Sertaline Vs HRT - help me decide

[ruthietoothie]

I'm really stuck. I'm struggling loads ATM with low mood and anxiety, and just feeling irritable all of the time. I think some of the symptoms could be perimenapausal and I was on HRT for about a year. I came off it though as was struggling with extreme anxiety linked to the protesagen.

I Def need something though as can't go on like this. Feels like I have two options: either go back on HRT or try sertaline. Can't decide though. Any advice?

I'm scared that sertaline will dampen my energy and sounds like it can make symptoms worse at first.
..

Would love any advice or reflections from ppl who've been on either xx

[DustyLee123]

If you’re over 45 then the NICE guidelines are very clear that it’s HRT

[ruthietoothie]

Well I am 43 so I guess it's not totally clear cut.... Dunno

[Whycantgiraffesdance]

Sorry you are struggling @ruthietoothie I have PND so slightly different but I struggled with the low mood and anxiety for months and at 40 I thought it could possibly be hormonal so I know the feeling!

im on anti depressants and after about 9 weeks now I feel like my mood is slowly improving. Is there any reason why Setraline in particular? I was on these before the ones I’m on now and I found the side effects particularly brutal, they made me feel nauseous and gave me stomach issues as well as heightened anxiety so asked to be switched. (Although I know a lot of people find them really effective so they may have worked eventually but personally I found the side effects too much!) I was on citalopram previously and now venaflaxine which I found are a lot easy to take initially than the Setraline.

I did see a gynaecologist whilst I was looking at the possibility of peri-meno and I have decided to go back on the combined pill and keep taking it without a break (her suggestion) as I feel I was much more stable emotionally when I was on the pill! I did try the mirena coil and oestrogen patchs for a few months but I got fed up with the constant bleeding so have settled on the pill for now.

sorry just thought I’d share my experience in case it helps at all! x

[TreesWelliesKnees]

I did well for a year or so on sertraline aged 44. I was trying to delay starting hrt and was more troubled by the mood changes of peri than the physical symptoms. It worked very well for me. I started hrt aged 45 and weaned off sertraline, which was fine until recently (now 47). I'm now on both as hrt wasn't cutting it anymore. Not sure if that's helpful but long story short, I do think sertraline can help with the mental peri symptoms. Actually it did help hot flushes too - no idea how that works.

[TreesWelliesKnees]

Oh, and in terms of energy levels, sertraline helps me sleep so I have more energy when I'm on it. Still not much though, even with hrt too. Peri has stolen it!

[ruthietoothie]

Thanks so much for sharing your experiences @Whycantgiraffesdance and @TreesWelliesKnees I really appreciate your taking the time to reply. Sorry that you have both faced these challenges and thanks for sharing your experiences as I navigate my own. It really does help!

I totally hear you @TreesWelliesKnees on the mental symptoms of the Perimenapause and interesting that you wanted to delay going on HRT. I went on it for a year from about 41 and it did help but I was still struggling quite a bit with both low mood and quite extreme anxiety. I think low mood has been something I've faced in other periods of my life but this level of anxiety and irritability feels very new.

I have always been a bit fearful of mood stabilisers and I think that was what attracted me to HRT but now I have started to feel a bit more cautious about HRT plus I just feel like I need something that will really make a difference.

I'm also anemic which can't be helping and parenting kids with additional needs. I've got a hectic job and a house renovation on the go so some of it is probably circumstantial too. Hard to say.

@Whycantgiraffesdance I was recommended sertaline by a GP friend of a friend but do keep hearing scary things about the side effects. Was on fluoxetine as a teenager and know I don't want to go back on that....

Got an appointment tomorrow with the menapause clinic so hopefully can reach a decision after that... Thanks again for the input and advice

[DivorcedAndDelighted]

Sounds like you might have progesterone intolerance. The problem is not HRT, but the type of progesterone you were given before. https://www.balance-menopause.com/menopause-library/prgesterone-intolerance-factsheet/

[Rorelius]

Having refused anti depressants for 20 years I started sertraline 4 weeks ago and really do feel a bit better. I was also asking for HRT and torn between the two. I'm 43. I will go back for hrt later but I'm glad I've taken the leap. I started really low (25) and upped to 50 after a week or so. No side effects bar slight nausea for the first week

[Falifornia]

@ruthietoothie

I've posted this on a few threads so apols if you've read it before!

I was lucky enough to be prescribed HRT > 5 years ago but my anxiety, irrational rage, overthinking (borderline paranoia?), brain fog and other utterly shit symptoms had got worse in recent months and my mood was desperately low, despite the HRT. I did some reading and asked my GP for an SSRI. She agreed it was worth a punt and bunged me on Sertraline. All I can say it that it's been an absolute game changer and I wish I'd done it years ago. It did take 3 weeks to kick in but I feel like a different woman.

I did feel a bit pukey the first couple of days but really no biggie. I feel better in myself than I have in months. I hope you get an equally positive outcome as it just sucks

[ruthietoothie]

Thanks everyone! @DivorcedAndDelighted so would your take be to go back on HRT but ask for the protesagen as a pessary or similar? I guess some ppl are on HRT and SSRIs.

@Rorelius so we exactly the same age! Can I ask what made you go for sertaline above HRT? I'm still a bit torn between them but feel a bit more up for trying an anti depressant especially given that I'm under 45 and also that I didn't get on so very well with HRT previously

@Falifornia that sounds really tough. Sorry you been through it all but glad the sertaline has made a difference. Are you still on HRT too?

[Asparagusluvva]

I would suggest trying sertraline or another SSRI if you didn’t get on with HRT. But start really gradually on a very low dose . I actually split my pills in half when I first started as I was concerned about side effects. Against my expectations, I felt better with hours of starting . However , with most people it is supposed to take weeks. Although perimenopausal, I feel they maybe worked with me so quickly due to a sort of hormonal turbulence , in a similar way that they work with PMMD. I took a low dose as I felt that it evened me out without numbing. And if you do decide to take them , if you want to stop, wean off them very very gradually.

[Rorelius]

The GP believed that's what I actually needed. I was really resistant, thought I was being dismissed for HRT. I reluctantly think he was correct now. However, the two things dance together don't they and I certainly have hormonal issues that need addressing too. So I'll be going back in a couple of years for that!

[Falifornia]

@ruthietoothie

No I ditched the HRT when I started feeling so much better. Most of my physical symptoms are not too bad. Am flushing a bit now I'm off it but really nothing desperate. I'm still using the oestrogen pessary though, to keep everything perky downstairs.

For me it was a toss up between upping the HRT again to battle the mental/cognitive/emotional issues or to change tack and try something different. I would absolutely go back in the HRT if I felt I needed it though!

[bluejelly]

I'm on both fluoxetine and HRT and feel it's the best of both worlds.

[Lovethatforyouhun]

Both for me!

[Ataloss44]

Both for me also

[imnotthatkindofmum]

I have HRT and citalopram. Don't know about sertraline but I'm happy with both.

[ruthietoothie]

Aw thanks so much everyone for sharing your experiences. Sounds like it's not uncommon to be reaching or feeling the need of SSRIS in early 40s and I guess that is maybe connected to perimenapausal stuff but also perhaps the life pressures we have at this stage in our life. Still feel a bit torn and also nervous of speaking to the gps as always feels so rushed and like they're dismissive of everything.

@Falifornia that sounds v familiar. I don't really have any physical symptoms which made me doubt at first whether it was perimenapausal...@Rorelius sounds like you got decent GP input but hear you on feeling fobbed off.

@ruthietoothie@Asparagusluvva thanks for the advice . That is where my head is at at the moment too. Such a minefield though - feels impossible to call it in a way, but thanks to all of you for helping me think it through xx

[ruthietoothie]

Thanks again to you all for the advice. I had an infuriatingly brief meeting with a gp today and they agreed to prescribe me Sertaline. It wasn't a very helpful discussion and they did suggest citalopram instead. Someone also suggested Propranolol for my anxiety which sounds a bit scary! Still feel torn about it all

[Whycantgiraffesdance]

I’m glad u saw your gp @ruthietoothie it’s really frustrating when you feel like you’re being rushed out though!

propanalol just takes the edge of the anxiety if you are having a panic attack for example. It stops the racing heart, palpitations etc. I was given 10mg to start but this didn’t really do anything so I was upped to 40mg which I could take 3 times a day. I think it upset my sensitive stomach but it is quite effective in helping when you feel really anxious. x

[ruthietoothie]

Aw thanks @Whycantgiraffesdance I appreciate you sharing your experiences. I actually went to the GP today as I was feeling anxious about the hurried way they had dealt with my yesterday and about the prescription of sertaline. Anyway as I've got an old but still live diagnosis of bi-polar they now saying they can't prescribe sertaline at all as can cause a manic onset. Instead they're referring me to a psychiatrist to look at medication which I'm guessing could take absolutely ages. So now I feel like I've been left close to crisis and with nowhere to go.

[Whycantgiraffesdance]

Ah I’m really sorry @ruthietoothie that’s not really what u want is it, more waiting!

if you do feel like you need more immediate help there is always 111 option 2 for mental health. They were really helpful when I was at crisis point. Please don’t suffer on your own ❤️

I know it’s not an option for everyone or one you should have to take but could you try and see a private pyschiatrist? I did this out of desperation as I knew the wait on the nhs would be ages!x

[DivorcedAndDelighted]

I'd suggest trying body-identical hormones eg Utrogestan, and having your estrogen as estradiol gel or patch. These hormones are the same molecules as your body's own hormones so more likely to be well tolerated than the old-fashioned conjugated HRT. Alternatively, many women get on well with having the progestin via a Mirena IUD. This isn't a body-identical form, but the dose is very low.
https://www.balance-
menopause.com/menopause-library/body-identical-hormones/