HRT or Sertraline?

[Jiminycricketsdog]

I’m 51 with regular periods. I feel well approximately 1 week of the month, just after my period.

I get to ovulation and I get pain, bloating, increased anxiety, jitters, poor sleep. This then carries on getting progressively worse adding in headaches, ringing ears, shaking, terrible bowel urgency and loose stools, tremors right up to my period - the period comes and I start to feel ok again and the cycle continues.

GP has written a script for 50mg Sertraline AND HRT (2 pumps gel and Utrogestan for the latter part of the month.

I feel this is too much to start with and would rather try one or the other. Bearing in mind I don’t have any hot flashes (it doesn’t point to low E)

Any idea whether I should really start it all together or one at a time?

HRT for menopause.

I have patches and sertraline. Be very glad you have such a supportive GP. If you start with the anxiety (3 out of 4 women I know have had this) they are a lifesaver. Everyone has different symptoms OP and not all GPs are so willing to help!

I take both. But I would try HRT first iiwu

I’ve read some awful side effects of Sertraline though, I cannot take any chances with loose bowels. I already have enough of this issue!

NICE guidance 2015 and updated this year is to offer HRT.
Not SSRIs. The guidance is very clear and GPs should follow it.

SSRIs are for women who are unable to use HRT (for medical reasons) or who are properly diagnosed with depression that existed before menopause.
Again, all in the NICE guidance.

HRT is for anxiety in menopause.

Her GP is out of date.

Definitely start with the HRT. I was on both. Both helped but the Sertraline caused severe TMJ and I am now booked in for surgery to fix the jaw joint degeneration.

I had bowel issues and worked out I am gluten sensitive. I fully cut out bread (my one true love 😢) and all other gluten sources and it resolved. I can now eat gluten in moderate amounts, but be prepared of the effects next day. Not sure if this was another side effect of menopause or is relevant to you, but just saying.

I’d just start on the HRT btw.

With HRT, you start on a low dose and try it for 3 months. If that doesn't help, the next step is to increase the estrogen , and if that doesn't help, consider changing the type and also the progestogen.

The problem with using HRT and another drug like an SSRI is that you'll never know which is working and which is not.

Consultants who are menopause specialists will often suggest using estrogen alone for several weeks, in order to get the dose right.
Then, add in progesterone. This is quite safe to do under medical advice and there is one type of HRT (Tridestra) which is estrogen only for 10 weeks then progesterone for 2 weeks - giving a 3-monthly cycle.

Be prepared to give the HRT a good try before considering other drugs.