Thursday 22 February 2018

Dear Dr Nina: Will SSRIs ease symptoms of menopause?

Menopause is by definition the end of menstruation. Stock photo
Menopause is by definition the end of menstruation. Stock photo

I am a 42-year-old woman and am going through the menopause. My mother died young, so I am not sure if early menopause is something I inherited. My GP confirmed I am menopausal and I suffer from a lot of symptoms - hot flushes, sleeplessness and anxiety. It is really stressing me out - I also had a bereavement recently - so my doctor has suggested I try a low dose, 5mg, of an SSRI, as well as suggesting HRT. Is the anti-depressant dosage low enough that I can just stop it whenever I want?

A Menopause is, by definition, the end of menstruation. It occurs between the ages of 40 and 58 with the average age being 51. Many women enter menopause not knowing what to expect or how long it will last. This lack of information can lead to fear and anxiety, which can make the whole experience worse. The important thing to remember is that the end of menstruation is as natural a process as the beginning of it and this does not need to be a time of fear, upset or discomfort.

Menopause occurring at 42 may seem early but it is within the realm of normal. The average age of menopause does seem to have a familial tendency. The years leading up to the end of menstruation can start up to 10 years prior to the final menstrual period. This phase is referred to as perimenopause and during this time periods may change or become more erratic. Hot flushes and urinary symptoms such as passing urine more often or episodes of stinging or discomfort passing urine occur in some. The phase of actual menopause starts with the last menstrual period and lasts officially 12 months from that date.

Symptoms vary hugely among women with some cruising through this time symptom-free while others suffer prolonged disabling symptoms. Hot flushes can occur - these are episodes of an intense feeling of heat and redness that passes from the chest up to the face and can be associated with profuse sweating. Other common symptoms include cystitis or urinary infections, vaginal dryness, skin changes, weight gain, and mood changes.

Once a year has passed since the last menstrual period the phase becomes post-menopause and this lasts the rest of a woman's life. Menopausal symptoms last on average from six months to five years but in a small percentage (about 15pc) of women may carry on much longer than that.

It seems cruel that nature drops this change at a time in a woman's life when many other things may be happening. Children may be leaving home, parents may be growing elderly or dying and women themselves may become grandparents. Anxiety and stress are not a normal part of menopause but other factors occurring in the perimenopausal period may make it harder to cope with the emotional impact of the end of your fertile years. Relief from symptoms can become a bit of a crusade for those affected. HRT is still prescribed in those with disabling symptoms but at the lowest dose effective for the shortest time possible. HRT is effective for hot flushes and vaginal and urinary symptoms but its benefit in other symptoms is not proven.

HRT doesn't work for anxiety so your GP has prescribed an ssri. You don't mention the brand but escitalopram is commonly prescribed and 5mg is the lowest dose. SSRIs can be stopped without weaning if you are taking the lowest dose. There is a chance, however, that such a low dose may not provide any beneficial effect. I would also stress that counselling, mindfulness, self-help books, and eating well and exercising are also likely to help your menopausal symptoms and your mood.

I have been recently diagnosed with arthritis. Are there changes to my diet or lifestyle that can help alleviate symptoms?

A. It has been estimated that one-in-six Irish people suffers from arthritis. Women are more likely to be affected than men and it is a factor in up to 30pc of GP consults. There are more than 100 different types. The majority of cases of arthritis present in people over the age of 55. The most common form of arthritis in this age group is osteoarthritis. This develops when cartilage (a tissue that covers the ends of bone in a joint) becomes worn down.  Osteoarthritis is most common in the hips, knees, and spine although it can occur elsewhere.

Obesity makes arthritis worse. The skeleton is put under serious strain by excess body weight. Maintaining activity is vital as exercise helps preserve the movement and function of the joint. Water-based exercise can be especially helpful.

There is no cure for osteoarthritis so the goals of treatment are to reduce pain, improve mobility and improve muscle strength. Be as active as possible as inactivity leads to deterioration of the condition. Anti-inflammatory drugs such as Ibuprofen are usually very helpful but long-term use should be under medical supervision. Other analgesia is usually prescribed in a stepwise manner.  Following a recommended exercise plan can provide huge benefits. 

Those affected often seek alternative remedies. Glucosamine and chondroitin, minerals derived from shellfish, are often tried. Most benefits were shown for glucosamine sulphate at doses 1,500mg a day but it has had mixed results in studies. I often recommend trying this but if there are no benefits after three months it’s probably not worth continuing, as it doesn’t help everyone.  Fish oils can help and are often recommended. Eating well and leading a healthy active life is paramount in maintaining good joint health.

Health & Living

Promoted Links

Life Newsletter

Our digest of the week's juiciest lifestyle titbits.

Promoted Links

Editors Choice

Also in Life