My story of hormonal depression: when my hormones change, I change

A famous quote by Ian Fleming says ‘Once is happenstance. Twice is coincidence. Three times is enemy action’. Unfortunately for Hannah, her enemy was her hormones and her body’s reaction to them when they changed. It was only after the birth of her third child that she realised it couldn’t be a coincidence – the return of her low mood, anger and anxiety had to be hormone related. 

“I couldn’t believe it. It was happening for the third time. As I sat spoon feeding my four-month-old daughter, the anger and irritation was unbelievable. How could this little delightful, smiley and happy baby stir such a terrible emotion in me?  

“It wasn’t just the anger and irritability that had now descended, but also the fatigue, the excruciating muscle aches, the interminable and constant headaches, the total insomnia, indecision and anxiety. It had all returned with a vengeance. The same symptoms had occurred at the same time after both my first and second children. Always at the 4-month stage, just when weaning began. I did wonder whether it was connected, but by the third time I knew this must be related to my hormones. 

“I had absolutely flourished throughout all three pregnancies, and would say I was the happiest, calmest and most contented I had ever been in my life. Those first three months, when everyone else seemed to be drowning in nappies, breastfeeding dilemmas and sleepless nights, I somehow felt calm and serene. Then something seemed to change. The first time I didn’t really understand what was going on, I just knew I felt quite unwell. I couldn’t sleep and I was very anxious. This all coincided with returning to work as a newly qualified GP and to a new job. I just assumed I must be a stressed new mother.  

“I yearned to get pregnant again to feel well and when I did, a year later, I felt completely better – that was until my baby was four months old. A few times, a fleeting question in my mind was, ‘could I have postnatal depression?’ But I pushed this thought to the back of my mind.  

“When everything began to go downhill quite spectacularly after my third child was born – and I had a five-year-old and a three-year-old as well as my baby at home – I finally realised, that I was definitely unwell and needed medical treatment. Looking back, I know I would not cope if I ever had to go through this again without medical treatment.  My GP felt that I really needed to start an antidepressant. However, soon after I began taking this, I developed paranoid thoughts, sweats at night and my sleep became much worse. Those three weeks of taking the drug sertraline were honestly the worst three weeks of my life.  

“I then stumbled upon the Association of Postnatal Illness (APNI) and their really helpful leaflet about postnatal depression. I read about the work of Dr Katherine Dalton and learnt more about depression that has a hormonal cause. I found out about the use of the hormone progesterone to treat such depression disorders, such as postnatal depression (PND), premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). I immediately stopped taking the antidepressant, sertraline, and the next day, against the guidance of the General Medical Council (the governing body for doctors in the UK), I prescribed myself some Cyclogest pessaries. I looked in the BNF, the prescribing guide for all drugs, and was shocked to see that they were actually licensed for this exact use. Within 12 hours of using the Cyclogest pessaries, I felt back to normal. 

Why had I not discovered this before? Why was this something I was not taught as part of my training? Why wasn’t this common knowledge? I was so grateful to feel normal again. 

“This discovery led to my fascination with the hormone progesterone; I read up on everything I could find online, in journal articles and in books.  

“But five months later all my symptoms came back, especially when I was premenstrual: the irritability, the anger, the anxiety. I would get a few days relief after each period and then it would build up again, every month the same would happen. I realised the progesterone pessaries were not working on their own anymore. Having become somewhat of a trainee expert on hormones by now, I knew I also needed estrogen to continue to help balance my hormone levels. I managed to see a private specialist who prescribed some Oestrogel. Slowly but surely over the following weeks, I did begin to improve. I was supposed to take a synthetic type of progestogen called norethisterone intermittently each month alongside the estrogen gel, but I found it unbearable. After the first tablet, I was climbing the walls, so I used my Cyclogest pessaries and made up my own regime of HRT as I felt confident I knew what my body needed, having done so much research.  

“I carried on my regime, for the next few years until I felt I could wean myself off both hormone treatments. I knew that as I had reproductive depression, the symptoms were more than likely going to return when I hit perimenopause as my hormones would be going through another big change. 

“After several weeks of a wobble a few months after my mother died of breast cancer, I knew it was time to restart the hormone support at the age of 44. This time I did go and see my GP who, perhaps unsurprisingly, offered me an antidepressant that I knew would never work for me. I explained that I needed hormone treatment and he agreed to prescribe the estrogen patches and progesterone pessaries. Gradually, with time and increasing the dose of estrogen patches significantly compared to the last time, I began to feel better. I felt relieved and thankful that I knew what treatment I needed to take to feel better. I realise many women are not so lucky.” 

If you have suffered with PMS or PMDD when you were having periods, or had depression after childbirth, then please be assured that if antidepressants do not work for you, there are hormone treatments available that can be very effective for the low mood that comes with those conditions, even if you haven’t yet reached the perimenopause. It is very likely that you will experience similar symptoms when your hormones start to change due to perimenopause, and HRT can be very effective at relieving those symptoms and help you to feel on an even keel. 

Dr Hannah Ward has written this factsheet with Dr Louise Newson on reproductive depression.

You can also listen to Hananh’s story in a video here.

Other resources on PMS and PND 

Our booklet on PMS 

Premenstrual Syndrome – visit NAPS at www.pms.org.uk and iapmd.org 

Postnatal depression – visit apni.org