secure funding for a clinical trial of MHT to treat menopausal depression have failed so far.

“We’re battling on all fronts, but we’re damned if we give up,” she said.

“The last estimate was that about 46% of menopausal women experience mental health issues.

“Now there’s a spectrum, from the complete debilitation to some anxieties and rage and so on. But whatever it is, we have to consider that this is a separate entity, and we have to then think, what’s the cause, and therefore, what’s a better treatment option?

“It’s not like we don’t have hormone treatments, they’re out there. It’s actually within our reach to be able to give it to patients who require that treatment at that time.”

The two-day conference starts in Melbourne today (Thursday 12 October) and will cover topics such as violence and trauma, ADHD, eating disorders, perinatal mental health, novel treatments and interventions, including digital mental health and brain stimulation, menopause and positive ageing.

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