Medications That Make Perimenopause Worse: A Review You Need Before Your Next Appointment

The Medication Blind Spot Most Doctors Miss

SSRIs and Libido: A Complicated Tradeoff

Antidepressants like SSRIs (selective serotonin reuptake inhibitors) are commonly prescribed during perimenopause, and often for good reason. Depression and anxiety genuinely spike during this transition, and SSRIs can be genuinely helpful. Low-dose SSRIs and SNRIs also have evidence for reducing hot flashes.

But SSRIs also suppress libido and the ability to orgasm in a significant number of people. When you're already dealing with hormonal changes that affect desire and arousal, adding a medication that blunts sexual response creates a compounding problem.

This doesn't mean SSRIs are wrong for you. It means the conversation should be explicit. Ask your doctor: Is there an antidepressant with lower sexual side effects? Would a lower dose still help? Is there a non-SSRI option worth trying? Bupropion, for example, tends to have fewer sexual side effects, and some people actually find it improves libido.

Beta Blockers and the Fatigue Spiral

Beta blockers are prescribed for high blood pressure, heart palpitations, and sometimes anxiety. Heart palpitations are one of the most common and distressing perimenopause symptoms, which means many women end up on beta blockers during this time.

The problem is that beta blockers slow your heart rate and lower blood pressure, and one of their most consistent side effects is fatigue. When you're already dealing with perimenopause-related exhaustion, this can make you feel like you're walking through wet concrete.

Beta blockers also interfere with exercise tolerance, which matters because regular physical activity is one of the most effective tools for managing perimenopause symptoms overall. If you're on a beta blocker and your fatigue feels disproportionate, it's worth asking whether the dose is still appropriate, or whether a different medication class would manage your palpitations with less impact on your energy.

Antihistamines and Vaginal Dryness

Most people think of antihistamines as allergy pills and nothing more. But they are anticholinergic drugs, meaning they dry out mucous membranes throughout your body. That includes vaginal tissue.

Vaginal dryness is already one of the most common and uncomfortable perimenopause symptoms. It gets worse as estrogen declines. Adding a daily antihistamine, whether for allergies, sleep, or motion sickness, pours fuel on that fire.

If you're taking a daily antihistamine and experiencing vaginal dryness or painful intercourse, bring both issues to your doctor at the same time. Sometimes switching to a lower-anticholinergic option, or using vaginal estrogen to address the dryness directly, makes a significant difference. The same principle applies to some bladder medications, antidepressants, and decongestants, all of which have anticholinergic effects.

Statins and Muscle Pain: Worse Than You Think

Statins are widely prescribed to manage cholesterol, and cholesterol does tend to shift unfavorably during perimenopause as estrogen declines. So more women end up on statins during this phase of life.

Statins can cause muscle pain and weakness, a side effect called myopathy. The risk increases with age and with certain genetic variants. Here's the overlap problem: perimenopause itself causes muscle and joint aches, often quite severely. When statin-related muscle pain lands on top of hormonally driven muscle pain, it becomes very hard to tell what's causing what.

Worse, the muscle aches from statins can discourage exercise, which is otherwise protective against both cardiovascular disease and perimenopause symptoms. If you're on a statin and experiencing significant muscle pain, it's worth asking whether the dose, the specific statin, or a medication holiday could help clarify what's hormonal versus drug-related.

Benzodiazepines and the Sleep Trap

Insomnia in perimenopause is brutal. It's understandable that some women end up with a prescription for a benzodiazepine or a Z-drug like zolpidem. These medications do help you fall asleep. But the sleep they produce is not restorative in the same way natural sleep is.

Benzodiazepines and Z-drugs suppress deep sleep and REM sleep, the stages that handle memory consolidation, emotional processing, and physical recovery. Over time, they can worsen the cognitive symptoms of perimenopause, including brain fog and memory lapses, precisely because deep and REM sleep are where the brain does its maintenance work.

They also create dependency fairly quickly, so that stopping them causes rebound insomnia worse than the original problem. If you've been relying on these medications for sleep, cognitive behavioral therapy for insomnia (CBT-I) is currently the most evidence-based treatment for perimenopause-related sleep disruption. It's slower than a pill, but the results last.

Birth Control Pills in Perimenopause: Who Benefits and Who Doesn't

Low-dose combined oral contraceptives are often prescribed during perimenopause to regulate irregular bleeding, reduce hot flashes, and provide contraception. For some women, this works well. Hormonal contraception can smooth out the hormonal fluctuations that drive the worst symptoms.

But the pill also suppresses your own ovarian hormone production and replaces it with synthetic hormones. For some women, this creates its own set of problems: low libido, mood changes, or a feeling of emotional flatness that wasn't there before.

There's also the risk stratification conversation to have. Combined oral contraceptives increase the risk of blood clots and are generally not recommended if you have migraines with aura, are a smoker over 35, or have a history of cardiovascular disease. If you're using the pill primarily to manage perimenopause symptoms rather than for contraception, it's worth discussing whether menopausal hormone therapy might be a better-targeted approach as you progress through the transition.

How to Have the Medication Review Conversation

Walking into a doctor's appointment and asking to review all your medications can feel like a big ask. But this is exactly the kind of holistic review that benefits women in perimenopause, and many providers genuinely appreciate patients who come prepared.

Bring a complete list of everything you take, including over-the-counter medications, supplements, and anything you take occasionally. Note when you started each one. Note which symptoms you're most troubled by. Then ask directly: Could any of these be contributing to the symptoms I'm experiencing? Are there alternatives I should know about?

You're not asking your doctor to take you off everything. You're asking for a collaborative look at whether your current medication picture still fits your current body. That's reasonable. That's good medicine.

A Note on Not Going It Alone

It can be tempting to experiment on your own, stopping a medication here, adding a supplement there, to see what helps. Resist that temptation with prescription medications especially. Some drugs require a taper. Others have serious withdrawal effects. Some combinations create risks that only become apparent with lab work.

The goal is partnership with a provider who takes perimenopause seriously. PeriPlan's tracking features can help you document which symptoms seem to correlate with medication changes, giving you useful data to bring to that appointment. Your observations matter. Bring them.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.