Hi Sarah, I think 25mg is a pretty low dose of sertraline. From what I understand some people do get good results from low doses but 100mg is more the average theraputic dose. I think people who start off low up it by 25mg every week until they are on a higher dose. I think the maximum is 200mg. You have to do what your doctor thinks is right for you, I think I would hesitate to go over 100mg myself but would consider 125mg now I have more confidence in it. The fact you have migraines must be hard as it gives me really bad headaches so not sure if you are having more migraines post sertraline. I think all the SE's do die off gradually though but it does take time & when you up the dose they come back. I have only worked all this out from googling & reading things on the net as it terrified me the first day I took it & for many weeks actually. You are on 75mg though now so its a good dose & maybe in another couple of weeks you might feel more benefit. Its such a slow acting drug I think a lot of people stop it before giving it a chance, I am too stubborn to have gone through all the nasty stuff with it to give it up. I keep a journal too & record stuff. If I look back on the early days its quite sad.
You ask how all this started. I turned 50 & had my first early period a month later which came as a shock as I am a 28 day exactly girl. It took me a good few mths to think meno. Next came palpitations which caused me anxiety. Visits to docs (male) where rubbish. Then the anxiety got slowly worse until I felt like I did in pregnancy only with quads. I had nausea all day & night, I stopped sleeping properly, then panic attacks. I stopped going on long journeys then I found I could not eat I felt so ill but forced myself. Between Feb-Sept I was back & forth to docs, a blood test said no meno. They tested me for ulcers & all sorts of samples got given & lost by the NHS. Early Sept saw me going to the docs & being told there was nothing wrong with me & it was then I came home & hit rock bottom basically. After that I got the sertraline & Benzo's. As well as all the above I was getting much worse period pain & never knowing when it was coming was awful, the nausea would be even worse just before a period, hair falling out, hot, Dizziness, wobbly aching legs, acid stomach, tummy upset. It is like the symptoms you have the day before a period pre peri are now every day of the month. Its fine to feel poorly for just one day, you can cope & have an early night.
What I have learnt from here is blood tests are unreliable. I have asked them to do another one for me last week & we shall see what the difference is between the last one. Lets hope there is a big difference & we can shout it from the roof tops & tell all these poor ladies unable to get help that they are not going mad. If it comes back no meno again I shall seek out private treatment or an NHS meno clinic.
I know nothing about HRT other than it might take a few types to get the right one & it takes time. There are risks but to be brutally honest I don't want another year like this one. There may be types that are ok for migraine sufferers. I don't think most GP's have a huge knowledge of everything unless you are very lucky. My daughter has a heart condition & if I ever go to the GP with her they are terrified & usually ask me what I think would be the best thing to prescribe for her. If she is very poorly we go straight to Alder Hey hospital not even our local hospital would be safe. I really think there should be more Meno specialists who know what all the symptoms are & can give better advice. If I can't get much help & I am very average age wise for it what is a 30 year old going through it early going to get told. I can't imagine how horrible that must be.
Anyway HTH's. If your appetite is poor my one big piece advice is force yourself & have an extra meal each day if necessary. Eat what you fancy. Just like in pregnancy I have had cravings for things & as an ex veggie to want chicken drumsticks & pork pies is pretty odd. I also have been wanting pickled onions. I found one under the bed the other day

Also do keep a journal it has helped me hugely. xxxx