In Focus: Menopause - Non-hormonal medication

[OvacomeSupport]

Dear All

I'm sorry the In Focus posts have reduced lately, I will be back on track in May and we'll be looking at diet, do let me know any topics you would like covered as part of this.

To end the topic of menopause, here is some information on non-hormonal medications, which our lovely volunteer Yesim, who is a pharmacist, has kindly written for us:

This is to let you know about medication that can be prescribed by your doctor for menopausal symptoms especially if you are unable to take Hormonal Replacement Therapy (HRT). These include:

- Citalopram

- Paroxetine

- Venlafaxine

- Clonidine

Symptoms of menopause can be many or few, and may affect your every day life, including:

Hot flushes

Night sweats

Low mood

Anxiety

Vaginal dryness

Problems sleeping

Decreased sex drive

Problems with memory

Problems with concentration

These symptoms can vary from individual to individual. Surgical menopause symptoms can be more severe than natural menopause. You may also find that even if you have gone through natural menopause, surgery for ovarian cancer can trigger further menopausal symptoms.

HRT is the most common treatment for most of these symptoms; however, there are many circumstances where you are unable to take HRT. This could be due to your personal preference or your medical history. HRT for ovarian cancer is a complex issue which you will need to discuss with your oncologist.

Here we would like to let you know about other options for the treatment of menopausal symptoms.

There are some antidepressants which can be beneficial during menopause.

Citalopram and Paroxetine both belong to a group of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs), which are commonly used to improve depression. SSRIs work by increasing serotonin levels in the brain. Serotonin is a substance which already exists in our body and helps keep our moods stable. Taking citalopram or Paroxetine may help with low mood and anxiety, and it is also sometimes prescribed for hot flushes.

Apart from the regular side effects listed on the patient information leaflets for SSRIs, a new study suggests that they may increase the risk of bone fracture by approximately 76% if taken during menopause for over 2 years. To read more about the study please check the link below:

nhs.uk/news/medication/anti...

There will be treatments available to help manage your risk of bone fracture.

You can read more information about SSRIs, citalopram and paroxetine on the NICE and NHS websites at following links:

bnf.nice.org.uk/drug/citalo...

bnf.nice.org.uk/drug/paroxe...

nhs.uk/conditions/ssri-anti...

Venlafaxine is another antidepressant, which belongs to a group of medicines called Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs), which work in a similar way to SSRIs. Venlafaxine like citalopram and paroxetine has an immediate relief on hot flushes and night sweats in menopausal women within 2 weeks of its use. However, like all medicines venlafaxine also has side effects, such as nausea and gastrointestinal symptoms.

You can read more about venlafaxine on the NICE and NHS websites using the following links:

bnf.nice.org.uk/drug/venlaf...

beta.nhs.uk/medicines/venla...

Apart from SSRIs and SSNRIs there is also a medicine called Clonidine. Clonidine acts by reducing the heart rate and relaxing the blood vessels the blood flows easily through the body, this in return reduces blood pressure and also eases symptoms of hot flushes and excessive sweating. You may be recommended clonidine for its dual effects on the body. But like the SSRIs and SSNRIs it has side effects including, drowsiness, dizziness, dry mouth, and gastrointestinal effects. However, most of these side effects are temporary and should resolve in a few weeks.

You can read more about clonidine on the NICE website using the following links:

bnf.nice.org.uk/drug/clonid...

If you decide to take any of the listed medication above and your symptoms do not improve after several weeks, you will need to let your doctor know.

Before starting any new medication, it is important to inform your doctor about any medication you are already taking including any over-the-counter and herbal remedies. Also let them know about medical conditions and allergies you have.

Menopause Matters is a website with lots of useful information at the following link: menopausematters.co.uk

We hope this information is helpful. Do get in touch if you have any queries.

Best wishes

Yesim & Anna

[Tempestteapot]

Thank you! I tried Venlafaxine recently and the side effects were hideous! Clonidine seems to have the least serious side effects (unless you already have low blood pressure). The loss of bone density with SSRI's is rather worrying too!

[OvacomeSupport Partner My Ovacome Team in reply to Tempestteapot]

Dear Tempsetteapot

Thank you for taking the time to share your experience. I'm sorry to hear you had such a rotten time with Venlafaxine. I hope you have found an approach to managing your symptoms that works for you now?

With regard to side effects including bone density loss, it's always worth discussing with your doctor so you can weigh up the risks versus benefits for you as an individual. There are medications to help with bone density loss, and the increased risk, which remained small overall, was observed when taking the SSRIs for over 2 years, whereas you may not need to take them for that long. If you're worried about bone density you can also ask for a DEXA scan which will measure your bone density.

If you need any more information on menopause treatments, do let me know.

Best wishes

Anna

[Cinderella]

I have found meditation mindfulness, exercise, diet and changing my lifestyle has helped me manage my menopausal symptoms after having surgery for ovarian cancer in Sept 2012. I was prescribed a homeopathic medication when I was referred to the hospital for Integrative Medicine in Dec 2015 for hot flushes and only needed to take it for 6 months since I continued with my medtation etc. I have learnt to listen to my body and have noticed that I usually start feeling hot and uncomfortable when I get angry or am stressed. I have therefore decided to try to relax more. I have also found breathing deeply and focusing on the breath calms me down very quickly and as a result I do not get hot flushes any more. I am also sleeping better and have a lot more energy. I am a retired pharmacist and I believe strongly that medicines and lifestyle changes work well together and often reduce the need to have too many medicines together or to have a medicine for a short time for certain conditions. It is not always easy to make lifestyle changes but it is definitely worth the effort especially when you experience the results.

[OvacomeSupport Partner My Ovacome Team in reply to Cinderella]

Dear Cinderella

Thank you for taking the time to let us know of your experience, and for such an informative reply. Recognising your individual triggers and making changes can have a huge effect, as you experienced. It's great to hear how well you're doing and what a positive impact your approach has had.

Best wishes

Anna

[bamboo89]

I'm not posting about menopause, but to ask if, under your Diet post, you might be able to include any clear recommendations about how to eat when you know you have ovarian cancer - there are zillions of 'cancer diets' out there, from full on vegan/organic all the way through to ketogenic. Its obvious that sugar has to go, but very difficult to work out whether its okay to continue eating some meat, fish, eggs and particularly dairy, which seems to have a bad rep when it comes to cancer, or whether its wisest to adopt a strict vegan approach. All in the hope it might make a difference to the progress of the disease, of course, though it might be that diet makes no impact either way on OC.

[OvacomeSupport Partner My Ovacome Team in reply to bamboo89]

Dear jwilliamsb

Thank you for taking the time to let me know what would be useful. We'll look to include vegan approaches and some of the anti-cancer diets in the May posts.

Best wishes

Anna

[Hidden]

Also on the subject of diet. I think a round-up of advice around bowel issues which many of us contend with would be helpful: white diet; high/low fibre; low fibre/low residue etc etc, what to do if you feel a blockage threatening; dealing with constipation ... and the opposite . Many of us have ended up doing a lot of anxious research ourselves and it would be good to avoid thisin the future.

[OvacomeSupport Partner My Ovacome Team in reply to Hidden]

Dear Mac27-UK

Thank you for this feedback. We'll make one of the posts in May about diet & bowel issues. As you say, it affects a lot of people and advice can be confusing.

Best wishes

Anna