Sertraline. and Peri Menopause.

[Roseformeplease]

Anyone been prescribed this? Depressed but told that this is a good way to treat symptoms of peri (hot flushes etc). Need something as very low and knackered, not sleeping and boiling hot. Thanks.

Oh dear- yet another GP dishing out powerful antidepressants rather than HRT.

Sorry but this gets me hopping.

Unless there are real medical reasons why you cannot take HRT then you need oestrogen, not antidepressants/ anti anxiety meds.

I'm sorry but it's a disgrace that so many drs who lack confidence to prescribe HRT fall back on other powerful drugs that have more potential side effects. These are mind-altering drugs and have no place for women who are lacking oestrogen UNLESS they have had recent breast cancer, blood clots and other serious illnesses that mean HRT is contra-indicated.
HRT is the first line treatment, not ADs.

Have a read of the website of gynae Prof John Studd and what he has to say about the scandal of drs prescribing ADs instead of HRT.

Have a look at this from the Menopause Matters site, too.

It shows that those kinds of drugs are alternatives to HRT- not to be used as a primary approach.

www.menopausematters.co.uk/prescribed.php

I'd go back to your GP and ask why he did not choose HRT for you and say you want to try it.

She suggested that I was depressed and that there were good results from Sertraline with hot flushes....Aaah. Not sure what to do now. I have only been depressed once before (20 years ago) and that was after my boyfriend's death and I was given Prozac when I had not got back on track 6 months later (prescribed by a Psychiatrist).

Is it worth giving the anti-ds a chance? She suggested that this way I could have HRT later as I am only 46 and they do not recommend it for long. Had a blood test and am definitely peri.

Ok- a few points to consider.

The basic 'flaw' with your GP's thinking is that she wants to keep HRT to a minimum. When she says 'they' do not recommend it for long, does she mean your drs' practice? Because the British Menopause Society issued a new directive last year which said there must not be time limits on the use of HRT- the old 2-5 years has been ditched but some GPs are out of touch.

I will link to this for you and if necessary print off and take to her.

BMS statement on HRT

Summary practice points

The decision whether to use HRT should be made by each woman having been given sufficient information by her health professional to make a fully informed choice.
The HRT dosage, regimen and duration should be individualised, with annual evaluation of pros and cons.
Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.
HRT prescribed before the age of 60 has a favourable benefit / risk profile
It is imperative that women with premature ovarian insufficiency are encouraged to use HRT at least until the average age of the menopause.
If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of administration.
It is imperative that in our ageing population research and development of increasingly sophisticated hormonal preparations should continue to maximise benefits and minimise side effects and risks.
This will optimise quality of life and facilitate the primary prevention of long term conditions which create a personal, social and economic burden
__

I will also link to the Women's Health Concern which is the patient arm of the BMS.

www.womens-health-concern.org/help/factsheets/fs_hrtrisksbenefits.html

Depression is known to be part of peri and menopause. But as you are also having classic meno symptoms it makes sense to use HRT which has few if any side effects at your age, and not powerful other kinds of drugs.

The risks of HRT at 46 are minute and they don't 'count' your years on it until you reach the age of average meno anyway- so you could start on it now and carry on to 52, then still have 5 more years if she insists on you only having 5 years!!! But if she is so out of touch then I'd suggest finding another GP.

pinkfrocks - thanks very much. You are a total star. I have made an appointment this morning and am going with a list of websites and documents for her to look at. DH has a Science degree so has looked at the stuff as well (my head is very woolly at the moment so I don't 100% trust myself). He seems to think that the evidence is unequivocal in favour of HRT.

Really. Thanks so much. I will report back to let you know as you seem to have an interest in the subject and also in case it can help anyone else.

Good luck and let me know how it goes!!!! :)

She was very nice but suggested that my low feelings, constant crying and over-reaction were signs of mild depression. I got a peek at the levels on the test - can't remember which way round (FSH, LSH?) but 18.2 and 30. She said she was happy to give me HRT but for 2 years max (it is just to smooth out the transition - not for long-term use, apparently). She looked at the list of links I gave her but didn't actually read them. She also referred me for a scan (periods came back for a month or so after years without). For now, the suggestion is take the anti-ds but review after the scan as HRT might make any problem there worse. Then possibly stop anti-ds and try HRT. She was fairly dismissive of HRT to stop osteoporosis (my Mum has it very badly but had a hysterectomy at 40 and is a heavy smoker and alcoholic so difficult to tell).

She mentioned risk of ovarian cancer with HRT and that the studies into it were very flawed.

But, my feelings are pretty low so maybe I am depressed as a separate thing from the hormones, or the hormones are exacerbating the depression, or it is entirely the hormones (or lack of them). Very hard to tell.

There is a women's sexual health clinic once a month and I might go to that when it next comes round and see what that Dr says.

It is like the MMR - everyone seems to have a view and I want to take the view that is most evidence based, most scientifically sound but there is no one place that seems clear about the right path.

I think I will

1. Take the anti-ds, starting tomorrow and see how they go. Any side effects she said stop immediately. Scan will be in about 3-4 weeks.

1. Have the scan and then find out what they say.

1. See the FP doctor separately.

1. ?? Not sure about 4. Probably cry a bit more.

I do have a good friend who is a GP and orginally gynae trained. I will quiz her too.

Advice?

can you change your GP?

Im sorry but her advice and 'rules' around HRT are wrong and out of date. she is not allowed to impose a time limit on you for HRT - see the piece from the BMS. she is supposed to advise you of the risks then you say if you want to continue to use HRT or not. There are women on HRT in their 80s.

If you are now 46, have a family history of osteoporosis, and have not had periods for a few years, you are high risk for osteoporosis as you have had an early menopause ( classed as before 45 though some consultants now say 47.)

why are you having a scan? what symptoms do you have that warrant a scan?

There is no real evidence that HRT causes ovarian cancer. She is being alarmist and not telling you the facts.

I'm sorry but her attitude is all wrong because you are too young to be without oestrogen and a family history of osteoporosis.

Can you afford to see a gynae who knows about menopause - and pay for the appt?

Yes - I can afford to see a gynae but am in a remote corner of Scotland so any recommendations need to be in Glasgow / Edinburgh (Edinburgh is easier).

The scan is because I have had no periods to speak of for years but had a brief (very black blood) one about 3 months ago. I thought nothing of it and it only lasted about 2 days.

I can see the other GP (male but OK with that) or the visiting once a month Family Planning / Woman's Health Doctor but it is 50+ miles to the next option.

Have a look at the Menopause Matters website. Dr Currie ( founder) is based in Scotland. she also does email consultations for £25 via the site and you could show her reply to your GP. Dr Currie is a consultant gynae and on the BMS committee.

www.menopausematters.co.uk

Can i jump in here? I have been on sertraline for many years. I am 45 and am 'peri' but my GP would disagree with me. I have been having night sweats for a few years now during second half of my cycle and they're getting worse. Last year I came off sertraline for a few months but couldn't cope. Whilst off, I had no night sweats whatsoever. Make of that what you will. I'm keen to reduce my dose of ad's

My gp took bloods and said that my hormones were alright. She alos mentioned that my symptoms werent that bad, blah blah. i've found her very dissmissive and she kind of laughs at me, you know 'ha ha dont worry it's not that bad' then she asks me if i want to go for a scan about my flooding or do i want a chest x-ray about my night sweats? Well feck me I've no idea, what's a chest x-ray for? She kind of worried me then. She won;t give me HRT as my bloods are 'fine'

Sorry turned into a rant. We've no real choice of which gp to see btw

ps if you also look at the Specialists part of the menu on that website it shows quite a lot of meno clinics in scotland. I am not sure where Dr C .

OP but the reason you are feeling depression and anxiety is because your HORMONES aren't working properly. So surely it is far more sensible to actually treat your hormone issues rather than just try to masque the symptoms with ADs?

I am also peri menopausal and my female GP was also very dismissive of my sudden inexplicable anxiety and depression. She informed me 'this is just what we ladies have to deal with at this time in our life'.

When I pointed out that my anxiety and depression weren't constant and could completely disappear for days or even weeks at a time she wasn't remotely curious. When I mentioned that the anxiety/depression episodes seemed loosely linked to my menstrual cycle she wasn't remotely interested.

It was only when I finally saw a consultant gynaecologist that she immediately diagnosed me as being peri menopausal and tiny fluctuations in my hormone levels were causing the random/anxiety.

She also informed me that 'most GPs know bugger all about hormones or the benefits of HRT' and that's a direct quote

Update:

I can't deny that the Sertraline has helped. I am still knackered but am sleeping well although my energy levels are low. However, I no longer feel dread, fear and upset all the time. I was sent for a scan and all is OK except for a 3cm fibroid.

What next? I was going to request HRT but gather oestrogen makes fibroids grow. I have a Mirena coil so no need for progestrone. Do I carry on the anti- depressants and try HRT alongside? I am seeing a friend (GP) on Wednesday and can ask her some questions. Should I push for a referral? If HRT, then patch? gel? Will HRT give me my energy back. I have become queen of the sofa, after being the person who gets things done.

That is a tiny, tiny fibroid. Many women have them, including me and HRT has never changed it- after 6 years. Also, you have a Mirena which means it is less likely to grow or bleed too much.

In your position I'd reduce the ADs slowly and add in HRT (estrogen only) straight off.

I think that is a good plan pinkfrocks. Thank you so much for your wisdom. Do you recommend a particular brand / delivery method?

Oestrogel is easy to use and change the dose up or down until you find what suits you best. Easier imo than cutting patches in half or having to go back to dr for another prescription. My consultant swears by it.

I sympathise the subject is still a bit taboo and the doctors are generally not that understanding. It took me 2 years to get diagnosed as I was only 44 when my periods completely stopped.Having said that there may be other health issues which can complicate diagnosis as I have subsequently found out 6 years later.
Please just book a double appointment with your doctor and get all the tests you need done. If this is family history of ostreoprosis or other age related illness then push this.
Sertraline is really good for the hot flashes luckily I mosty got mine at night but since on this there are very rare.
HRT wise I had to go through about 3 before finding the right one which suits me and I have been on that for a couple of years now.
You will know if you need HRT if your bone density test shows ostreoprosis or pre-ostreoprosis and additionally if you need it to be able to have sex. You GP cannot tell you not to have sex at your age if sex is painfull like it was for me then you need some form of HRT.
They have to give you as they cannot deprive you of a sex life when you are under 65.
Sorry about the long post but it is close to my heart.

Oestrogel. Will request that one. How can you tell if it is working? Will I get my mojo back?

You will tell if it's working by the effects.
Give it time- start off on 1 pump for a week or so and if no improvement go to 2 pumps.
Do that for 3-4 weeks and then if no better try 3 pumps.
They say give any HRT 3 months to see if it helps.

Oh and the other thing to consider is that some women find the Mirena gives them side effects- like PMT. You will know if your moods have coincided with having the Mirena. If they have then maybe it has to come out?

LOL- why do you say they can't deprive you of a sex life up to 65? Is 65 some magic cut off time?

Women who have vaginal dryness can often be treated by just local (vaginal) HRT and don't need systemic HRT. But some need both- vaginal creams or pessaries and HRT.

If someone JUST has vaginal dryness and no flushes etc or other symptoms then the dr would prescribe localised treatment.

Have had the Mirena (3 of them) for 13 years!

Pinkfrocks: No Just making a point because the sex aspect seems a bit taboo! and yes can be localised but full HRT may be needed initially for the oesteoprosis and can be helpfull overall with hormones , hot flushes etc .My understanding is that GPs only prescribe full HRT for a short time say 5-7 years but if you start your menopause young early 40's like I did you may want to stay on full HRT for longer. Anyway each case is individual but just making the point on the sexual aspects. I would not know about the localised treatment as I have not tried it as yet.

Don't want to takeover someone's thread but just wanted to say pinkfrocks you are a fantastic source of information! Don't stop posting on these threads as you are helping so many.
I'm just peri at age 45. FSH only slightly raised. Weird irregular periods but not feeling as if I need anything yet. I have a couple of hours of feeling a bit emotional just before period starts and bit hot at night during it, otherwise ok.
What alarmed me was the printout I was given from doctor which seems to heavily push anti- depressants. It's so bizarre given that the cause of symptoms are hormonal.
There is osteoporosis in my family but GP said if I was doing ok then they would only prescribe HRT after a bone scan. I also mentioned my prolapse (very long story- history of previous surgery) ,knowing that HRT can help slow down its progression and was told I would only need oestrogen if there were signs of atrophy ( which there aren't).
I think I'm going to go down the phone consultation route.