Q: Much to my own surprise (having had horrendous PMS for decades), I’ve had a fairly smooth ride in terms of physical symptoms of the menopause – no heavy perimenopausal bleeds, just a few waves of hot flushes but no night sweats, no disrupted sleep and seemingly, no memory problems etc.
However, now I am nearly 52, my mood is very very low. I feel very sad and empty about mistakes and missed opportunities in my life and tussle with a lot of feelings of guilt and shame (and jealousy).
About to see my GP and wondering if this is depression separate from my hormone changes or closely related. (There are a number of objective life factors that I’m struggling with). Is there any particular SSRIs that are recommended in this situation? (I don’t particularly suffer from anxiety – though I have my moments).
I’m more than 18 months on from my last period.
A: It is good to hear that the physical side of menopause is not too bad. When menopause comes at the usual time (around 50), it coincides with life events and ageing, both of which can play a real role in our emotions and psyche. Any low dose SSRI will help depression but NICE Guidance in the UK suggest that low mood (rather than clinical depression) at menopause should be treated first with HRT or Cognitive Behavioural Therapy (CBT). With your GP it will be helpful to really assess if you have depression or hormone related low mood. This can be hard, but many women can tell the difference themselves, recognising when honest, the stress factors or life events that neither HRT or antidepressants will change. CBT or counselling might be a better option in that case. Here is a link to a leaflet about CBT and menopause.