Unsure what to ask for next

[Timwith2noses]

I’m 43 and feel peri menopausal. I did some research online, tracked symptoms for a while and spoke with my GP who suggested bloods. I had bloods that showed no indications of menopause. GP said that based on symptoms they would prescribe oestrogen patches if I wanted to try them (I have mirena in situ). I tried them for a few weeks and found they helped with night sweats but I didn’t feel they made any difference to my mood or anything else. I had really bad breast pain for a few days while taking which also
made me think maybe I didn’t need them.

my husband disagrees and thinks I ‘was better’ in terms of my mood when I was using the patches.

I had a review appt with GP, explained all the above and SSRIs were suggested. I thought it was worth a go, am now three weeks into sertraline and I feel worse than ever. Night sweats have returned with a vengeance but now I can’t sleep, have increased anxiety and am more emotional than ever (though I do think insomnia is affecting this). I have read that insomnia is common when you start taking sertraline but can go away after a few weeks. I don’t know what to do next - I have a review with GP in another couple of weeks but I’m not sure whether to persevere with sertraline or not at this point, and if not what to ask for next. I was thinking maybe I try patches again?

my main symptoms/issues are:
emotional lability
night sweats
some brain fog - not massively problematic yet
early morning waking
mood changes/irritability.

on patches the sweats disappeared, I’m not sure anything else changed but honestly it’s hard to be completely objective.

on SSRIs I have night sweats, insomnia, early waking, increased anxiety, emotional lability and still irritable.

I really don’t know what to do next, I just want to feel normal.

Sertraline can cause night sweats so maybe explore an alternative?

i didn’t realise that. Makes sense though because they are awful now. Thanks.

Why don’t you wait and see what the doc suggests?

I’d try the gel rather than patches see if that helps the mood / brain fog etc

3 wks isn't long for an anti depressant I think you need to give it at least 6 weeks as side effects often settle.

SSRI swears are usually temporary as your body gets used to things. But I dint understand why you didn’t persevere with the HRT. It can take 3-6 months to settle as your body needs to build up its levels. Both you and your dh did see some benefits. I would have carried on with patches and even increased as you may have been on a low dose. Breast pain that is like period breast pain often goes away after a few months also. How long were you on HRT ?

To be honest, because I was unconvinced that I needed it, and the bloods didn’t show a need.

I might, and I might bring the review forward but I’m wondering if it’s worth stopping the SSRI now or not, it’s useful to know what others experiences have been. It is very odd to feel worse when you are hoping to feel better.

Thanks, that’s useful to know.

I think I had an 8 week supply. Perhaps it needed longer: I had the sense the GP was not convinced it was needed either but that may be in my head.

Having been in your situation but without the sweats it took a few weeks for the breast pain to settle, that is normal. It also took a few months to feel the benefit of the HRT and get everything right. Sertraline is so hard to come off I would want to be really sure you need it. HRT sorted my moods out. I am quite angry now that I was given sertraline when I needed hormones. The tests are not reliable and I think it’s best to go by symptoms.

@Timwith2noses You gave up with the HRT too soon probably.
The guidance is try it for 3 months and then increase the estrogen if it's not helping.

This is in the NICE guidance, as well as the emphasis that SSIS don't help and are only to be tried for women with pre-existing peri depression (clinically diagnosed.)

So, the guidance, which is evidence-based, is to persevere with HRT and tweak it, not persevere and tweak ADs.

You might think about going back onto HRT.
At 43, blood tests are unreliable and are really there just to check your thyroid is ok and there are no major issues with other diseases.