Consultant suggesting low dose 2 weeks SSRIs not HRT? Anyone find this helped?

[ShadesOfPemberley]

Saw the menopause specialist today in clinic.

She was nice enough, not unhelpful and I didn’t feel fobbed off (though she did inaccurately assume I had made absolutely no dietary or lifestyle changes and kept telling me it would help to cut down caffeine and cut out alcohol, DESPITE me telling her I’d already done both!!)

She was however much more keen on me trying 2 weeks per month of SSRIs than she was with starting HRT. I have no problem with this as it seems a decent fit for my symptoms which are much more low mood, anxiety, rage than physical symptoms yet. I am 48 and still have pretty regular periods.

I just don’t know if she was suggesting the SSRI route because… I don’t know… is it cheaper? Please forgive my paranoia, I’m not suggesting she wasn’t trying to give me the best advice!! My GP had been so totally fine with prescribing HRT (she only sent me to the consultant because I have other medical issues and she wanted to be sure HRT wasn’t contraindicated, and it turns out it’s not contraindicated) so I’m just a bit thrown by the consultant’s real reluctance to start HRT now.

Could it be because I mentioned I’ve had severe PMS symptoms in the past (rage etc) and she just thinks worth trying the SSRIs as they might do the trick for the time being?

Also most importantly, anyone tried the SSRI route in early menopause? Was it helpful? I certainly have no burning desire to take HRT before I need to it’s just a bit of a surprise that the consultant was so firm that she wanted to try another path. (For now; she obviously did say HRT might help in the future)

Thanks to anyone who can give insight!!

Oh to add!!! This was NHS menopause clinic. I did speak to a private menopause GP a few months back who was all set and ready to prescribe HRT which is why I wondered if it’s an NHS cost thing? Or conversely are private menopause specialists sometimes TOO quick to move straight to HRT? Any insight much appreciated!!!

Genuinely baffled by this as NICE menopause guidance from 2015 expressly states no SSRIs and HRT instead. You can check it out yourself online.

One thing I've picked up from other forums is that the drs who work in meno clinics are not necessarily 'real' consultants (RCOG) but sometimes GPs doing meno 'shifts' so it all depends on her training.

Did she not explain why she favoured those drugs?

Or conversely are private menopause specialists sometimes TOO quick to move straight to HRT? Any insight much appreciated!!!

It's supposed to be a mutual agreement, after discussing pros and cons of treatment. But I doubt anyone 'good' will suggest SSRIs as they are not recommended unless there is existing depression not linked to hormones (NICE explains this.)

You will definitely get everyone saying that SSRI's should not be diagnosed for menopause or peri menopause symptoms.

However, I was prescribed low dose Fluoxetine (prozac) with my menopausal symptoms and they work brilliantly. I had major rage and anger, it was getting to be a bit of a problem because everyone and everything irritated me. I had other symptoms as well latterly but this is what first instigated the Dr's visit. It saved me to be honest.

I am now on HRT and take both and the HRT manages the anxiety and hot flushes but the Fluoxetine manages the anger issues.

It's the medical guidance from NICE, not just opinion so regardless of personal experiences it's surprising that they are being offered . Their advice is HRT first and foremost, with adjustments and reviews to control symptoms, unless a woman has contraindications when SSRIs can be used to control hot flushes. And also CBT and talking therapies before SSRIs along with HRT for mood etc. This was the update this year. Women should be given the choice along with the pros and cons if their treatment deviates from it.

I was in 2 psychiatric wards for approx 6 weeks over the summer (first time this happened) and was prescribed SSRI’s to help with anxiety, depression and insomnia. One was anti psychotic. I’ve been changed one of them recently as it caused me to gain weight. But I didn’t have a discussion if this was to help with menopause which I’m in and on HRT patches for it.

For me the route to the psychiatric wards was a build up of a lot of things in my life, not necessarily menopause or HRT related. I’ve found the medication helps but of course don’t want to be on these forever. I’m also on levothyroxine for underactive thyroid.

Thanks so much everyone!

Thanks Jingling… she’s def a consultant gynaecologist not a GP… I looked her up 😂

I did tell her I’ve suffered with bad BAD PMS rage earlier in my life, maybe this was what prompted the SSRI suggestion?

Badbury, that is very heartening to hear it helped you. Rage and irritation (extreme!!) are some of my most problematic symptoms so if it helps with those that would be life changing for me.

but she did mention they can cause lowered libido which is another big problem for me…

She explained that testosterone for low libido comes with other side effects that I really wouldn’t want but I was really hoping non-testosterone HRT would also help with libido…? If osteogen would help then I would rather avoid testosterone for now for other reasons.

i had read that SSRIs were no longer considered as first-line peri treatment!! Which is why I wondered about her suggesting it. She was young and very pleasant so I felt confident I wasn’t just being fobbed off but she was very firmly not keen on me starting HRT and there was no clear reason why except for: you can start it in the future when you have more reason to/other symptoms, and why not try SSRI as it sounds like rage/anxiety are your biggest problems. Which they are tbf…

To be clear: her main advice was eat well, exercise, cut alcohol, reduce caffeine… THEN think about SSRIs… but she was partly just on autopilot with that because I was telling her I’ve done all those things and she still sort of kept suggesting I do them first… so I wasn’t fobbed off but I can’t be sure she was REALLY listening… if that makes sense.

Sorry to keep updating… it’s all coming back to me after the appointment! She did mention PMDD and ‘severe PMS’ when I was telling her about my history of extreme pre-menstrual anger, so I wonder if she’s sort of sideways diagnosed me with that rather than focusing on the peri?

If SSRIs might help with that then I would be grateful tbh. I’ve had this cyclical rage for years and years now but because I used to have very irregular periods (other medical issue) I don’t think I connected the dots as it was hard to see the connection between furious rage and my period starting 10 days later because it only happened every few months when I would actually have a period

@ShadesOfPemberley I was given 2 weeks on/off of SSRIs for PMDD a few years ago. It's standard for that but not so much for menopause. In my case it actually turned out to be no help as I also have a different issue which is treated differently, but if you do have PMDD it could help. It does seem odd that she'd think PMDD rather than menopause at 48 though. I found that the oestrogel I was later prescribed was much more helpful for severe PMS symptoms though.

I think you're going to have to make up your own mind. Now that you aren't excluded from using HRT, your GP could give you that

Also, you can't have testosterone without estrogen as they need balancing and you have to be on HRT for 3 months before adding testosterone.

It's maybe worth reading the fact sheets.

https://www.balance-menopause.com/menopause-library/antidepressants-and-menopause-factsheet/

www.balance-menopause.com/menopause-library/why-the-menopause-can-make-you-angry/

There is evidence (mentioned on that link) that diet can do a lot for PMS symptoms as well as other lifestyle changes or self-help like mindfulness, meditation and yoga.

Thank you so much Jingling, your expertise is so so helpful!!!

LadyBug, I agree it does seem an odd way for her mind to pivot with a 48yo… I’m still
a bit baffled but I will think this all
through. I do actually have a friend who is a GP so I may try to meet her for a coffee before Xmas and see if she has any advice on which way to go.

hugely appreciative of everyone taking the time to reply so kindly and thoughtfully

Apparently some gynae consultants are not meno consultants - different training.

id get another opinion if I was you

Newgirls thank you… she’s listed on the British Menopause Society… it’s all a big confusing tbh and I wish it had been a more straightforward appointment!

agreed tho I now know Im ok to take HRT as it’s not contraindicated with my other conditions. So I guess I can go to my usual GP if I decide to. There is one at my surgery who is very empathetic to peri so I would see her if I could.