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[Summer-sky]

Hi GypsyRoseLee,

I would say it's dialled them down which is a huge improvement but yes I do have occasional resurgence of symptoms and I'm not 100% on why that is.  It's interesting what you said about your GP saying Setraline doesn't work like that as in stopping and starting.  When it happens I do wonder if I need to increase but I try and track back and go back to basics as in have I gone off course with my diet etc or has it been a particularly bad time for stress or have I taken on too much or not piped up when maybe I should have done - all that kind of stuff which I think all adds to a burden on the adrenals which in term effects a load of stuff with meno / hormones, physical & mental stuff. Are there any triggers around those times it happens perhaps?  Or is it just random? x

[GypsyRoseLee]

Thank you for getting back to me. In a weird way I'm glad it's not just me, my GP looks at me as if I'making it up (why on Earth would I?). Like you I try and track back through my diary to try and spot a pattern but there's none. I've had a reoccurrence during a very enjoyable holiday but then sailed through a stressful family bereavement with zero symptoms.

All I can think is that sometimes our hormones still have a surge and so the symptoms break through, over powering the Sertraline. I've considered temporarily increasing Sertraline during these episodes but then presumably it would take a while for the increase to kick in? And then, would you be dealing with side effects each time you decreased again?

[Wrensong]

Ayesha

I am not falling apart with heart problems, bone issues or anything else related to not taking HRT, but one has to bear in mind, a healthy lifestyle with a good diet and exercise is an essential part of aging.  My only issue after turning 70 has been vaginal atrophy and I am happily taking topical HRT to rid me of the nasty symptoms.

It's lovely to hear that you are generally very fit & healthy & will be especially reassuring to many women who can't or prefer not to take systemic HRT.
Wx

[Wrensong]

GRL

One of my GP friends is involved in research into this and apparently gut biome is massively more influential than previously thought. Though I wonder whether stuff we can buy OTC is actually strong enough to repair our biome?

I've read that it can take up to 2 years for our gut flora to recover after a single course of antibiotics, but imagine it depends on a whole host of variables, inc antibiotic type, duration, diet & many other factors.  I think, as you say, the relatively small numbers & reduced range of bacteria in OTC supplements, yoghurts, kefir etc are unlikely to be able to make up for post-antibiotic decimation, but I feel I need to do all I can to try to turn the situation around.  A friend from nearly 40 years ago has spent his working life in probiotics R&D, so it's a field I was introduced to way back in my early 20s & have found fascinating ever since.


Thank you for the advice about Sertraline & yes, I would need to start as low as possible.  I see Summer-sky has mentioned use of a tablet cutter which as a small adult, is what I have to use with various meds, so always look for tablet form rather than filled capsules if there's the option.

All very helpful info ladies, thank you.
Wx

[GypsyRoseLee]

Ayesha

I am not falling apart with heart problems, bone issues or anything else related to not taking HRT, but one has to bear in mind, a healthy lifestyle with a good diet and exercise is an essential part of aging.  My only issue after turning 70 has been vaginal atrophy and I am happily taking topical HRT to rid me of the nasty symptoms.

It's lovely to hear that you are generally very fit & healthy & will be especially reassuring to many women who can't or prefer not to take systemic HRT.
Wx

Now I can't take HRT, I take heart when I look at my Auntie who has never taken HRT. She's late 70s and is very fit and limber. She hikes most weekends, does weekly yoga and pilates. When out shopping with me and my daughters she can out walk us all. To be honest she's far fitter and healthier than my MIL who was on HRT but rarely moved from the sofa.

[Banjo1973]

Although this might not be of use, i hope this is supportive...

My daughter is on Sertraline for anxiety - it transformed her life. She started on 25mg as an adjustment dose. She did feel nausea at first so stayed on this dose for 2 weeks (was supposed to be 1). She has been on 50mg for around 18 months with no side effects, only positives.

Speaking of family members my mum is 77 (no HRT) she cycles, walks at least 25 miles a week and does pilates. She's in very good shape (nightmare personality though!!!)

[Wrensong]

I love to hear of women like that GRL.  What an inspiration & if she's a blood relative, suggests you have good genes.  My mum  never took HRT & was physically pretty fit until she passed away at 74, sadly following a late diagnosis.  She was pleasantly plump so probably had good bones & a buffer of oestrone I almost certainly lack, being underweight, that I suspect helped her avoid some menopause symptoms.  She was postmenopause at 46, on ADs & meds for anxiety & sleep for as long as I can remember though, so sadly wasn't without health issues.    We had completely different body shapes & likely as a result, I have osteopenia & degeneration in the C-spine due to discs drying out.  I also had to have BSO 6 years ago, so now have indequate testosterone as well as lacking oestrogen & recently had total hysterectomy (i.e. cervix too) & PF repair  so coming off HRT would need very serious consideration.
Wx

[Wrensong]

Banjo1973, that's all helpful to know, thank you.  I hope your daughter continues to do well & your Mum doesn't drive you insane!!

[Banjo1973]

Thank you xxx

[Ana21]

I'm also considering non-hormonal options to reduce vasomotor symptoms.  After a long wait, it's great to see fezolinetant is available.  One of my concerns is the potential risk of neoplasm which appears to be dose dependent.  From an article in the Lancet, November 2023, Risk of neoplasm with the neurokinin 3 receptor antagonist fezolinetant:

"The higher incidence of neoplasms with fezolinetant requires an in-depth evaluation of all cases observed to further assess associated baseline risk factors and propose risk minimisation strategies. According to the US Food and Drug Administration clinical review, no underlying mechanism or potential risk was identified during the non-clinical development of fezolinetant.5 Fezolinetant acts as an antagonist of the neurokinin B receptor 3 in kisspeptin, neurokinin B, and dynorphin neurons, possibly affecting kisspeptin signalling, but this adverse event could also result from other off-target effects."

Aging is the strongest risk factor for neoplastic disease.  Hoping to hear more as side effects are reported.  And looking forward to reading about the experiences of the women on this forum.

I had to type this reply twice because my sweating hands slipped on the keyboard and obliterated my post.

[Wrensong]

I hadn't seen the Lancet article you cite Ana21, but the last of the 4 papers I posted at the start of this thread (the safety evaluation) does touch on the neoplastic potential.  I was sure I'd read & bookmarked a very long article on Fezolinetant that also covered the safety aspect, reassuringly with Nick Panay among the authors, but frustratingly I can't find the paper at all now.   The detail in your extract is beyond my ability to interpret, I'm afraid!

I'm sorry to know about the degree of sweating, that must be horrible for you.  Has HRT ever helped that for you?  I don't sweat under any circs, which is good in some ways as it means my bedding remains dry at night when I overheat.  But it's problematic in other respects as it means I overheat very intensely, feel very unwell as a result & take an age to cool down, having lost that natural mechanism that facilitates it.  I'm long term hypothyroid & some of us are said to lose the ability to sweat as the disease progresses.  Getting that hot seems to be a massive stress on the body which feels as though it's associated with a huge release of cortisol &/or adrenalin, so I'm then wide awake & really struggle to get back to sleep.  I seem to only manage about 5 hrs a night max & that's tortured (often by feverish nightmares) & badly broken.  I can't be sure whether the realease of cortisol/adrenalin associated with waking suddenly in the small hours causes the overheating or the overheatng provokes the adrenal response.  Either way it's a horrible combination.  I've experimented with diet in the hope of getting an insight into whether low blood sugar might be involved, but whatever I do with meal content & timing the overheating & insomnia persist.  In my early 60s & nearly 2 decades since peri began I'd hoped to have it cracked by now.
Wx

[laszla]

GRL

One of my GP friends is involved in research into this and apparently gut biome is massively more influential than previously thought. Though I wonder whether stuff we can buy OTC is actually strong enough to repair our biome?

I've read that it can take up to 2 years for our gut flora to recover after a single course of antibiotics, but imagine it depends on a whole host of variables, inc antibiotic type, duration, diet & many other factors.  I think, as you say, the relatively small numbers & reduced range of bacteria in OTC supplements, yoghurts, kefir etc are unlikely to be able to make up for post-antibiotic decimation, but I feel I need to do all I can to try to turn the situation around.  A friend from nearly 40 years ago has spent his working life in probiotics R&D, so it's a field I was introduced to way back in my early 20s & have found fascinating ever since.

I look after my 87 year old mother and despair when the docs give her antibiotics when it's almost certain she doesn't need them and I fear they simply weaken her immunity by blitzing her microbiome.

So I set her on her a re-colonizing her desert-like gut programme, consisting of a probiotic supplement (probably the least useful element of this, as you suggest Wrensong), but more importantly near daily fermented foods - thank god she loves kimchi and beetroot sauerkraut -, daily prebiotic foods - onions, garlic, leeks, which all suit her Mediterranean diet, and as many plants a day as she can stomach (so to speak), mindful of Tim Spector's suggestion that we consume about 30 a week - which includes coffee, herbs and spices.
We haven't had her microbes analysed or anything but over the last few months her immunity and overall health and wellbeing definitely seem better.

[Wrensong]

Hi laszla, how lucky your dear mum is to have you looking out for her & how rewarding for you both that her health seems to be improving for the dietary care you're taking.  I agree about the high plant intake & have followed a high fibre, mostly plant based diet for the last 4 decades.  Luckily I love fruit & veg & enjoy cooking!  As regards fermented foods, I eat 2 different types of high protein natural yoghurt daily & have made my own in the past.  We have other members who make their own kefir & sauerkraut which I think is laudable!  I also make dense, suety whole rye bread, which is a v good source of fibre for our gut flora & also tastes delicious!

Gosh, this has gone way off topic, sorry everyone.
Wx

[Wrensong]

There are a couple of new, interesting links here on Fezolinetant, from Newson Health, one article, one podcast & transcript.  I think both worth a read/listen.  Importantly somewhat cautious about the use of this new drug until further data on safety, efficacy & systemic effects are available. 

I have not got around to discussing Fezolinetant with a specialist & won't be asking to try it any time soon.

I hope the links are not worrying to anyone who may already have started it.

Wx

https://www.balance-menopause.com/menopause-library/fezolinetant-explained/?mc_cid=e7f79426ae&mc_eid=6a80ee11db


https://www.balance-menopause.com/menopause-library/hot-flush-drug-fezolinetant/?mc_cid=e7f79426ae&mc_eid=6a80ee11db