Venlafaxene prescribed for Peri menopause

[JoeCrackers]

has anyone else experienced this?

I am 45 and had an appointment with my doctor yesterday to discuss what I believe to be peri symptoms and discuss going on HRT
i had a phone call with him around a year ago after having some blood tests done. At the time I’d been feeling really tired and flat, my skin had gotten very bad and my hair had thinned and was falling out. My blood tests came back ok although I’m not sure what the actually checked for. He was quite sympathetic and asked what I wanted to do. We decided on a watch and wait and I’d come back to him if things changed/worsened.

in the last few months I’ve been having terrible insomnia,night sweats, irregular periods, no real interest in doing things but the worst is the brain fog and memory loss. It’s debilitating, im
mixing up my words, making stupid mistakes at work and I can’t remember what I’m doing or where I put anything. Feel like I’m going mad.

When i went to the appointment it was a locum doctor I saw. She asked v briefly about my symptoms and I said I was interested in maybe trying some hrt possibly in a gel form. She started talking about this other medication that she would prescribe first saying it was really good for mood and brain fog. She was speaking fast and it was a while before I realised it was an anti depressant she was talking about. I was a bit surprised but she said it’s often used to treat these symptoms. She said just take it for 6 weeks and come back of it didn’t help and we could try something the coil or am implant. I asked about side effects, she said there’s none??!

I said I was also concerned about bone and heart health during peri and this obviously wouldn’t do anything for that or my insomnia but she just said not to worry about that. When she went to write my prescription a box popped up to say it was contraindicated with the triptans I take for migraines, which have also increased. Again said not to worry just try not to take the triptans if I can- if I dont take them I wouldn’t be able to get out of bed if I have a migraine.

since coming home I’ve done my research and it seems Venlafaxene is a strong antidepressant which has severe withdrawal symptoms when you stop. The only symptoms of menopause it was mentioned as being good for was hot flushes which is the one I told her I didn’t have!

I’m going to make another appointment to see my own gp but I’m really annoyed about this. Mostly at myself for not speaking up and saying I’m not depressed, I’m forgetful, confused, tired etc but also at the doctor for handing me out 6 weeks worth of antidepressants without even asking if I was depressed or trying to find out why

sorry it’s so long, anyone else taken this medication?

I'm sure some more knowledgeable people than me will be along soon, but I'm pretty sure this goes against NICE guidelines for menopause symptoms.

Having said that, I was on sertraline (an ssri) for a year or so before switching to hrt and I have to say it was excellent at helping with the low mood, sleep problems, lack of motivation, brain fog, and anxiety, as well as hot flushes. I was in the earlier stages of peri and it was the right choice, I think.

He;, NICE guidelines say to use HRT. I’d not take them and go back.

In a word, NO.

This is outdated treatment, GPs told to stop using ADs by NICE in 2015 but some still aren't educated on it all- goodness knows why.

Read the NICE guidance yourself on menopause diagnosis and treatment, then you can go back, informed.

You’re absolutely right Venlafaxine is absolutely horrendous to come off & not what she should be recommending in the first instance (along with any AD’s). It’s HRT first since it’s much easier to stop any time compared to AD’s & HRT addresses the cause not the symptoms. To casually tell you to stop your tryptans is really poor. She sounds like a terrible GP. You’re right to complain but it’s sadly standard practice where I am. Have had to fight for HRT & told by one categorically that given the risks of HRT & cancer (I’m not even high risk) he could prescribe an AD which has no risks & no side FX (bullshit). It’s really hard because there’s now so much good advice/info out there now & so we know exactly what we need & yet the majority of GP’s are not up to speed with it yet. 🍀

Thanks everyone for the replies, I’m definitely going to go back and speak to my own GP

it was the way she just really casually said oh If you don’t find they help you can just stop and try something else when just stopping them causes all sorts of problems in itself. At least if I try HRT and I want to stop I won’t have same withdrawal

I’ll definitely read up on NICE guideline thanks for that advice. It’s scary how readily she was handing AD’s out. Im also annoyed at the waste of medication. I went to the chemist on the way home to pick them up before I’d a chance to read up on them so now even if I don’t take them they’ll need to dispose of them

@CamelliaAndPrunus sounds like they were really beneficial to you, did you go on them specifically for peri menopause symptoms?

What is shocking is that there are easy to access training courses out there for GPs.

The British Menopause Society runs online courses on HRT etc all year round and the cost- to the practice or the GP is small- about £100. There is also an annual menopause conference in London which has speakers from all over the world.

There are also some basic, but simple, guides to HRT for GP on a site called GP Notebook https://gpnotebook.com/simplepage.cfm?ID=x20200220132547335581

It's sheer laziness, or lack of interest in women's health, if a GP is out of date. This should be a mandatory part of their CPD.

@JinglingSpringbells 💯 agree, we should be able to go to the GP and expect them to guide us not the other way around.

it’s something that affects half the population at some point they should be experts in it.

do you think I should make an actual complaint about that doctor or is it pointless?

I believe Venlafaxine is indicated if non hormaonal treatments re unsuccessful or not wanted. It’s in the NICE guidelines. For hot flushes.

Yes. I described all my symptoms, we agreed it was peri but earl (I still had fairly regular periods). The mental symptoms were more bothersome than the physical ones, so the gp said i could choose but if it was him he'd try an ssri first. I suppose the key thing actually was that I was given that choice. And he really listened. Your GP sounds shit.

It may be worth complaining simply because her attitude may be impacting on many other women.

It's easy to find the NICE guidance (it was pinned as a sticky here for years but has gone) and under 'Diagnosis and Treatment' says very specifically SSRIs are NOT to be used as first line treatment in women with peri menopause symptoms'. It says 'they have no place' - which is pretty strong!

It's also shocking she dismissed the contraindication with your migraine meds and her solution was just to not take them!

I'm no expert on ADs but my limited understanding is that they often take months to work, and a 6 week trial would not necessarily be enough, whatever they were given for.

Published 2015

[[https://www.nice.org.uk/guidance/ng23
Psychological symptoms

1.4.5Consider HRT to alleviate low mood that arises as a result of the menopause.

1.4.6Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.

1.4.7Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults).

@JinglingSpringbells Wow that is really definitive, shocking that a doctor would go straight to anti depressants within about 3 minutes of meeting me when I’d specifically said I wasn’t depressed

thanks for all your help, I feel much more confident going back to the doctor now

Over prescribing of AD’s has been going on way too long with little knowledge, concern or care about the longer term consequences & side effects ie patients unable to get off them & stuck due to adverse withdrawal effects, no proper tapering schedules or support to get off them.

GP’s are now being advised to suggest social prescribing, talking therapy, support & stress management in the first instance in MH as opposed to AD’s but in menopause care it still seems the knee jerk reaction.

GP’s seem still to think the risks of cancer from HRT trump the side effects & risks of dependency from AD’s.

This really needs to change. Of course not everybody suffers adverse withdrawal from AD’s but a large proportion do.

The cancer risks of HRT have been demonstrably debunked.

There is also supposed to be a massive drive to get people off unnecessary AD meds - basically bcos it’s fuelling the number of benefits claims & often not indicated in the first place.

That’s not to say that AD’s don’t have a place & a value in healthcare, because they most certainly do. But trigger happy, irresponsible, uninformed prescribing is the bain of many patients’ lives.

Please please don't use Venlafaxine. I could have written your post word for word.
I was consistently told that I wasn't in Peri menopause (46) as I was too young.
I was railroaded into using Venlafaxine and it almost destroyed me. I have been left with permanent tinnitus despite managing to withdraw from the medication almost a year ago. I went from happy go lucky professional person to a shadow in 6 months of this medication. Been on HRT now for 5 months and finally a little glimmer of the person I was is coming back.
I think there are a lot of GPS out there who are very ill informed about menopause and irresponsible with prescriptions for very strong antidepressants.
Grrrrr! 😡

@lanawinters God that sounds awful, glad to hear you are starting to feel better. Originally I was thinking maybe I’ll try them what’s the harm but after hearing about others experiences there’s no way I’m touching them

your doctor sounds like mine, she didn’t even say whether she though I was in peri or not it was just straight to anti depressants with no other considerations. I’m going to message my own doctor in the morning to make another appointment. I’ve always found him quite open and approachable, ironically when I went last week and it was a woman doctor on I was quite pleased thinking she might have a better understanding but I guess not

@CamelliaAndPrunus glad to hear you had a positive experience as I’m sure lots do. At least as you say it was a decision you came to together, not where the doctor had already made their mind up

@JoeCrackers I had similar- I said I thought I was perimenopausal and wanted to talk about HRT, and doc said that HRT had lots of risks and as I was having periods I want menopausal. She offered me sertraline (I didn't know it was an antidepressant) either continuously or 2 weeks on, 2 weeks off. I have never been diagnosed with depression.

I went private and got HRT. Felt totally back to normal after 2 weeks.

I wrote a letter to my GP practice outlining my concerns about what she said, and telling her I wasn't going to take the sertraline.

@poshme its crazy that AD’s seem to be the first port of call for so many doctors.

was it expensive to go private if you do t mind me asking. Once you’ve got your prescription can you get it filled on the NHS or do you need to always pay?

I’ve sent a message through the booking app to my doctor this morning outlining my concerns and asking for an appointment with my own GP so we’ll see what happens

With Venlafaxene you absolutely can’t “just stop”, it’s an absolute nightmare to come off! I had it for a really bad depression and I did need it, and it worked, but having been on it for 19 years it was horrendous to come off! I did manage in the end though, but I’d have to be in a very deep very black hole before I took it again, and I certainly wouldn’t touch it for menopause, you have many options to explore before you go down that road

Yes I'm afraid it was expensive. £240 for appointment, and £150 for the meds.

Hoping to get NHS prescription next time. I've got an appointment with a more senior GP in a few weeks to discuss it.

I'm so angry it took going private to be listened to. I'd been to my NHS GP 3 times and been fobbed off each time.

@Whatthediddlyfeck that’s the things that’s really shocked me, that she went straight to Venlafaxene, it’s sounds like a really strong one.

I can understand if I was severely depressed that the benefits would outweigh amd side effects but it seems quite a reach to go to that immediately when I haven’t gone because of depression.

@poshme that is quite a lot and it’s a disgrace that you needed to do that. GP’s seem quite happy prescribing things that are no help and get wasted rather that the things we actually need

@JoeCrackers Unfortunately you’re not alone. So many women are prescribed antidepressants and/or anti anxiety meds when they really need HRT. You absolutely should not be forced to going private - HRT is readily available on the NHS and with the new prescription certificate it’s more affordable than ever.

From what you’ve said it sounds very much like you’re perimenopausal. I’d suggest arming yourself with as much info as possible before you see your GP again & ask specifically for what you want. The ‘gold standard’ is estradoil gel (the oestrogen component) and Utrogestan (the progesterone component which you’ll take for days 15-28 of your cycle, assuming you have a womb), although of course your GP may suggest alternatives dependent on your other medications.

Good luck & I hope you’re feeling better soon.

I think the reason they err towards a prescription for Venlafaxine is that is supposedly a better medication for anxiety.
I was totally overwhelmed by anxiety caused by peri-menopause despite never having suffered previously. I was convinced it was my hormone levels but was ignored and told my bloods were fine and I was 'too young'.
I was desperate in the end and it was nearly my complete undoing. (Anxiety completely disappeared on HRT! Nothing now ... nada!)
Keep going with GP to prescribe you HRT. You absolutely do not have to pay extortionate fees to go private.

@Bananasplit80 definitely I’m an expert on the NICE guidelines so I’ll be ready when I do get to see him. Hopefully he will be a bit more willing to listen than the last doctor. Felt like she had already decided what she was prescribing regardless of what I said

@lanawinters that sounds horrible, I’m definitely feeling more anxious than before but I wouldn’t say it’s my main concern. More the forgetfulness and brain fog. I didn’t even mention the word anxiety to the doctor so not sure why she went straight to anti depressants. Amazing to hear the HRT has really worked for you. Shouldn’t be this bloody hard to get though.

hopefully I’ll hear back from them tomorrow with an appointment 🤞

Got a message from the doctor today saying he is sorry to hear about what happened and he’s organised a phone call tomorrow to discuss. I’d have preferred a face to face but we’ll see how it goes.

thanks everyone for your help and advice