Starting HRT while tapering sertraline for perimenopause symptoms at 49

[70percent]

Hi. I'm 49 and have perimenopause symptoms since coming off combined Pill last November. I'm seeing my GP in a couple of weeks about going on HRT.

BUT. I am also tapering sertraline and am now on a very low dose. It's got a bit bumpy so it'll be a while till I'm completely off it. I had wanted to be off the sertraline (I've been on it for over 10 years) before I started HRT but that doesn't feel an option now. Can anyone tell me if they've successfully started HRT while being on sertraline, or even successfully come off sertraline while on HRT?

Thanks

I started hrt while on citalopram. I started citalopram around 48 for peri meno anxiety. Start hrt around 2 years later. I’m now 58, through meno and still on low dose of both. I take a tiny dose of citalopram but without it I get feelings I can’t cope with normal every day life. There a new study that show women’s brains can be permanently affected in meno re mood and memory. Think I’ve got both lol.

@Hellohelgado you have a link to the study ? Thanks

The bbc does a write up and there’s a link to the research if you want more
https://www.bbc.co.uk/news/articles/c9qpp1g5ylvo

Thanks @Hellohelga

so I can be on an SSRI at a low dose and HRT at the same time.

I’d seen that study but thought of it more to be about likelihood of developing dementia.

I listened to a podcast about the menopause brain recently, which was sort of helpful and might be of interest.

Yes you can take both in fact I think citalopram is pretty common combine with hrt. Speak to your gp.

Thank you for the details on the study @Hellohelga. Do you mind if I ask what dose of citalopram you take alongside HRT ?

10mg currently but in the past have had 20mg

I was in sertraline then citalopram for 20 years. Started HRT in 2016 and came off citalopram finally in 2017. Still on HRT.

Thank you

I'm on Sertraline and HRT. I’ve been fine.

It’s very common especially for those who have had PMDD and are now in peri.

Your GP should be able to advise on this.

@70percent

You can be on both an not come off sertraline. These meds work differently - and affect different parts of our biology. And together - they may actually give you the best combination of help.

Good luck!!!!

I came off sertraline after being on it for a number of years. Started perimenopause and my moods were all over the place. Once I started hrt gel, I sunk very low, intrusive /obsessive thoughts, and my GP started me back on sertraline immediately. It was life changing.

I take 30mg citalopram alongside HRT, working well for me at the moment.

Thanks everyone this is really helpful and quite cheering! I’m seeing my GP in a week.

I successfully tapered an SSRI called paroxetine ( notoriously difficult to come off) it took me years, but I think the HRT really helped with the last bit of the taper.

Thanks @meemeemammy that’s interesting. I haven’t changed my dose of sertraline since March as I got so low. I thought I’d tapered too fast but I think it was menopause symptoms. I still haven’t got the right HRT dose so for now I’ll stick to my equivalent of 1mg sertraline. How long did it take you to taper off your SSRI once you were on HRT?

@70percent Well done on getting to 1mg! You've done great. 5mgs and under was the hardest for me. I used liquid and a marked 1 ml syringe and dropped by 0.01ml every 6 weeks. You have to stick on the dose like you did if you feel low and try again in a month or 2. What I found was each taper was different - I'd manag one smoothly then come crashing down the next one. I also timed them with my period. Does sertraline come in liquid form? What dose HRT are you on? Once I was on HRT I kept going with a drop every month or if didn't work every 2 months. They had stopped doing the liquid form so I had to go a bit quicker. Cinnerizine travel sickness tablets really helped with my vertigo.

Thanks @meemeemammy

sertraline does come in liquid form but it was a fight to get it prescribed and then it expired v quickly so I cut up a 25mg pill in half, dissolve in 10 ml water and then use a syringe. I’m currently taking 0.4 of a 1 ml syringe. I dropped to below 0.4 to possibly 0.3 and crashed in Feb / March and I now don’t know if it was withdrawal or menopause depression.

I was reducing every month or 6 weeks till March but haven’t dared reduce as my HRT still isn’t quite right. I don’t have any periods and before HRT was on the pill so my cycle didn’t seem to have affect my mood. Have you had to change your HRT as you’ve reduced the paroxetine?

Hi, As you're dissolving 12.5mg in 10mls each 0.1 ml will be quite a drop still. Depending on where you are ( I'm in UK) you can get marked 1 ml syringes with 0.05 marked on them so you could try and do a 0.05ml drop next time. It's likely withdrawal. If you feel fast negative feelings that are stronger and different to your previous history it's usually withdrawal ( but I think it's worse in peri, so it is confusing) I kept a daily journal on my phone about how I was feeling to track and go over previous drops to see how long they'd take until I felt better. Day 5 onwards was particularly bad ( sertraline has a half life of 26 hours - so I'd expect the drop to be out your system on day 6- so you may feel worse from day 6). I'm answer to your HRT question I did end up on a high off licence dose which I obtained privately, and have then had to reduce this to suit manufacturers guidelines, although I'm still on 150mcg oestrogen which the NHS menopause clinic agrees with. I crash below this. What did your recent bloods say? What dose oestrogen/ progesterone are you on?

Thank you so much @meemeemammy
I’m dissolving 25mg in 10ml water. My syringe seems to have the right markings - the practice pharmacist from my GP practice has been really helpful, unlike the GPs! She’s previously helped me with the maths and we agreed the drop in Feb / March may have been too big a percentage change. I’ve got a private appt with a gynae for menopause in early November so I’m going to stay on same dose of sertraline till then. My holy grail is a psychiatrist who understands tapering and the menopause (preferably on the nhs!) but such a person seems hard to find. Or a menopause specialist who understands tapering and withdrawal!

I’m currently on 100mg progesterone continuously and 2 pumps oestrogel. I did try 3 pumps for a while but reduced as trying to work out if oestrogen or progesterone giving me night dreads.

I’ve been keeping a mood and sleep diary for the last year or more.

Did your menopause specialist understand the tapering?

Syringes. I bought a pack on Amazon or similar after Boots stopped having the ones I wanted (yes I’m in Uk). Between 0.3 and 0.4 the markings are divided into 5 so each line is 0.02ml. ChatGPT has been helpful when I haven’t seen the pharmacist 😩

That's great that you've had good support - being believed, offering good guidance and listening is half the battle! I think that's a good idea to stay on the same dose until your private menopause appointment. This is kinda what happened to me in the end- I was on a small dose and just started HRT and didn't know what was what. Newsons health put me straight on to 50 Micrograms of oestrogen to taper up to 100 micrograms with cycally progesterone. When I went to them I was only on 25mcg oestrogen and 200 mg progesterone and felt absolutely bloody awful. I got a lot of instant relief from the 50 oestrogen , but couldn't go back to work until I was on 100 MCG when I felt so much better. What I probably didn't manage well was I went up further with the oestrogen ( newsons supported this, but GP didn't) this caused a breakdown in communication with private and GP, so I think my advice would be don't go higher that 100. Progesterone really really helps my sleep. On my progesterone free parts I struggle to sleep. The menopause specialist will give you advice on what to do next but I think if you go up to 3 pumps that's classed as a higher dose and you may need 200mg progesterone. I was scared of the progesterone at first, but now I love it as I can sleep! Newsons did really understand about the tapering, but they listened to my story, my symptoms and have been excellent. Going back to syringes you can get 0.1 ml syringes that are divided into 10 and each 10 is divided into 1 so it's easier to go slower. I think they're for rodents usually!