Mirtazapine as alternative to HRT

[BG2015]

I was previously taking HRT from 2017 to June this year when I was diagnosed with hormone sensitive breast cancer.

I cannot take HRT anymore but am suffering with horrendous night sweats which is affecting my sleep, I'm probably getting 5 hours of very broken sleep with insomnia mixed in.

My GP has prescribed me mirtazapine but having read the side effects I just don't want to gain weight. It seems the majority of people do. I'm in the middle of chemo and losing my hair - I don't want to be bald AND fat.

I'm not vain but just an average 52 yr old size 14 that tries to eat well exercise and keep my weight stable. It's just going to affect my mental health so much if I put weight on. I've already gained 8lb since starting chemo with steroids and only tolerating certain foods during chemo week.

Can anyone suggest an alternative as I'm not going to take this medication.
Thanks

I'm really sorry to read of your diagnosis. I know you posted on another part of the site and I was so in awe of your positive attitude.

Is there any way you could access of menopause specialist as you really need that kind of advice.

I know that NICE suggests lots of alternatives when HRT can't be used and you may find info online. Have a google for Nick Panay who runs the main specialist meno clinic in London, and is a world expert. There may be something online as he's often interviewed.

I know that some blood pressure meds and anti depressants are often given for night sweats etc but can't help with the names- sorry.

You might find something on this site to help.

It's all been re-designed and it's not as quick to find info, but if you have time, there may be something here that helps.

www.balance-menopause.com/menopause-library/

Sisterly sympathy OP. I had cancer last year (endometrial not breast) and my consultant has advised against HRT. I'm also suffering from bad night sweats and have been offered Venlafaxine, an SSRI, which apparently can help. I'm undecided about trying them as I've read that coming off them can be difficult. Maybe your Dr could see if you could try them perhaps? There's some info on HRT alternatives here https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/Alternative-non-hormonal-options-HRT-Sep-2017.pdf

There is also a drug that is otherwise given for ADHD that helps with flushes for certain women. I can't remember the name.

I wish you good luck with your battle.

I'm pretty sure prozac or citalopram also works for hot flushes?
I've had mirtazapine for depression and I did really stack on weight so I couldn't keep taking it. But citalopram was fine.
Talk to the GP about trying an SSRI antidepressant instead?

BG2015 I was on mirtazipine for 3 years for insomnia caused by menopause. I went from 12 st to 19 St and cost the nhs Bariatric surgery..! Please don't go near the stuff it's evil . It gave me an incredible insatiable desire for carbs and I would drive out of my way to get a steak slice or pasty fix pretty much every day ..!

My holy grail for sleep is Amitriptaline. 10mg at night increasing to 2 after a few weeks. I have also just started a patch at age 57 as heard something on the radio that informed me I didn't need to suffer the side affects of menopause.. so may even be able to stop that once the flushes stop.

Fink
My partner has been taking amitriptyline for his back so we do know they work well for sleep. (He also has some left) he's stopped taking them now as he's had surgery on his back.

I'm just not sure whether I can take them with having breast cancer and chemo, although I can't see why not.

I'm always wary of taking other peoples medication.

I've not taken the mirtazapine- they're still in the box unopened. I just don't want to battle with my weight (already put half a stone on because of the steroids) after all the treatment has finished.

I was scared to take mirtazipine because of the appetite thing, and yes tbh I did gain weight on it (and I was overweight already) to start with. I’ve also lost weight on it, too, though - a stone and a half - and my appetite calmed down after the initial carb-fest.

Unless I’ve been drinking, which screws up sleep anyway, I only need to take half a pill (so 7.5mg instead of 15mg) to get a good night’s sleep, and it’s pretty miraculous for that, honestly - I’ve had problems sleeping my whole life and this is the only thing that’s ever changed that. I take it to stop the jaw-clenching that my SNRI gives me, and it’s been very effective for that, too.

I wouldn’t write it off until you’ve tried it, especially if you’re taking it for sleep issues - poor sleep causes an increase in ghrelin, the hunger hormone, which can contribute to weight gain in menopause anyway, so you may find it cancels itself out by improving your sleep and lowering your ghrelin levels. I can’t say I’ve noticed a huge difference with night sweats, which I do still get sometimes even on oetrogel, but then I didn’t know it could help with that so wasn’t watching for it, iyswim. 15mg leaves me feeling quite zombiefied the next day, but 7.5mg is my sweet spot.

You could try even a quarter tablet to start with, and see how you go with it; it’s not one where you get withdrawal symptoms like SSRI/SNRIs, so if it doesn’t suit you then don’t stay on it. Always take it in the evening, to get the benefit of the sleep improvement.

Promises
I'm so nervous of taking them. I've just checked and I could break them in half.

Last night I slept in half hour/one hour slots and seemed to see every hour. I can cope with it as I'm not working but when I go back to full time teaching after Easter I will be shattered. I need to get my sleep sorted by then.

They’re easy to break in half with your fingers; I do it every day. Get a big sharp knife and cut a couple into quarters, and start with a quarter. You’re not suddenly going to gain three stone because you took a couple - it’s an increase in appetite which causes the weight gain (a tendency to crave carby/ sweet things), so it’s a gradual thing. If you can find the sweet spot where it helps your sleep and night sweats without zombifying you and making you eat all the things, then honestly it’s worth persevering with… if you can’t find that sweet spot and it doesn’t suit you/ makes you feel horrible for more than the first couple of days, just stop!

Finding meds that work for you is trial and error (I should know, I’ve been on enough of the bloody things over the years 🙄). Personally Amitriptyline made me feel like a zombie, but my mum swears by it for her neuralgia. When you find the one that suits you, you’ll praise the heavens, so keep trying. We shouldn’t have to suffer through menopause when there are things that can help.

Just thought I'd report back.
I decided to try the Mirtazapine. I've been on them for a week, I'm only taking 7.5g so breaking them in half.

It's been trial and error when to take them as I was taking them at 6pm and then falling asleep on the sofa at 8pm. Now I'm taking them about 8.30pm.

The night sweats are much better, they're not totally gone and I do still get warm. My sleep is improved. I still wake up but get back to sleep much quicker. I do feel quite groggy when I wake up - goodness knows what the full 15mg would do.

So far I can't say I'm particularly more hungry, my appetite is normal!

I have chemo today and after that I have about 4 nights of insomnia and feel hungry because of the steroids I take for 3 days so I'll be interested to see how I fare sleep wise.

That’s good news @BG2015, and well done for giving them a try. I hope they make a positive difference to your sleep after your next bout of chemo. 🤞

I take mine at bedtime, and I’m usually falling asleep with 45 mins (I used to lie awake for hours before mirtazipine!).