Voy consumer survey data, 2026 (Voy internal)
Key takeaways
- SSRIs are frequently prescribed to women going through perimenopause and menopause for symptoms like low mood and anxiety, sometimes instead of HRT.
- Sexual side effects, including reduced interest in intimacy, difficulty with arousal, and changes in orgasm, are among the most common but least discussed side effects of SSRI use.
- If SSRIs were prescribed for what might actually be menopause symptoms, it is worth exploring whether hormonal treatment could address the root cause more effectively.
When the solution creates a new problem, you deserve to know about it. You went to your GP feeling unlike yourself. Low mood, anxiety, disrupted sleep, a general flatness that was hard to explain. You left with a prescription for antidepressants. For many women in perimenopause, this is exactly what happens.
Selective serotonin reuptake inhibitors, or SSRIs, are among the most prescribed medications in the UK. They are effective for clinical depression and anxiety disorders and there are situations where they are absolutely the right treatment. But for women in midlife whose symptoms are driven by hormonal changes, SSRIs are sometimes prescribed when the underlying cause has not been fully explored. And when SSRIs are the answer to a question that was never quite the right question, the effects on intimacy can become part of the problem.
This article explains what SSRIs do to sexual function, why this matters particularly at menopause, and what your options are if you recognise yourself in this picture.
How SSRIs affect sexual function
SSRIs work by increasing the availability of serotonin in the brain. This can lift mood and reduce anxiety, but serotonin has a complex relationship with sexual function. Higher serotonin levels tend to dampen dopamine, the neurotransmitter more closely linked to motivation, pleasure, and arousal.
The result, for a significant proportion of people who take SSRIs, is a noticeable change in their experience of intimacy. Research consistently shows that sexual dysfunction is one of the most common side effects of SSRI use, though it is the least likely to be raised in a standard appointment.
The effects can include:
- Reduced interest in intimacy
- Difficulty becoming aroused
- Reduced sensation
- Delayed or absent orgasm
- A general sense of emotional flatness that extends to physical connection
These effects can begin within the first few weeks of starting treatment. For some women they settle over time. For others, they persist for as long as the medication is taken, and in some cases, difficulties with sexual function can continue after stopping SSRIs.
The blood flow question
There is an additional mechanism that researchers are beginning to explore: the possibility that SSRIs may affect blood flow to vulval and vaginal tissues. At menopause, falling oestrogen already causes changes to these tissues, making them thinner, less elastic, and more sensitive. If reduced blood flow compounds this, the effect on comfort and arousal could be significant.
It is important to be clear about the evidence here. At this point, research suggesting SSRIs restrict blood flow to vulval and vaginal tissue is at an early stage, largely from animal studies. This does not mean it is not relevant, but it does mean it should be framed as an emerging area of interest rather than established fact. If you are on SSRIs and experiencing genital discomfort or changes in sensation, this is worth raising with a clinician who can assess what is driving your symptoms.
When SSRIs are prescribed for menopause symptoms
One of the most important things to understand is that the symptoms SSRIs are intended to treat, low mood, anxiety, sleep problems, irritability, difficulty concentrating, overlap significantly with the symptoms of perimenopause and menopause.
This is not a failing of individual GPs. Menopause training in medical education has historically been limited and a standard appointment rarely allows the time needed to fully explore what is happening hormonally. But the consequence is that some women spend years on antidepressants when hormonal change was the underlying driver and their symptoms, along with any sexual side effects from the medication, continue to go unaddressed.
A Voy consumer survey found that 57% of women aged 38-70 had never spoken to anyone about their sexual health symptoms and only 13% had ever raised the subject with a medical professional. These numbers reflect not embarrassment alone, but a healthcare experience that has not always made space for these conversations.
What you can do if this resonates
If you are on SSRIs and experiencing changes in intimacy or if you suspect that your low mood or anxiety may be connected to hormonal changes rather than clinical depression, there are several things worth knowing.
You do not have to accept this as a fixed situation. Sexual side effects from SSRIs are real and recognised, but they are not inevitable or permanent. Options exist, including adjusting the type or dose of medication, exploring whether hormonal treatment might address the root cause, or combining approaches.
“Stopping SSRIs without medical guidance is not advisable. This is important. Antidepressants should never be stopped abruptly, and the decision to change, reduce, or stop medication should always involve a clinician who understands your full picture. This article is not a recommendation to stop taking medication.”
HRT and SSRIs can be used alongside each other. For women whose symptoms have both a hormonal and a psychological component, combining HRT with an SSRI can be very effective.
Vaginal oestrogen is worth knowing about. Vaginal oestrogen (a topical treatment that helps restore tissue health without the systemic effects of full HRT) is a safe and well-evidenced option for many women. It can help with dryness, discomfort, and the physical changes that make intimacy feel difficult, and it can often be used even by women for whom systemic HRT is not suitable.
Having the conversation
One of the things that makes this territory difficult is how rarely it gets discussed. It can feel awkward to raise intimacy with a GP. It can feel ungrateful to mention that a medication that has helped your mood has changed your experience of connection. It can also feel uncertain, because you may not be sure whether what you are experiencing is menopause, medication, stress, or something else entirely.
All of those feelings are understandable. And all of them are reasons to seek out a clinician who has the time and the specialism to help you work through them properly.
If you recognise yourself in what this article describes, whether you are on SSRIs and wondering about the effects, or you have been told your symptoms are depression when something else might be going on, a 45-minute consultation with a BMS-trained menopause specialist is a chance to see your whole picture for the first time. Not just a prescription, but a proper look at what is driving what you are feeling, and what the options actually are.
