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Deborah - Interview 05

Age at interview: 48
Brief Outline: After suffering increasingly severe premenstrual tension (PMT) for which she was prescribed citalopram, Deborah saw a menopause specialist. Monthly Prostap injections for 4 months induced a medical menopause. Now free of PMT she is on HRT.
Background: Deborah is postgraduate student. She is married with three adult children. She started the menopause at age 46. Ethnic background/nationality' White British.

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Deborah’s menopause story is closely linked to her experience of premenstrual tension (PMT). After increasingly severe PMT characterized by feelings of paranoia and mood swings which she describes as ‘really horrible, terrible, debilitating, frightening’, Deborah consulted her GP and was prescribed the antidepressant citalopram. However, this had a negative effect on her sex life by inhibiting orgasm and she decided to discontinue its use, experiencing unpleasant side effects associated with withdrawal.

Disillusioned with the service provided by her GP, Deborah had a more sympathetic response from a specialist whom she consulted privately. After carefully explaining the physiological process of menopause, he prescribed a course of monthly Prostap injections over a four month period to induce a medical menopause with the aim of suppressing ovulation and eradicating PMS. Menopausal symptoms followed, with a gradual drying up of periods, and hot sweats at night which disrupted her sleep. Much to her relief, Deborah found that her PMS symptoms eased.

At the end of her treatment, Deborah was fitted with a Mirena coil and prescribed HRT (Evorel patches, 100mg). Deborah is unsure, however, why she has had the coil fitted or how the patches really work. Her understanding is that the patches suppress ovulation and thus prevent hot flushes. She wishes, however, that the patches were better designed, noting that they leave ‘filthy plaster marks’ when removed.

Deborah feels on the brink between being a young person and moving into later life. Fed up with colouring her hair, she is ready to go grey, but is unhappy with what she describes as menopausal weight gain. A devoted mother who takes pride in her children’s achievements, Deborah is looking forward to becoming a grandmother. At the same time, however, as a postgraduate student she is excited by new career options which are opening up.

Deborah was interviewed for Healthtalkonline in December 2008.

 

Deborah’s moods went ‘haywire’ and she experienced problems reaching orgasm while taking...

Deborah’s moods went ‘haywire’ and she experienced problems reaching orgasm while taking...

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And then with the citalopram treatment that sent my moods just haywire, and I felt frightened because at that point a couple of times I felt myself sitting in what should have been familiar environments like my sitting room, not feeling at home, and like things were out of perspective, and it was very frightening.

And you said the citalopram had an impact on your sex life. Can you talk a little bit more about that.

Yeah I’ll tell you about that because I would really like other women to, well I’d just like to share some of this really because I think on the packet, the information that comes with them, it talks about, I think it did actually mention, well there was something about sex life. But what it did to me was meant that I couldn’t have orgasm, and so it took a bit of, well, I worked this out after so maybe it’s two or three goes at sexual intercourse and I couldn’t come basically, so I went back to the GP and I saw the younger GP and he was fine about it, but it was as though, yes I remember him saying to me, “Well this is unusual”, so I thought well I wonder if it is actually, and I don’t know*.

Fair enough when I was on it, it improved my mood, it did. And if I’d have stayed on it, then I’d have been kind of like happy but you know I didn’t want that.

So I finished the citalopram because of the sexual side effects but there again I didn’t get advice about coming off it gradually so that was just horrible and scary because, I was only on about 20mg or something, but I finished straight away and it was very frightening, I did feel quite paranoid.

[* Note' difficulty reaching orgasm (anorgasmia) can be a side-effect of citalopram]

 

Deborah describes her consultation with a specialist

Deborah describes her consultation with a specialist

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But the specialist was more sympathetic, I felt because I’d gone private I’d got more time, he tried drawing diagrams and explaining hormones, but I still don’t get it. So he said that he kind of allowed me to trust him, and I felt that I trusted him, I trusted his specialist knowledge, and his expertise and he said that if I would go along with some treatment, things might get worse, he explained that he would put me through the medical menopause and so things would get worse for well up to six months I think he was saying at that time. But then after that things would improve, so the way he explained, I think, was that my PMS was linked to ovulation, so if he could suppress ovulation then the PMS would go away.

My GP wasn’t happy, I ended up going back to the same practice, but seeing the older doctor who I’d seen before and just, when I’d seen him originally about PMS his response then was, “Oh my wife suffers a lot, so what I suggest you do is stick a flag on your desk and…”, oh, it was just completely inadequate because I wasn’t coping with daily life really.

 

Deborah is ready to go grey though she knows it will age her ten years

Deborah is ready to go grey though she knows it will age her ten years

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I think I’m ready to go grey, that’s a big thing for me somehow about colouring my hair. I’m fed up of colouring my hair and I know that it would immediately make me look ten years older. So there’s something very physical and kind of stereotypical and immediate about that aspect of my appearance, that’s kind of an issue for me.

 

Deborah and her husband are going through a rough patch but they’re ‘muddling through’

Deborah and her husband are going through a rough patch but they’re ‘muddling through’

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And your sex life, did it [menopause symptoms] affect that?

Well that’s been up and down because of his issues as well anyway really. So we’re kind of muddling through and I think he understands.

I feel like my libido has gone off a bit but we’ve been together for years, so we’ve been through ups and downs, and at the moment it feels like we can, no not always, sometimes it feels pretty, pretty difficult, but I remember I think I heard this on the radio, somebody talking about intimacy, and it was probably like a marriage guidance person or something like that and they were saying that intimacy is not just intercourse, and I think I’ve hung onto that, and sometimes it’s about actually sharing personal private things and so at least you feel close.

 

Deborah describes what happened when she took the antidepressant citalopram for unbearable...

Deborah describes what happened when she took the antidepressant citalopram for unbearable...

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I couldn’t cope with the PMS (premenstrual syndrome/tension) so I took my husband along to the GP and I saw a younger GP in that practice, and I think he could understand then the severity of my symptoms, which were heavy periods, and I felt like I was kind of going a bit paranoid, so he prescribed citalopram* at that stage, which I think is kind of like a Prozac type thing. And I took that for a while, and that was quite upsetting, because for a fortnight it made me feel quite zonked out and my husband was not sympathetic. He seemed to think that, well he just didn’t seem to understand, and then what I found, and probably this is more relevant to PMS, and it’s fine if you don’t want to use this bit but, it affected my sex life really, and I felt like I hadn’t been given clear information about that as a side effect.

And you said citalopram had an impact on your sex life, can you say more about that?

Yeah I’ll tell you about that because I would really like other women to, well I’d just like to share some of this really because I think on the packet, the information that comes with them, it talks about, I think it did actually mention, well there was something about sex life. But what it did to me was meant that I couldn’t have orgasm, and so it took a bit of, well I worked this out after so maybe it’s two or three goes at sexual intercourse and I couldn’t come basically, so I went back to the GP and I saw the younger GP and he was fine about it, but it was as though, yes I remember him saying to me, “Well this is unusual”**, so I thought well I wonder if it is actually, and I don’t know.

Fair enough when I was on it, it improved my mood, it did. And if I’d have stayed on it, then I’d have been kind of like happy but I didn’t want that.


[* Note that antidepressants such as fluoxetine and citalopram are sometimes prescribed in the treatment of severe premenstrual syndrome, although they are not licensed for this purpose.
** difficulty reaching orgasm (anorgasmia) can be a side effect of citalopram.]

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