Ministry of Menopause

Antidepressants for Perimenopause? What Your Doctor Missed

You went to your GP with anxiety. Or brain fog. Or insomnia that came out of nowhere. Or heart palpitations that sent you to A and E. Or a fatigue so deep that no amount of sleep made any difference. Your blood tests came back normal. You were told there was nothing wrong. You were offered antidepressants. And at no point, in any of those appointments, did anyone say the word perimenopause. If this is your story, you are not alone. You are one of hundreds of thousands of women whose perimenopause has been misdiagnosed as depression, anxiety, or stress, and this episode of the Ministry of Menopause explains exactly why it happened, what the science says, and what you can do about it now. Dr Golda is a practising GP herself and she is clear that this is not about blaming doctors. It is about naming a systemic gap in training and awareness that is leaving women undiagnosed for years. Perimenopause can begin in the late thirties. Its symptoms extend far beyond hot flushes and irregular periods. Anxiety, panic attacks, brain fog, insomnia, rage, heart palpitations, fatigue, joint pain, histamine reactions, and cognitive changes are all well documented features of the perimenopausal hormone transition. Yet many GPs are still relying on a single FSH blood test to rule perimenopause in or out, despite the fact that FSH fluctuates so wildly during this stage that a single reading is clinically unreliable. Women are being told their bloods are fine when the blood test itself was never the right diagnostic tool in the first place. In this episode, Dr Golda walks through what the misdiagnosis pattern looks like in practice, tells the story of a typical woman in her early forties whose symptoms were dismissed, and explains what NICE guideline NG23 actually says about antidepressants versus HRT as first line treatment for menopause related mood symptoms. She also explains her integrative four pillar assessment model, shaped by training at Vancouver Coastal Health in Canada, which looks beyond hormones alone to include cortisol and HPA axis dysregulation, mast cell activation and histamine intolerance, and gut health including the estrobolome. This is the episode that arms you with the knowledge to walk into your next appointment and advocate for the assessment you deserve. Dr Golda also discusses why she built the Known by Dr Golda symptom tracker, available at drgolda.com, which tracks 36 perimenopause and menopause symptoms daily, generates a visual heat map of your patterns over time, and produces a consultation report you can take to your doctor. Because when you walk into an appointment with data instead of descriptions, you change the entire dynamic of that consultation. Data gets taken seriously. Vague feelings get dismissed. This episode explains why tracking is the single most powerful act of self advocacy you can take right now. This Episode Answers Can perimenopause be misdiagnosed as depression? Why did my doctor give me antidepressants instead of HRT? Are blood tests accurate for perimenopause? Why was my FSH test normal when I have every symptom of perimenopause? What should a proper perimenopause assessment include? Can I ask my GP for HRT? What does NICE guideline NG23 say about menopause treatment? Is it perimenopause or anxiety? Can perimenopause cause panic attacks? Why does my doctor not believe I am in perimenopause? Can perimenopause cause heart palpitations? Is brain fog a symptom of perimenopause or depression? Should antidepressants be first line for menopause? What is the difference between perimenopause anxiety and generalised anxiety disorder? Can perimenopause start at 38? Can perimenopause start at 40? What is an integrative approach to menopause? What is the HPA axis and how does it relate to perimenopause? Can perimenopause cause histamine intolerance? What is the estrobolome? How do I advocate for myself at the GP? Should I get a second opinion about perimenopause? Why are so many women in perimenopause being put on antidepressants? Can you have perimenopause with regular periods? Topics Covered in This Episode The widespread misdiagnosis of perimenopause as depression, anxiety, and stress across the UK and internationally. Why a single FSH blood test is clinically unreliable during the perimenopausal transition and should not be used to rule perimenopause out. The story of a typical woman in her early forties whose symptoms were dismissed and who was prescribed antidepressants without a hormonal assessment. What NICE guideline NG23 says about first line treatment for menopause related mood symptoms and why it is still not being consistently followed in primary care. The difference between clinical depression that exists independently of hormonal change and mood symptoms driven by the perimenopausal hormone transition. The role of nuance in clinical decision making and why antidepressants are appropriate for some women in perimenopause but should not be the default first response when the hormonal picture has not been explored. Dr Golda’s four pillar integrative assessment model: hormonal assessment, HPA axis and cortisol regulation, mast cell activation and histamine intolerance, and gut health including the estrobolome. How training at Vancouver Coastal Health in British Columbia shaped Dr Golda’s whole person approach to menopause. The Known by Dr Golda symptom tracker and why daily symptom data transforms the quality of a clinical consultation. How to advocate for yourself at your next GP appointment including asking for a perimenopause assessment and referencing NICE guidelines. Why the misdiagnosis of perimenopause is not just a medical error but a message that tells women their experience is not real. Mentioned in This Episode NICE guideline NG23 on the diagnosis and management of menopause. The Society of Obstetricians and Gynaecologists of Canada menopause guidance. Known by Dr Golda symptom tracker with 36 symptom daily tracking, heat map visualisation, and downloadable GP consultation report at drgolda.com. Dr Golda’s integrative four pillar perimenopause assessment model. Vancouver Coastal Health integrative clinical training. Full clinical resources, education, and support at drgolda.com. Daily perimenopause and menopause content and community on Instagram @doctorgolda. Share This Episode If this episode explained what has been happening to you, share it. Share it with the friend who was sent home without answers. Share it with your WhatsApp group. Share it with your GP if you feel comfortable doing so. Post it in your Instagram stories and tag @doctorgolda. Leave a review on Apple Podcasts or Spotify so that the algorithm puts this episode in front of more women who need to hear it. Every share puts this information in front of another woman who is sitting in her kitchen right now wondering what is wrong with her when the answer is nothing. She is in perimenopause and she deserves to know. About Dr Golda Dr Golda is a doctor with over twenty years of clinical experience across the UK and Canada. She holds dual board certification in the UK and Canada, and the Management of Menopause Certificate with the British Menopause Society. She trained at Vancouver Coastal Health in British Columbia, where she developed her integrative approach combining evidence based medicine with holistic, whole person care. She is the host of the Ministry of Menopause podcast and the founder of drgolda.com, where she is building a clinical and educational platform for women in perimenopause and menopause worldwide. This podcast provides general health information and is not a substitute for individual medical advice. Do not stop or change any prescribed medication without consulting your own healthcare provider.

I Don’t Recognise Myself Anymore (Perimenopause Identity Crisis)

“I used to be the fun one. Now I just feel beige.” Those were the exact words a patient said to Dr Golda in a recent consultation, and they capture something that millions of women in perimenopause feel but rarely hear anyone name out loud. The loss of identity during perimenopause is one of the most common and least discussed experiences of this stage of life. Women describe feeling like strangers in their own bodies, losing interest in things they once loved, withdrawing from friendships and social life, and no longer recognising the person looking back at them in the mirror. It is not a small thing. It is not vanity. And it is not something you should just push through in silence. In this episode of the Ministry of Menopause, Dr Golda explores why the perimenopause identity crisis happens, what is driving it on a hormonal and neurological level, and why reclaiming your sense of self is not a luxury but a genuine clinical priority. Drawing on over twenty years of medical practice across the UK and Canada, including formative integrative training at Vancouver Coastal Health in British Columbia, Dr Golda explains why so much of what women experience as low mood, loss of motivation, social withdrawal, and flattened personality during perimenopause is actually a grief response. You are grieving a version of yourself that you think has gone. But she has not gone. And that is the conversation this episode is here to have. This is not a clinical lecture about oestrogen levels. This is a conversation about you. The actual you. The woman who used to dance without thinking about it, who had opinions, who wore the bold lipstick, who stayed up late because she was excited about something rather than because she could not sleep. Dr Golda talks about why those things matter clinically, not just emotionally, and gives you one practical thing you can do this week to start reconnecting with the woman you were before perimenopause moved in and rearranged the furniture. If you listened to the recent Ministry of Menopause episode with Danielle on fashion, style, and identity in menopause and it resonated with you, this episode goes deeper into why that conversation matters so much and why identity, confidence, and self expression are not separate from your health but central to it. Whether you are in early perimenopause, deep in the transition, or postmenopausal and still trying to find your way back to yourself, this episode was made for you. This Episode Answers Why do I feel like a different person in perimenopause? Is it normal to lose your identity during menopause? Can perimenopause change your personality? Why do I feel so unlike myself in my forties? How do I get my confidence back during perimenopause? Why does menopause feel like grief? Can hormonal changes affect your sense of self? Why have I lost interest in everything during perimenopause? Is perimenopause personality change permanent? Why do I feel flat and empty in perimenopause? Can perimenopause cause loss of motivation? Why do I feel invisible since starting perimenopause? Is identity loss a symptom of menopause? Can perimenopause make you withdraw from friends? Why do I not enjoy things I used to love anymore? Does perimenopause cause emotional numbness? Can you get your personality back after menopause? Why do I feel like I have lost myself? Is it perimenopause or depression? Can perimenopause change who you are? Topics Covered in This Episode The perimenopause identity crisis and why it affects almost every woman going through the hormonal transition. Why the loss of self in perimenopause is a grief response rather than a personality flaw. The connection between declining oestrogen and changes to mood, motivation, social engagement, and sense of self. How integrative medicine approaches the whole woman rather than just her symptoms. The role of identity, self expression, fashion, hobbies, and social connection in clinical recovery during perimenopause. Why no doctor ever asks about the lipstick and why they should. The difference between treating symptoms and treating the woman. How Dr Golda’s training at Vancouver Coastal Health in Canada shaped her integrative four pillar approach to menopause care. Why reclaiming one small part of your pre-perimenopause identity can create a ripple effect across your mental health and wellbeing. The clinical link between identity loss, low mood, anxiety, and hormonal fluctuation in perimenopause. Mentioned in This Episode Dr Golda’s clinical practice, resources, and full ecosystem at drgolda.com. Daily perimenopause and menopause education, community, and conversation on Instagram @doctorgolda. The Ministry of Menopause podcast episode with Danielle on fashion, personal style, and identity in menopause. Dr Golda’s integrative four pillar approach to menopause care covering hormonal assessment, HPA axis and cortisol regulation, mast cell activation and histamine intolerance, and gut health including the estrobolome. Vancouver Coastal Health integrative training and its influence on Dr Golda’s clinical philosophy. Share This Episode If something in this episode shifted for you, even slightly, send it to one woman who needs to hear it. Screenshot your favourite moment and tag @doctorgolda on Instagram. Post it in your WhatsApp group. Send it to the friend who told you she does not feel like herself anymore. Every single share puts this conversation in front of another woman who thinks she is the only one feeling this way. She is not. And she needs to know that. This is how we change the conversation about menopause, not one woman at a time but one share at a time. About Dr Golda Dr Golda is a GMC registered GP with over twenty years of clinical experience across the UK and Canada. She holds dual board certification in family medicine in the UK and Canada, and the Management of Menopause Certificate with the British Menopause Society. She trained at Vancouver Coastal Health in British Columbia, where she developed her integrative approach combining evidence based medicine with holistic, whole person care. She is the host of the Ministry of Menopause podcast and the founder of drgolda.com, where she is building a clinical and educational platform for women in perimenopause and menopause worldwide. This podcast provides general health information and is not a substitute for individual medical advice. Always consult your own healthcare provider for personal medical decisions.

A Royal Fashion Writer on Why Getting Dressed Feels So Hard in Your 40s and What to Do About It

This week I am sitting down with Danielle Rogers Clark, London based fashion stylist, royal style writer for UK national newspapers, and the woman behind Give Good Dress. Danielle has spent over twenty years in the fashion industry working behind the scenes at major fashion brands, styling for the UK's biggest department stores, and working with high profile clients and TV shows. She now runs Give Good Dress as a personal styling service both in person and online, combining fashion with wellbeing and mindfulness in a way that I think will resonate deeply with so many of you. We are talking about something that does not get enough airtime in the menopause conversation and that is what happens to your relationship with getting dressed when your body, your hormones, and your entire sense of self are shifting underneath you. If you have ever stood in front of your wardrobe and felt like nothing fits, nothing feels right, and you have no idea who you are dressing for anymore, this episode is for you. Danielle and I explore why your 40s are actually the decade where style starts to mean something completely different. We talk about the connection between how you dress and how you feel, why so many women lose their sense of personal style during perimenopause and midlife, and how fashion can become a tool for reconnecting with purpose and identity rather than just another thing on the to do list. Danielle also shares her insights from writing about royal style for national newspapers and what we can all learn from the way public figures use clothing as communication. This is a conversation about much more than clothes. It is about permission. Permission to take up space, to invest in yourself, and to dress for the woman you are becoming rather than the woman you used to be. If this episode speaks to you, please share it with a friend who needs to hear it. Find Danielle at www.givegooddress.com. If you would like to book a personal styling session with Danielle, whether in person in London or online from anywhere in the world, head to www.givegooddress.com to get in touch and schedule directly. Find me at drgolda.com and on Instagram at @doctorgolda. If you want to stay in the loop on everything I am building, including clinic news, new episodes, and early access to what is coming next, join my email list at drgolda.myflodesk.com/q0iv4ooge8 and make sure you are on the waitlist for Dr Golda Clinic at www.drgolda.com This podcast is hosted by Dr Golda Parker, a GMC registered GP. The content discussed in this episode is for informational and educational purposes only and does not constitute medical advice. Always consult your own healthcare professional regarding any health concerns. #MinistryOfMenopause #StyleOver40 #Perimenopause

The Rage Nobody Talks About: When Perimenopause Turns You Into Someone You Don’t Recognise

Ministry of Menopause Podcast with Dr Golda Episode Description The disproportionate anger. The guilt that follows. The terrifying feeling that you are becoming someone you do not recognise. Perimenopause rage is one of the most common symptoms women experience and one of the least talked about. In this personal Saturday episode, Dr Golda opens up about the neuroscience behind the rage, shares real stories from women across the UK and North America, answers listener questions, and explains why this is not a character flaw but a neurochemical storm that can be treated. What You Will Learn The neuroscience of perimenopause rage and how fluctuating oestrogen disrupts serotonin, GABA, and dopamine, removing your brain’s emotional buffering system. Why progesterone decline removes the calming safety net and amplifies emotional reactivity during perimenopause. Real listener stories from women in the UK and North America experiencing rage, guilt, and the fear of going crazy. How perimenopause mood symptoms are often misdiagnosed as depression and treated with antidepressants rather than hormone assessment. Dr Golda’s integrative approach combining holistic assessment from Vancouver Coastal Health with UK NICE NG23 and BMS evidence based guidance. Practical advice for partners and family members on supporting someone through perimenopause mood changes. Why rage is not a character flaw and how understanding the physiology removes the shame women carry. Keywords Perimenopause rage, menopause anger, perimenopause mood swings, perimenopause symptoms, menopause and anger, oestrogen and serotonin, perimenopause emotional changes, menopause rage episodes, perimenopause mental health, menopause mood changes, perimenopause relationships, menopause guilt, progesterone and mood, GABA menopause, perimenopause anxiety, menopause GP UK, menopause doctor UK, menopause support, perimenopause what is happening to me, menopause and relationships, integrative menopause treatment, NICE NG23 menopause, BMS menopause guidance, perimenopause misdiagnosis depression. Resources and Links Visit drgolda.com for private menopause consultations, resources, corporate speaking enquiries, and every episode of the Ministry of Menopause podcast. NICE NG23 Menopause Guideline: nice.org.uk British Menopause Society: thebms.org.uk Medical Disclaimer This podcast and all associated show notes are intended for general informational and educational purposes only. Nothing in this podcast or these show notes constitutes medical advice or should be used as a substitute for the advice of your own GP or qualified health professional. Every woman’s experience of perimenopause and menopause is different and management should be individualised. If you are experiencing symptoms, please consult a registered medical professional before making changes to your health plan, treatment or supplementation. Patient stories are anonymised composites and do not represent any single identifiable individual.

Why Can’t I Think Straight? Perimenopause Brain Fog and What Is Actually Going On in Your Head

If you have ever forgotten a word mid sentence, walked into a room with no idea why, or genuinely worried you might have early onset dementia, this episode is for you. Dr Golda explains exactly why perimenopause causes brain fog, what is happening to your oestrogen receptors, your cortisol, and your gut brain axis, and what you can do right now to get your brain back online. Featuring real patient stories from her work with women across the UK and North America, this deep clinical episode goes beyond the usual advice and into the science that actually matters. What You Will Learn Why oestrogen receptors in the hippocampus and prefrontal cortex are directly responsible for the memory lapses, word finding difficulties, and concentration problems in perimenopause. How progesterone decline removes the brain’s calming neuroprotective influence, creating the wired but unfocused feeling so many perimenopausal women describe. The role of cortisol and HPA axis dysregulation in compounding brain fog, and why chronic stress makes cognitive symptoms significantly worse during perimenopause. How the gut brain axis and the estrobolome influence circulating oestrogen levels and why gut health is a crucial piece of the brain fog puzzle. Dr Golda’s integrative approach combining North American holistic assessment from Vancouver Coastal Health with UK NICE NG23 and BMS evidence based guidance. Why brain fog is so often misdiagnosed as depression or stress and what questions to ask your GP to get a proper perimenopause assessment. How HRT can restore cognitive function by re-engaging oestrogen receptors, and why so many women describe it as switching the lights back on. Keywords Perimenopause brain fog, menopause memory loss, brain fog during menopause, oestrogen and brain function, perimenopause cognitive symptoms, menopause word finding difficulty, HRT brain fog, cortisol and memory, perimenopause symptoms, menopause GP UK, menopause doctor UK, integrative menopause treatment, NICE NG23 menopause, BMS menopause, estrobolome brain health, gut brain axis menopause, perimenopause dementia fear, brain fog in your 40s, menopause and concentration, progesterone brain, HPA axis perimenopause, perimenopause misdiagnosis. Resources and Links Visit drgolda.com for private menopause consultations, resources, corporate speaking enquiries, and every episode of the Ministry of Menopause podcast. NICE NG23 Menopause Guideline: nice.org.uk British Menopause Society: thebms.org.uk About Dr Golda Dr Golda is a GP who has practised in the UK across both NHS and private settings and Canada, with a clinical focus on perimenopause and menopause alongside her broader general practice work. She holds dual board certification in the UK (nMRCGP) and Canada (CCFP) along with the Management of Menopause Certificate with the British Menopause Society. Her unique clinical approach combines the integrative and holistic medicine she developed at Vancouver Coastal Health in Canada with rigorous UK evidence based practice following NICE NG23 and BMS guidance. A former BBC health contributor, former RCGP accredited GP Trainer, and former Academic Advisor to Manchester Medical School, Dr Golda is the host of the Ministry of Menopause podcast and founder of drgolda.com. Her free email community can be found at https://drgolda.myflodesk.com/q0iv4ooge8 Medical Disclaimer The Ministry of Menopause podcast and all associated show notes are intended for general informational and educational purposes only. Nothing in this podcast or these show notes constitutes medical advice or should be used as a substitute for the advice of your own GP or qualified health professional. Every woman’s experience of perimenopause and menopause is different and management should be individualised. If you are experiencing symptoms, please consult a registered medical professional before making changes to your treatment or supplementation. Patient stories are anonymised composites and do not represent any single identifiable individual.