Has anyone been prescribed ADs for meno symptoms???

[speedytortoise]

So, I'm 55, previous breast cancer (non hormonal) and have been on HRT (Livial/tibolone) for a fair few years..... 9 ish? Recently had lower than usual moods, anxiety, some 'warm' flushes. Previous to BC diagnosis I was very active, no problem with moods etc.

Recently saw my GP who wants me to stop HRT, and having had a blood test, went back, and test were clear and GP has now prescribed Citalopram. She said it would help with any flushes, and my moods, and after a month I should then stop the Livial.

I've checked the leaflet, and discussions on here, and to be honest hot flushes seem to be listed as a possible side effect!!

So my question is, has anyone else take ADs for meno symptoms, and what was the outcome??

Jago68
Yes the bleed is triggered by a fall in progesterone but thats not the same as thinking the more you take the bigger/ heavier the bleed.

More progesterone = thinner lining.

That's why taking it every day means no bleed at all - it stops the lining growing.

If you say the NHS suggests a 3 month cycle on this regime I'm afraid that is wrong. I used to use that only under supervision of a consultant and now use it every 6-8 weeks. Your GP is wrong I'm afraid. Unless you are VERY peri and having natural periods when longer cycles like this are more acceptable.

speedy sorry your thread has gone off on a tangent.

The dose for gel is on the leaflet- just checked, In the middle of a page under how to use, it says the dose it 2 pumps.

LOL no worries QotN.... we're all here for the same general reason!!

Well one less thing for me to worry about, bone density scan this morning confirms I'm in the 'normal' range, with no cause for concern now. They did say I should chase my GP in about 2 years for a follow-up scan, but right now all is OK.

Gpbsays she discussed it with rep

Jago68

A rep? Your GP is following advice of a sales rep when prescribing?
A rep is not a medical professional.

There are zillions of posts on another meno forum (Menopause Matters) about the regime you and I use, with women begging to try longer cycles and their GPs will rarely allow (because it's considered 'off label) or if they do it's on the condition of an annual scan to check all is well- and these must be paid for privately.

There isn't much more I can say really.

I was on HRT for premature ovarian failure as prescribed by my endocrinologist but my GP switched me to buspirone an anxiety med and I felt a lot better on it

@Lauren83
How old are you now and how far since your diagnosis of POI?

The medical advice of all gynaes is you must use HRT at least to the age of 51 (average meno age) to prevent 1 osteoporosis and 2 heart disease.

If your GP does not understand this they are treating you incorrectly.
This is potentially serious because there are very real risks of illness in later life ( 50 and beyond) with loss of estrogen early, even Parkinsons and dementia are now considered linked.

Please re-think and if you are still under 51, see a specialist about what to do now.

@QueenoftheNights thanks for the reply, it's a complicated one for me as I was diagnosed with POF at 27 (I'm 35 now) and I have been under an endocrinologist and a gynaecologist for the past 8 years but also spent 6 of those years undergoing IVF cycles with donor eggs so it wasn't suitable for me to stay on HRT during my IVF cycles, the IVF and eventual pregnancy have included estrogen and progesterone as standard. My GP did advise that the buspirone was often used to treat some of the symptoms associated with POF in place of HRT (he suggested this on his opinion not because of the IVF) I will definitely make sure I do some proper research if I consider going back on it in the future

Have you ever been in touch with the Daisy Network charity? It's led by the POI team at the Chelsea and Westminster (incl Nick Panay). Worth looking at their website and if you join you can access online chats with medics.

I'm not sure- really- how what you are taking can replace estrogen. If your GP is prescribing it for symptoms like anxiety, it won't be touching the issue of bone density and heart health.

Even if women with POI don't have symptoms of meno, estrogen is needed to reduce the risk of other diseases.

www.menopausedoctor.co.uk/menopause/early-menopause

There is a link to the Daisy Network in that link.

This is a useful piece of info from the Daisy site.

so-daisy-uploads.s3.amazonaws.com/uploads/2016/11/ESHRE-POI-GUIDELINE_Patient-version_non-iatrogenic-POI.pdf

Had to come off HRT after six months due to high blood pressure (very stressful time at work). A month later and I've been a mental wreck. GP has just put me on Prozac for a month, and is referring me to a menopause clinic. I just want to be the person I used to be instead of this anxious, weepy, depressed, shell I seem to have become.

It's been a month, @speedytortoise, how are you doing?

Chokaholic I hope the Prozac starts working for you quickly, let us know how you get on.

YeOldeTrout (great name!) I am afraid to confess I've not yet started..... I was worried about the side effects and have a lot going on, so was waiting for things to level out before trying them. Unfortunately life hasn't levelled out..... and I only have 6 weeks or HRT left, so I need to get a wriggle on.

I was struggling last year with horrendous bleeding and hot flushes, had a hoohah over getting my mirena replaced ...a random localised appointments issue, and was also recommended Vagifem, and up till now this all seems to be working quite nicely

I also got a referral to the Menopause Clinic, with a couple of questionnaires to fill in about lifestyle/feelings/family history and I will say I did think that the questions were heavily weighted to provide an answer of "menopausal and quite overanxious"

Both the nurse and the doctor mentioned ADs as an option.

Having had the mirena in and with that settling down the bloodbath effect I was really only there to get something to deal with the hot flushes, and the gel or pessaries were recommended if I was sure I didn't think the ADs wouldn't be a much better idea

I really got the feeling that it was quite the hard sell for those as opposed to anything else, and I think that surely it makes much more sense just to replace something missing than add in other heavy duty meds.

I will say my GP seemed very clued up about options, but was a little panicked by my blood pressure (white coat) and migraines (irrelevant) which did not help but as I said I seem to be sorted now!

I'm 47 and recently been given sertraline after visit to gp as I feel awful. I'm not sure I should be taking ADs and haven't taken yet as I really can't afford to be affected even more at moment as I have loads going on. Doctor checked my oestrogen level and said it was ok. However a different gp put me in HRT last year but I stopped taking it after 6 months as I felt worse! Doctor didn't check progesterone.... don't know if they should? Don't know what to do tbh as I feel a wreck. Periods fluctuating wildly,'only just got a period recently after no sign for 3 months. Any ideas anyone, sorry if I've hi jacked!

The advice from NICE is

1 Unless you have had pre existing low mood and a diagnosis of depression, the treatment for low mood in menopause is HRT (unless you can't for other reasons like breast cancer.) This is set out very clearly in the Nice guidelines' SSRIs etc have no place in the treatment of meno symptoms.... low mood ' [my summary]

2 If you used HRT for 6 months and felt no better, the next step ought to have been to try a different type. It is usually the progestogen element that makes women feel rough and as there are 4 types available with HRT, it's always best to try different types.

what were you taking?

You also need to add in lifestyle self-help - exercise, good diet, no booze, maybe mindfulness, other types of help if needed, etc- apologies if you do this already.

oh and your doc is wrong to test estrogen levels- tests are never accurate which is why NIce says do not test women over 45 ( younger is okay as they may be having a prem menopause.)

waste of time doing blood tests- only shows hormones at that hour on that day and in peri they cahnge all the time.

that is interesting Queen about the SSRIs ...it's going to be the next medical scandal I reckon! Like "Mother's Little Helpers" in the 60s with women off their faces on valium!
Just casually reading and listening the experiences of others it seems the route of prescribing ADs/SSRIs is pretty popular.

Dr Louise Newson who is a very media-savyy GP with her own meno centre, often tweets about this use of ADs and also posts surveys on twitter asking which women have been offered ADs. she's horrified but she alone can't educate GPs- it's something the BMS is trying to do.

It's as if there is a generation of drs who are terrified of HRT but quite happy to offer mind-altering drugs to shut women up.

Yes ADs have a place but most women get more benefits from estrogen.

Agreed QotN.... having now talked to 3 different GPs at my surgery it seems to be the 'standard'. Reach 55 yrs, and you're cut off. No discussion, no option. Well, other than Red Clover and ADs. Great.
I did think my anxiety was getting better, I was coping ok, but than had one little thing go wrong, and it's back, but at least I recognise it now and will ride it through until things stabilise again.

I'm still not convinced about the ADs, but will try, stop the HRT, and go back if things go badly wrong.
I plan to start taking the ADs tonight.

Oh good lord, I took a Citalopram last night, and today I have been a total mess. So tired, in an exhausted to my bones way, legs felt shaky, foggy head, almost felt like I was coming down with something. Of course, I could be, and it could be unrelated, but I have too much to do this week, so will park that idea for a while. Citalopram is back on the shelf.

@speedytortoise sorry to hear you feel so bad after taking the AD. I was thinking of starting taking sertraline soon but not sure I should. Got too much to do to be in a state. I was taking femoston originally and didn't feel any better. Sounds like I need to go back to doctor and try different hrt. Hope you're feeling better soon OP.