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[higher]

I am peri menopausal, had a Mirena put in 18 months ago & 2mg elleste solo. At recent meds review I summarized my increasing monthly migraines/mood swings/tiredness and the GP says sounds like fluctuating oestrogen levels but as I am at the max dose possible try Sertraline? To take in addition to existing HRT and then maybe phase out the Elleste - does this sound a good idea? Thanks for any advice!

[Dotty]

If your problems are due to hormones then the first line of attack should be hrt. Maybe your dose needs changing. However some ladies do use anti depressants as well x

[higher]

They upped the dose from 1mg to 2mg Elleste solo but GP says thats the max?

[Dotty]

It's the maximum in the tablets but you can get higher dose with gel or patches x

[Dotty]

This is taken from the Nice guidelines:

Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults).

[higher]

Oh I see, thanks for that. Just found out that none of my local pharmacies have any Elleste solo due to "supply problems" so maybe its a good time to change!

[racjen]

That seems pretty bizarre to me - the two aren't interchangeable, one is HRT and the other is an anti-depressant. To suggest substituting one for the other is just downright ignorant. You should try switching to a type of estrogen that allows for a higher dose first (Estrogel or Evorel patches), and only consider trying anti-depressants after giving that a good go. Bloody GPs.......

[higher]

Yes it does worry me to add more meds as I am 100% sure its hormone fluctuations but I suppose if GP has had success with it before maybe its worth a try? Also mentioned low sex drive to GP and it says Sertraline can cause that too! Just found out I cant get the Elleste 2mg now anyway so will try and speak to doc again. Feel like I need an expert to talk to but none at our GP practice.

[dahliagirl]

Surely you would be better with a patch or gel with migraines - it is supposed to give you a more even dose.


"Migraine
Migraine is often triggered by hormonal fluctuations and therefore may occur around the time of a period. Such migraine may improve at the time of the menopause. Some women find that migraine may be triggered by the daily hormone fluctuations which can occur with oral (tablet) HRT so the transdermal (patch or gel) route is usually preferred with a history of migraine."
https://www.menopausematters.co.uk/atoz.php

[higher]

Thanks I just spoke to (another) GP and they will give me Oestrogel but I need to work out how to use it!

[CLKD]

However some anti-depressant medications do help with menopause symptoms. 

[dahliagirl]

That's better - there are lots of oestrogel users on here.

[higher]

Thanks, I dont even get flushes any more "just" mood swings/migraines/tiredness/breast pain/spots!

[CLKD]

Sounds within normal limits from where I'm sitting.  Finding a solution can be Trial and Error   

[Hurdity]

Hi higher

 

I agree with Dotty - no to ADs and change to transdermal oestrogen. Oral HRT can also depress libido as well as ADs so you may be onto a winner with patches or gel....don't let the doc persuade you to do otherwise! If after 6 months of changing dose you still can't resolve anxiety through other means then maybe think again. There are lots of talking therapies and mindful techniques as well as exercise and fresh air that can help with anxiety.

Hurdity x