Amitriptyline is one of the most useful medications for managing pelvic pain because it helps several different symptoms at once. It doesn’t suit everyone, but if you are someone with pain on most days it often improves pain. Around 1 in every 2 people who try it find it helpful.
Amitriptyline isn’t a pain killer, so you won’t feel better straight away, but when taken every day in very small doses it can help a range of different problems including:
- A sharp or burning pain.
- An overactive bladder. You may need to go to the toilet often, get up at night to pass urine or rush to the toilet.
- A pelvis where everything just feels ‘sensitive’.
- Painful pelvic muscles or tender points in other muscles like your neck or shoulders
- Migraine or other headaches
- An irritable bowel
- Poor sleep
- Painful vulval skin
- A bloated feeling
A long time ago, Amitriptyline used to be used in high doses (around 150mg daily) to treat depression, and it is still called a ‘tricyclic anti-depressant’ on the packet insert, even though no-one uses it for that anymore. If you are depressed there are newer and better medications (such as Duloxetine) you can use, if you need them.
For pelvic pain we use Amitriptyline in low doses (5-25mg daily). This dose can be continued long term if it suits you.
When you first start amitriptyline, you will often find that you sleep better at night. Some people still feel sleepy in the morning, but many wake up easily and have no problems. Always take it early in the evening around 3 hours before bed. Take it every evening, not just on the days you have pain and then ask yourself in a few weeks time ‘Do I feel better?’, ‘Is my life a bit easier now?’. ‘How are my headaches?’ ‘How is my bladder?’. If you are feeling generally better, then you should continue to take it. It is not addictive and can be taken long term if needed.
Each blue tablet contains 10mg amitriptyline. It can be broken in half by placing it on a bench and pushing down on both sides with two fingers, or by using a pill-cutter. You should start with a dose of 5mg taken early in the evening, preferably 3 hours before bed.
You should stay on this dose until not sleepy in the mornings then increase to 10mg. After around a week or so on 10mg you can increase it slowly by adding 5mg every few days or so. If you are sleepy on the medication, then stay on the dose you are on, or a slightly lower dose. The sleepiness usually wears off in around a week.
The right dose for each person varies and like most medications, women often suit a lower dose than men. Some women find that just 5-10mg at night makes a big difference to their pain. It is all they need and there is no need to try a higher dose. Other women, especially those with an irritable bladder or bad headaches, may be better on a higher dose, up to 25mg in the evening. Men may be able to take higher doses.
You are the one to decide which dose helps your pain most but doesn’t make you too sleepy. It is better to be on a smaller dose that you are happy to continue taking, than a larger one that you stop using due to side effects. There is a 25mg tablet (yellow) available if that dose suits you best.
