Perimenopause with PCOS: Anxiety, Patches and Antidepressants

[FuzzyFeelingFairy]

I'm 47 and have been really struggling lately, so I'm reaching out to see if anyone has had similar experiences.

I was diagnosed with PCOS in my 20s due to infertility, and over the past year I've been noticing more signs of perimenopause — heavier painful cycles, sleep disturbances, migraines, and now high anxiety. I've been trying to manage things with supplements, but over the past few months my mental health has really taken a dive. I'm constantly anxious, not sleeping well, and plagued with fear thoughts — particularly about my loved ones. It feels relentless.

Thankfully, my GP has been amazing (which I know isn't everyone's experience), and two weeks ago they started me on HRT patches. After a particularly horrid weekend, they've also started me on antidepressants. I’m grateful for the support, but feeling pretty lost right now.

I’m struggling to find solid info about how PCOS affects perimenopause/menopause. The only thing I keep seeing is that PCOS increases your risk for anxiety and depression — which definitely feels real, but doesn’t help much with what to do about it.

I’d really appreciate hearing from anyone who:

1. Has experience with HRT patches — what were your first few months on patches like? How long did they take to help balance hormones?

2. Is on antidepressants for perimenopausal anxiety — how long did they take to kick in, and did they help?

3. Has been through perimenopause/menopause with PCOS — what was it like for you, and do you have any advice or resources you can share?

Right now I just feel desperate to get off this emotional rollercoaster and feel like myself again. Thanks so much in advance to anyone who takes the time to share.

To be blunt, GPs were told by NICE is 2015 not to prescribe ADs for peri menopause. Sadly, many are. This info is STILL in Nice guidance.
Unless you were depressed and had a sound diagnosis of depression prior to peri, SSRIs are not recommended. All the symptoms you mention are very common in peri and the treatment is not ADs.

https://www.drlouisenewson.co.uk/knowledge/antidepressants-and-menopause

Can antidepressants be prescribed for menopause symptoms?
Menopause guidelines are clear that antidepressants should not be used as first line treatment for the low mood associated with perimenopause and menopause. This is because there is no evidence that they help improve psychological symptoms of perimenopause or menopause.

Despite this clear recommendation, a Newson Health survey found that when seeking advice from a healthcare professional about their perimenopausal or menopausal symptoms, over a third of respondents (39%) said they were offered antidepressants instead of HRT as the first course of treatment [1].
While 26% of these women were offered one type of antidepressant, 8% were offered two types and 5% said they were offered more than two types [1].

Antidepressants are not effective for the low mood and anxiety associated with perimenopause and menopause as they are not treating or addressing the underlying cause of low hormone levels.

The 'proper' way to manage this is to prescribe HRT for 3 months then review the dose and type if necessary. You may need a higher dose or a change in the type of progesterone (which is in the patch.)

Using ADs at the same time means it's impossible to know if the HRT is at the right dose.

I'm sure your GP means well, but they are behind the times.

Maybe take the info above- print off the info in full- and show her if you don't feel confidence about not taking ADs without asking.