PSSD or menopause? How to tell them apart
The menopause and SSRI antidepressants can both lower your sex drive. Sexual changes that began on the tablets and stayed after stopping may be PSSD.
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The menopause and SSRI antidepressants such as sertraline can both lower your sex drive and change how sex feels. If your changes began on the tablets and stayed after you stopped, it may be post-SSRI sexual dysfunction (PSSD). The leaflets in UK packs warn that sexual problems have sometimes carried on after stopping.
PSSD is more than a sex problem, even though the name says so. In 2022, doctors and researchers drew up a checklist for recognising it. At its heart is a lasting change in how your genitals feel, often numbness. It also lists feeling emotionally flat, problems with concentration and memory, and changes in other senses.
In midlife the two can arrive together. The NHS says you may be offered an antidepressant for low mood or hot flushes caused by the menopause. So you might start one just as your hormones change. When sex changes too, it’s easy to put it all down to the menopause.
The story in 3 lines
- The NHS lists a lower sex drive, vaginal dryness and problems with memory or concentration as menopause symptoms (NHS).
- The UK sertraline leaflet lists hot flushes, irregular periods and less interest in sex as common side effects, and warns sexual problems have sometimes continued after stopping (leaflet).
- Two PSSD researchers write that people may put lasting changes down to ageing (Healy and Mangin).
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Can the menopause cause the same symptoms as an SSRI?
Yes, many of them. The NHS menopause page lists a lower sex drive, vaginal dryness, sex that feels painful, low mood and problems with memory or concentration.
The UK sertraline leaflet names less interest in sex, hot flushes, extra sweating and irregular periods among its common side effects. The UK Cipralex (escitalopram) leaflet adds that women may find it hard to reach orgasm. Side by side, the two lists could describe the same woman.
Specialists in menopause and sexual health say the menopause can also change the vagina, vulva and clitoris and make sex uncomfortable. So one symptom alone won’t tell you which it is. If low mood is part of it, see PSSD or depression.
How can I tell if it’s PSSD or the menopause?
Timing is the clearest clue: when each change started, and what happened after your last tablet. The NHS says a change to your periods is usually one of the first signs of the menopause. Its symptoms often go on for years.
The PSSD checklist starts from the medicine. The change in how your genitals feel has to still be there at least three months after you stop. You shouldn’t have had the same problem before the tablets, and nothing else should explain it. Our page on when it counts as PSSD explains the three months.
Listen to your own words, too. The NHS menopause page talks about dryness, burning, itching and pain. It doesn’t mention numbness. If touch now feels muted, or no longer feels sexual, say so. That’s the one change the PSSD checklist says must be there.
Lasting changes are easy to put down to age. David Healy and Dee Mangin, two doctors who research PSSD, say orgasm can come back after stopping but “will often feel weaker than before”. Once people are off the tablets, they write, they “can attribute changes like this to ageing”. That’s even more likely, they add, because many people stay on SSRIs for years.
An example: your two timelines on one page
Can you have PSSD and the menopause at the same time?
Yes, nothing rules it out. The PSSD checklist doesn’t mention the menopause at all. It does ask that nothing else could explain the symptoms, so expect your GP to look at the menopause first.
What matters is whether the menopause explains all of it. Vaginal dryness may well be the menopause. But if your genitals have felt numb since your first months on sertraline, it’s fair to ask whether the medicine did it.
Women may not get asked the right question. Healy and Mangin write that women often describe PSSD as a loss of desire, and that changes in genital feeling “are not always volunteered unless asked about directly”. So if your GP asks only about desire, mention the numbness yourself. Our page on PSSD in women covers what women describe.
Katie took fluoxetine (Prozac), also an SSRI, for about three years from the age of 21. At 35 she still lists numb sexual sensation among her symptoms, and says she had none of them before the drug. Her clip shows PSSD from the inside. It isn’t about the menopause.
What can I do?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop suddenly.
Take both timelines, menopause and medicine, to your GP, with exact dates: “Sertraline 50 mg from January 2023, last tablet March 2024.” Add changes beyond sex, such as feeling emotionally flat or struggling to concentrate.
Three questions for your GP
- Which of my symptoms fit the menopause, and which don't?
- Could the antidepressant explain the rest, as the leaflet warns?
- Can this go in my notes as a possible side effect, and be reported to the regulator through the Yellow Card scheme?
You could start with: "The sertraline leaflet says sexual problems have sometimes continued after stopping. Mine began on the tablets, and they haven't gone."
Report it: it helps everyone
A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.
- No proof needed. A suspicion is enough, even years after stopping.
- Where: the Yellow Card scheme in the UK, MedWatch in the US. Our Yellow Card guide for PSSD shows each step.
- Use the right words. If symptoms continued after stopping, write Post-SSRI sexual dysfunction (MedDRA 10086208).
Our reporting guide walks you through it
What else do people ask?
Is vaginal dryness a side effect of SSRIs? It can be. The UK sertraline leaflet lists a “dry vaginal area” as a rare side effect, and the PSSD checklist names less vaginal wetness among the changes that can stay. Dryness is on the NHS menopause list too, so check when yours began.
Can coming off an antidepressant cause night sweats? It can. The UK Cipralex leaflet lists sweating, including night sweats, among the symptoms people can get when they stop. The sertraline leaflet says symptoms from stopping usually wear off within two weeks, though for some people they last longer. So night sweats that start soon after your last tablet may not be the menopause.
I started my antidepressant after the menopause. Can it still be PSSD? Yes. The checklist sets no age limit. It asks whether you had the same problem before the tablets, so what counts is how things were just before you started, not at 30. Write that down too.
For some people PSSD has lasted years after stopping. Nobody knows yet who will be affected, or whether it will ease. If touch has felt numb or muted since taking an antidepressant, say those words to your GP, whatever your age, and report it. Our PSSD page explains more.
Sources
- NHS, Symptoms of menopause and perimenopause, page last reviewed 19 May 2026. It lists “reduced sex drive (loss of libido)” and vaginal “dryness, a burning feeling, irritation or itching”, which “can also make sex feel painful”. It also lists “problems with your memory or concentration”. Periods: “One of the first signs of perimenopause is usually a change to your periods.” Symptoms “usually last for 7 to 9 years, sometimes longer”. The page does not mention numbness. Overview, Menopause and perimenopause: “It usually affects women between 45 and 55 but it can happen earlier.”
- NHS, Treatment for menopause and perimenopause, page last reviewed 19 May 2026. “If you have low mood, depression or anxiety caused by perimenopause or menopause, you may be offered antidepressants.” For hot flushes and night sweats, “a doctor may suggest clonidine, or an antidepressant.”
- Viatris, Lustral (sertraline) patient leaflet, electronic Medicines Compendium (UK), last revised December 2025. Section 2: “In some cases, these symptoms have continued after stopping treatment.” Withdrawal symptoms “wear off within 2 weeks. In some patients they may last longer (2-3 months or more).” Section 4, common (up to 1 in 10): “decreased sexual interest”, “hot flush”, “increased sweating”, “menstrual irregularities”. Rare (up to 1 in 1,000): “dry vaginal area”.
- Lundbeck, Cipralex (escitalopram) patient leaflet, electronic Medicines Compendium (UK), last revised May 2025. Section 4, common: “women may experience difficulties achieving orgasm”. Section 3, symptoms when stopping: “sweating (including night sweats)”.
- Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas 2014;79(3):349-54. Abstract only. Changes to the “labia majora/minora, clitoris, vestibule/introitus, vagina”; “sexual symptoms of lack of lubrication, discomfort or pain, and impaired function”.
- Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Proposed criteria from expert agreement. Necessary: “An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops.” Also “present for ≥3 months after stopping treatment”. Under “There should be”: “No evidence of pre-drug sexual dysfunction that matches the current profile”; “No current medical conditions that could account for the symptoms”. Possible symptoms include “decreased vaginal lubrication”, “emotional numbing”, “other sensory problems involving skin, smell, taste or vision” and “cognitive impairment”. The paper mentions the menopause only for persistent genital arousal disorder. It sets no age limit for PSSD. On duration: “These enduring conditions can remain for months, years or indefinitely after the causative drug is stopped.”
- Healy D, Mangin D. Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence. Epidemiol Psychiatr Sci 2024. On ageing: orgasm “will often feel weaker than before”. Also: “people can attribute changes like this to ageing for instance, especially as a large proportion of patients remain on SSRIs for many years after initiation”. On women: “females commonly frame it as a loss of libido”; changes in genital sensation “are not always volunteered unless asked about directly”.
- MHRA, Yellow Card scheme: “Reporters are asked to submit Yellow Card reports even if they only have a suspicion that the medicine or vaccine may have caused the adverse reaction.” MedDRA term: Post-SSRI sexual dysfunction, 10086208.
- Moral Medicine, I Lost My Sexual Identity After Prozac, interview with Katie, 26 May 2026, embedded as an extract from 0:35 to 1:23. From the YouTube auto-captions: “I’m 35 and I’m from the UK”; fluoxetine at 21, “for around 3 years with some gaps”; her symptoms “include loss of pleasure, physically numb sexual sensation, sexual dysfunction, anorgasmia”; “I had not ever experienced any of these issues prior to taking the drugs”. Her story on our site: Katie’s story: 14 years after Prozac. Background on PSSD, not evidence about the menopause.
Sources checked on 27 October 2026. AI-assisted writing and review, not clinical review.
This information does not replace medical advice. Talk to your doctor before you make any decision about your treatment.
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