Does anyone have any experience with Sertraline (or other) during peri? (I’m 39 and struggling with GP)

[Workingfortheholidays]

I’m really looking for any advice or experience anyone has please - I’m certain I’m in peri menopause. Irregular lighter periods, low mood, hot flushes, night sweats so bad I have to sometimes change my PJs twice, dry skin etc etc.

However the biggest symptom I have has been crippling anxiety and panic attacks - I’ve never had any form of mental health issues my whole life.

The issue I’m having I’ve been to the doctors three times about this and all they’ve done is try to offer me sertraline which I declined. They did bloods to rule out anything underlying which were all fine. they say I’m too young for peri which I don’t agree with.

I’ve been to a private menapause clinic and am just awaiting to do the FSH blood test before they will prescribe any HRT. However as this takes some time I’m considering going back to the doctors to try sertraline as this is living hell. I start a new job in a few weeks and am trying to give myself the best shot of not messing it up due to anxiety.

anyone any advice of help or support would be massively appreciated as I just don’t know where to turn next

I’m on HRT and long term antidepressants. I recommend Claire Weekes’s work on anxiety. It’s life changing. I also recommend exercise - lots of exercise, including weight training. Eat a lot more protein than you think you need. I aim for 140g daily. Get as much sleep as you can.

I’ve been on sertraline and it’s good but I really recommend taking as holistic approach as you possibly can to both anxiety and menopause. The worst thing you can do is shrink your life. Good luck 💐

thank you so much for the reply! Sorry to hear you have been struggling too. I’ve not heard of that one I’ll look into it.

that’s really good advice and I’m trying to make those changes. I did a while ago and then just fell back into bad habits with diet exercise and drinking which I’m sure didn’t help but I just lost all motivation and care. I’ve cut out alcohol, back on my high protein diet and strength training 2-3 times a week as well as 2-3 5ks a week so I’m hoping that this will also help if I continue being consistent

You can get HRT from pharmacies like Boots, Superdrug and Tesco online by completing a questionnaire.

At 39 this is classed as early menopause and you need HRT.

You should not need to see a private clinic. Your GP sounds useless and in fact if they can't prescribe they should refer you to a gynaecologist- but that will take months.

You also do not need an FSH test and I'd like to know which clinic is asking for this. It's an inaccurate test and won't necessarily diagnose anything.
Usually, privately, a test result is available in 24 hours- so why the wait?

SSRIs are not suitable and GPs are advised by NICE on this in the new menopause guidelines.

I don't know why GPs push anti depressants- they are powerful, mind-changing drugs, all with side effects and there is a national policy to stop prescribing and also get people already on them off them, through using CBT and other resources. They also takes weeks or months to work, so your HRT will come through faster than that.

Can you?? I did not know this - I’m going to look into this today!!

it’s a specialist menopause clinic and the doctor is recommended by the British menopause society so I trusted what she said.

the reason for the wait is that I need to do it on day 2 of my period for the most accurate results. It did baffle me a bit because she said that even if it came back hormones fine we could try HRT.

what is an SSRI please?

I don’t really want to go on them but I just need this anxiety and panic attacks to go away - it’s horrendous. I had one while getting my nails done yesterday 🥺

An SSRI is a type of antidepressant- the sort that women are offered - sertraline etc.

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychiatric conditions.

Yes I understand why you have to wait and ideally it's supposed to be tested twice over 2 months.

https://onlinedoctor.boots.com/HRT-treatment-online

https://www.onstella.com/ (Initiated by Tesco, I think.)

You may come up against an age factor here, but you can try.

The first thing you need to know is that your doctor is wrong. Peri is symptom based and therefore blood tests will not help to show if you are or are not... Put simply... If you are having the symptoms of perimenopause then you in perimenopause and as you are displaying them all in bucket loads you are in fact in perimenopause.

The second thing you need to know is that you need to read Davinas McCall book on the menepause. It will help you become informed with advice on what to say to the doctor and so you actually understand what is going on and your doctor cannot bamboozle you with stuff you don't know.

The third thing you need to know is that you can put your symptoms into chat GPT and ask it what you should say to a reluctant GP in order for you to get HRT. This helped me greatly.

Read the book. Get informed. Know your doctor is incorrect and that guidance has changed. Request an appointment with a different GP is necessary. It is your right to be able to be prescribed HRT if you want it.

Thank you @Mumathome1thats really helpful. Buying the book now!!

the problem I’ve come across is the guidelines state symptom based diagnosis is only for over 45.

just got back from the doctors and was an awful experience. Would not prescribe HRT because they only should do so once periods stopped 🙄 which I know is absolutely not correct.

I’ve accepted the sertraline as it’s better than nothing. And will just wait for my private doctor to come back to me after bloods.

honestly came out of the appointment and burst into tears it’s horrible feeling so helpless

I’m torn to try the Stella ok mentioned or I’ve heard good things about VOY - I wonder if they’d prescribe me without the blood test

thanks everyone for all the helpful information - can’t believe it’s 2026 and this is how women get treated

the problem I’ve come across is the guidelines state symptom based diagnosis is only for over 45.

No it's not.

Diagnosis can be at any age but a blood test for women under 45 is offered to exclude any other conditions that may present similar to menopause. It is not used to diagnose menopause.

You really should not be taking that drug as it can mask the benefits of estrogen once you start it. And it's not an instant fix- it can take weeks and also have side effects.

To be honest your experience warrants a formal complaint.
HRT comes is 2 types- for women with periods and women without.

Your GP is 10 years out of date.

I'm not impressed with the private clinic either.
It's fine to test FSH for fertility etc but as you have so many peri symptoms anyway they should have offered HRT.

I think you should see another GP and refuse to accept ADs.

Read all the info online by Dr Louise Newson- that's where Davina gets her info (she's not an expert herself.)

https://www.drlouisenewson.co.uk/knowledge/how-to-talk-to-your-doctor-about-hrt-and-get-results

My GP surgery also tested my FSH/LH because I was 39 when I asked for HRT.

But it was explained very differently to me - they said that they don't usually test for perimenopause, that diagnosis is based on symptoms alone, but in younger women they test looking for early menopause (before age 45) because it can come with associated health risks at a young age. I think they called it Premature Ovarian Failure.

They did also tell me either way they'd prescribe me HRT for the symptoms - which they did (my LH/FSH was off anyway).

Just wanted to add, as I wasn’t clear earlier, that I’m on ADs (an SNRI) for depression and anxiety, not menopause-related anxiety.

HRT has been a massive help. I was lucky to have a really good GP. I really feel for all the women who don’t.

Sertraline is okay but it's not a NICE approved treatment for perimenopause or menopause and shouldn't be prescribed as such. It's good that bloods were done. Was your thyroid checked?

Thank you so much for this. It’s so hard when there’s so much conflicting information floating around. I might try the online appointment I can get one on friday with Stella.

I really don’t want to take ADs but I just feel stuck and will try anything at this point. I had a panic attack while getting my nails done earlier this week was awful, I’ve been going to the same lady for years there was nothing that triggered it.

I didn’t sleep well last night and the sweats were wild so I’m just feeling super sensitive today and stuck.

It was yes - everything absolutely normal. My GP told me he was prescribing it for perimenopause symptoms. Literally said those exact words when he rang me back after consulting a senior doctor

That makes a lot of sense. My mum went though menopause at 45 which I have also told them

Then I would complain via the practice manager because he's out of date, misprescribing and needs training so he can learn to follow the NICE guidelines. It's not good enough.

https://thebms.org.uk/wp-content/uploads/2025/04/09-BMS-TfC-NICE-Menopause-Menopause-identification-and-management-%E2%80%93-from-guideline-to-practice-MARCH2025-D.pdf

Edited to add link to NICE guidelines for clinicians

Also to add @JinglingSpringbellsin no way and I being judgemental but he didn’t look like he trained when those guideline were on 10 years ago so I was initially hopeful he would be more up to date

Thank you - added to my to do list for
tomorrow

Do it in your own time, no rush. It's your GP's responsibility to keep abreast of changes to NICE guidelines. You're just doing him a favour by letting him know how out of touch he is. Priority is getting yourself sorted.

Have you seen the NICE guidance?
https://www.nice.org.uk/guidance/ng23

Extracts here:

1.3.6
Consider [consider does not mean must] using the person's serum FSH level to confirm menopause only: in people aged 40 to 45 with menopause-associated symptoms, including a change in their menstrual cycle in people under 40 in whom menopause is suspected (see also diagnosing and managing premature ovarian insufficiency). [2015]

See also the recommendations on offering psychological support to:
people experiencing early menopause (aged 40 to 44) and
people with premature ovarian insufficiency.

Vasomotor symptoms
1.5.1
Offer HRT to people with vasomotor symptoms associated with menopause. [2015]

1.5.4
Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone. [2015]

You can print if off and show your GP.

Can you take a partner or a close friend to help advocate for you ?

Is there not another GP you can see?

Seriously, this is terrible because how many other women are being prescribed incorrect drugs ?

Natural menopause (as opposed to surgical menopause) is diagnosed at the point when you haven't had periods for one year. It typically happens between 45-55. After that you're postmenopausal.

Perimenopause is the run up to menopause, and symptoms typically last 7-9 years, but can last longer. So at 39, you're absolutely not too young to be having perimenopause symptoms.

In case it applies, employers with over 250 employees may be obliged to develop mandatory Menopause Action Plans from next Spring, so many will already be looking ahead to this. If they offer a menopause support service as a benefit, it's well worth taking advantage of this as they often give you access to 1-2-1s with medical experts who can go through your symptoms & all the options with you. In some cases they can also prescribe HRT.

Also menopause cafes/meetups where you have a chance to speak to other women in the same boat can be really helpful and make you feel less alone. Especially if you're getting the run around from the doctor's office.

Good luck and hope you get some relief soon.

I’ve been to a private menapause clinic and am just awaiting to do the FSH blood test before they will prescribe any HRT. However as this takes some time...

@Workingfortheholidays Have you seen a doctor in person at this clinic? Have you stressed how bad your symptoms are?

I'm wondering what the value is of an FSH test when all your symptoms point to peri?

They could start you on HRT and if it works, that's proof you needed it. An FSH test seems a waste of time and if your periods are irregular, you could be waiting weeks.

I'd suggest you contact them , explain how bad you feel and whether they will agree to starting HRT now.

If you want to PM me the clinic I'm happy to have a look (I've had private menopause care for years with an excellent consultant, so I know what to look for!)

I have seen someone in person and explained how bad it is.

how I understand the point of the hormone test is if it is more likely to be peri or premature ovary insufficiency - both would likely be treated with HRT but slightly differently.

i wish I’d pushed back more with the GP yesterday. He said the maon reason was the long term health risks outweigh the benefits (I know this is rubbish) but really what’s would be the harm in just trying it for 3 months

thank you for your kindness I’ll see if I can figure out how to PM as never worked it out on the app!

Peri and POI are treated the same apart from women in peri using sequential HRT and women post menopausal using continuous if they choose to.

The difference is that some women with POI (it's got a new name now) have no symptoms. But they still need HRT to protect their heart, brains and bones.

Your GP sounds useless.

First, the risks only apply to women who start hrt after 50-51, not to women having an early menopause.

The risks only kick in after several years and even then they are tiny- far less than being overweight and drinking 2 units of alcohol a day.