Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Wrensong on January 13, 2024, 08:41:12 PM
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Seems this drug has now been approved for private prescription in the UK & approval for NHS prescribing may follow. Potentially great news for those women with a history of hormone sensitive cancers for whom HRT is contraindicated.
https://thebms.org.uk/2023/12/bms-update-fezolinetant-licensed-by-the-mhra/
https://www.theguardian.com/society/2023/dec/18/veoza-fezolinetant-menopause-drug-hot-flushes-wins-uk-approval
https://www.medicines.org.uk/emc/files/pil.15361.pdf
Not read this one in detail, just scanned it so far.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10026946/
Wx
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I was wondering how long it would take before someone finally posted on this matter. There are thousands of women who cannot or do not wish to take HRT and hopefully this drug will be approved for prescription on the NHS as there is so little out there and vasomotor symptoms can go on and on. My understanding is that this drug only helps with the sweating and none of the other synptoms so it is limited but I thnink that many will give it a try and hopefully it will get approval as a lot of work has gone into it.
Meg
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What wonderful news. I can no longer take HRT thanks to BC a few years ago, so my GP started me on Sertraline to help with temperature control. It's worked brilliantly but it's so good to have other options out there.
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It is good news to now see alternatives coming into fruition.
I will definitely be looking into that myself.
GypsyRoseLee
I am also thinking of giving sertraline a go in the near future. How do you find the it? Did you start on the lowest dose? Any major side effects?
I knows we are all different when it comes to medications, but would be good to get an idea how others have found it ( sorry for the side track) 😊
Thanks.
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Hi Nas
The first 2 weeks on Sertraline made me feel quite spaced out, but nothing unpleasant. I also had epic, vivid dreams which I really enjoyed. My sleep improved hugely too. I initially started on 50mg which my GP told me was a loading dose, then I increased up to 100mg which was the therapeutic dose (though plenty take much higher).
Sertraline has been brilliant for me. Virtually all my peri symptoms were psychological. Mood swings, awful anxiety and very low mood. HRT really helped (I saw the famous Prof Studd) but I think I also needed the Sertraline. Prof Studd told me that when women are severely progesterone intolerant (like me) then HRT + ADs are necessary.
This combination worked excellently for me for about 85% of the time. But a few times a year I would get a relapse and my symptoms would suddenly return, out of the blue. It would last a couple of weeks or so then disappear just as suddenly.
4 years ago, when I had to stop HRT, I was very frightened that the relentless low mood and anxiety would return, but they didn't really. Instead, it just followed the same pattern of just a brief relapse a few times a year.
No one has ever been able to explain these relapses to me. My GP insists that Sertraline doesn't stop and start working like that, but they can't explain why it happens?
I honestly feel Sertraline has been brilliant for me and I was lucky to not experience any nasty side effects. But I understand that any initial side effects don't last and are a small price to pay x
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Thanks so much for sharing GypsyRoseLee
Sounds like it’s working really well for you, with minimum side effects .
I will have a chat with the medics to see if this can be an option for me also. It’s the anxiey I struggle with and being hyper sensitive towards everything. It’s quite debilitating.
Thanks again x
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You're very welcome. Anxiety was probably my worst symptom of perimenopause. From the very first day of taking Sertraline I could feel the anxiety quieten. I have two GP friends who both take Sertraline for anxiety which I find very reassuring.
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GRL
my GP started me on Sertraline to help with temperature control.It's worked brilliantly
It's so good to know that Sertraline has been so helpful for you since you were obliged to stop HRT :). I'm also considering meds other than HRT to help with relentless vasomotor symptoms at night which, long postmenopause, are totally wrecking my sleep & of course, consequently stamina & resilience by day.
I had to have numerous courses of antibiotics, some heavy duty IV, for some weeks after gynae surgery in Spring last year & since then my menopause symptoms have ramped up to a degree I'm really struggling to cope with & all tweaks to HRT have proved ineffective. I suspect the beneficial gut flora involved in our feelgood neurotransmitter balance were all but decimated by the ABs & all attempts to redress that situation with probiotics, prebiotics & my habitual healthy, high fibre diet, have made no difference whatsoever. So I'm interested to know of other meds women have found helpful for vasomotor symptom relief & may well ask to try Sertraline, though some of the side effects common to SSRIs are problematic for me due to other conditions.
Great to see you posting again & to know you're doing well. I wish you all the very best.
Wx
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Science has taken a long time to get to this interesting stage of treatment for menopause symptoms.
In the late 90's the only reason I went on HRT was to relieve hot flushes that were crippling me, total exhaustion. I stayed on it for 5 years only and when I came off it was great, no more problems with any other menopause symptoms.
Its great news for women who don't want to use hormone treatments and I will say this with another thread in mind, that 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.
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I must agree with you Ayesha, science has certainly taken a while to get to this stage. I’m so glad advances are being made at long last.
Good to hear that you are ticking along nicely, particularly with the help of VA treatments. I’m hoping to be able to continue with them too 🤞
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You're very welcome. Anxiety was probably my worst symptom of perimenopause. From the very first day of taking Sertraline I could feel the anxiety quieten. I have two GP friends who both take Sertraline for anxiety which I find very reassuring.
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Yes reading this, also makes me feel reassured that it could work for my anxiety also. It’s at the top of my list of things to ask my doctor on Thursday. I’ve got 6 weeks until I return to work, so if the sertraline can work a bit of magic prior to my return, I will be happy 😃
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Hi Wrensong, I remember how helpful and supportive you were when I was posting more jregularly on here. I still often come back to read, just don't often post.
I agree with you that your gut biome is very significant when it comes to hormones and symptom control. 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? Like you, I've spent a fortune on Actimel, Kefir and Yakult but never felt they really worked.
I would definitely give Sertraline a try, it may well prove helpful even in only a small dose as you're sensitive to ADs.
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You're very welcome. Anxiety was probably my worst symptom of perimenopause. From the very first day of taking Sertraline I could feel the anxiety quieten. I have two GP friends who both take Sertraline for anxiety which I find very reassuring.
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Yes reading this, also makes me feel reassured that it could work for my anxiety also. It’s at the top of my list of things to ask my doctor on Thursday. I’ve got 6 weeks until I return to work, so if the sertraline can work a bit of magic prior to my return, I will be happy 😃
It's definitely worth a try. My GP friend told me that even if you get negative side effects in the first couple of weeks this just shows that the Sertraline is starting to do its job.
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Thank you Wrensong for the information and links on Fezolnetant, it's encouraging to see other avenues for this particular symptom especially when it is playing havoc with daily life or sleep and HRT is not an option or for women who don't want to go that route.
Hi Nas,
Just to echo what has already been said on Setraline on this thread, it helped me over a massive hump when I couldn't take HRT post endometrial cancer. I am super sensitive to any drugs / antibiotics etc but post hysterectomy I took the plunge (I was very reluctant in all honesty) to help with night sweats and some other meno symptoms that were pretty bad and it helped to push me back out in the world without feeling like I was going to faint in supermarkets, palpitations and all manner of things, especially with driving. Of course some of these challenges are due to lack of oestrogen but it certainly helped with the post meno mental side of things. The starting dose is usually 50mg but I started on 25mg and couldn't handle that so I literally restarted on approx 6mg for a week (with pill cutter) then moved to 12.5mg for around 3 weeks then to 25mg and now 37.5mg and it has made a huge difference. It's a very low dose and I did it slowly but definitely by week 9 the difference was immeasurable and way before that definitely things were settling. Of course, if Setraline doesn't work or your doctor says it is contraindicated for your treatment there are other ones to try and as other ladies on the forum have mentioned in other threads. I have a few friends on Citalopram and they are doing well with that. The Oncologist I see recommended Venlafaxine specifically for hot flushes too. Remember there are always options :) I hope it's a good appointment on Thursday and you are settling ok on the drugs. xx
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Hi Summersky. Can I ask do you feel Sertraline very effectively suppresses your symptoms all of the time? Or do you have the occasional resurgence of symptoms like I do?
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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
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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?
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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
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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
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AyeshaI 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.
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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!!!)
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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
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Banjo1973, that's all helpful to know, thank you. I hope your daughter continues to do well & your Mum doesn't drive you insane!!
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Thank you xxx
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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.
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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
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GRLOne 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.
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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
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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