The hand on your hip
It's late, the lights are off, and your husband's hand is resting on your hip the way it used to when that meant something. You lie there and wait to feel anything at all.
Nothing comes. You aren't upset with him, and you aren't tired exactly. The part of you that used to want this has just gone quiet. So you do what you've been doing for months. You turn over and say you're worn out, and he says okay, and you both pretend it doesn't sting.
The Zoloft has done what it was supposed to do. The week before your period doesn't wreck the house anymore. You haven't snapped at the kids over nothing in a long time. But since you started it, your sex drive has faded away, and about ten pounds have settled around your middle. Some days you wonder which version of yourself you'd rather be.
You may have mentioned it to your doctor and been told that feeling steady is worth the trade. You may never have mentioned it at all, because it felt ungrateful to complain about a medicine that was working.
Wanting your body and your desire back isn't ungrateful. These are real side effects, doctors take them seriously, and with the right help there are ways to change them.
The side effect nobody asked about
Sexual side effects from SSRIs, the family of antidepressants that includes Zoloft, are far more common than most people are told. The drug's official label lists low sex drive in only a few percent of women, but that number came from people who happened to mention it. When researchers actually ask, somewhere between 30 and 50 percent of people on SSRIs report problems such as lower desire, trouble with arousal, or difficulty reaching orgasm.
For most people, these effects ease after the medication is stopped, though it can take a while. A small number of people report sexual side effects that last long after stopping, which is called post-SSRI sexual dysfunction. One study put the risk at about 1 in 200, though it only looked at men and the condition is hard to measure. That's one more reason to bring up sexual side effects early instead of quietly putting up with them.
Weight is the other common complaint. Sertraline is gentler on weight than some SSRIs, but long-term use is linked to gradual weight gain for some people, often around two to four pounds a year.
A fading sex drive isn't just part of getting older or being a tired mother. It often has a cause, and a medication side effect is one of the most common and most fixable ones.
Coming off, the careful way
If you and your doctor decide to stop the Zoloft, how you stop matters as much as the decision itself.
Please don't stop on your own or all at once. About 1 in 5 people who suddenly stop an antidepressant they've taken for six weeks or more get withdrawal symptoms such as dizziness, irritability, trouble sleeping and flu-like feelings. Stopping suddenly can also bring back the symptoms you were treating. Researchers who study this recommend tapering slowly, with smaller and smaller cuts to the dose and two to four weeks between each step, so you and your doctor can watch how you're doing. For someone who has been on an SSRI for a long time, a slow taper can take months.
Go in with a plan in case your PMDD (premenstrual dysphoric disorder, a severe form of PMS) comes back. I wrote about what PMDD is and why it happens in an earlier post. Keep tracking your mood every day while you taper, and mark the first day of your period, so you and your doctor can spot a return early.
If it does come back, you have options. The 2023 guideline from the American College of Obstetricians and Gynecologists lists several first-line treatments for PMDD. One is taking an SSRI only in the second half of your cycle instead of every day. Another is a birth control pill that contains drospirenone, taken continuously. A third is cognitive behavioral therapy, a practical kind of talk therapy. Some women find a combination that works better for them than daily medication.
If you ever have thoughts of harming yourself or feel that you can't go on, call or text 988 to reach the Suicide & Crisis Lifeline in the US, any time, day or night. PMDD can bring those thoughts on quickly, and they deserve immediate help.
The part your treatment has been missing
While your mood was being treated, your PCOS probably wasn't.
Most women with PCOS have insulin resistance. Your cells don't respond well to insulin, so your body makes extra. All that insulin raises your testosterone, makes it easier to store fat around your middle, and makes that fat harder to lose. That's why eating less and exercising more so often disappoints women with PCOS. The hormones come first, and the weight follows.
Metformin works on that problem directly. It lowers the amount of sugar your liver releases and helps your body use insulin better. The 2023 international PCOS guideline recommends it for the metabolic side of PCOS. It's approved for type 2 diabetes and prescribed off-label for PCOS, which means it's approved for something else but can legally be used for this, and that's common.
What metformin did for me
I'll tell you about my own experience, because it's the part of this I can speak to most directly.
When I started metformin, I didn't expect much. The first few weeks were mostly about getting through the upset stomach, which eased once I switched to the extended-release version. Then, slowly, over months rather than weeks, the weight around my middle started to come off. I wasn't eating less out of willpower. I just wasn't as hungry, and the afternoon crashes that used to send me looking for sugar faded. My waistband was the first thing to notice.
That was my experience, and everyone's is different. In studies, the average effect is more modest. A 2023 review found that women with PCOS on metformin lost about half a point more of BMI than women on a placebo, and only women with a BMI of 25 or higher saw that difference. Some women lose more than that, and some lose very little.
Metformin may help in other ways too. In a 2006 study of 64 women with PCOS, six months of metformin left them more satisfied with their sex lives, and the improvement went along with weight loss and more regular periods. That study didn't compare metformin with a placebo, so it's encouraging rather than proof. The evidence on mood is weaker. Some small studies found less anxiety and depression, and others found no change. So metformin is a treatment for insulin resistance, and it won't replace a treatment for PMDD.
The main side effect is an upset stomach, which usually improves after the first few weeks and is gentler with the extended-release version. If you take it long term, ask to have your B12 checked.
GLP-1 medications are another option to ask about. They improve how your body uses insulin and usually lead to more weight loss than metformin. But they have real downsides: nausea and constipation, high cost and insurance battles, muscle loss if you don't get enough protein and strength training, and weight regain for many people who stop. The research on how they affect mental health is also mixed, which matters if you're coming off an antidepressant. They can't be used during pregnancy and need to be stopped well before you try to conceive.
Here's something you could say to your doctor:
The sertraline helped my PMDD, but I've lost my sex drive and gained weight. I'd like to talk about tapering off slowly with a plan in case my symptoms come back, and about starting metformin for my PCOS and insulin resistance.
Two doctors, one plan
This works best when your doctors talk to each other. Women with PCOS and PMDD often have their mood handled by one doctor and their periods by another, and nobody looks after the metabolic side. There's even evidence that psychiatrists and gynecologists each tend to favor the treatments their own specialty knows best. Ask whoever prescribes your sertraline to plan the taper, ask whoever treats your PCOS about metformin, and make sure each of them knows what the other is doing.
If a doctor brushes off your sex drive or your weight as unimportant, that tells you more about their training than about your concerns. You can ask again, or see someone else.
For care focused on PCOS, Allara Health is an online practice for PCOS and women's hormone and metabolic health. It pairs doctors with dietitians and takes many major insurance plans, though it isn't available in every state. Sesame lets you book a specific doctor at a set price without insurance or a referral.
I have no financial relationship with either company. I'm not an affiliate, and I don't get paid if you book. I mention them because telling you to find a doctor who understands PCOS isn't much help without somewhere to start.
PCOS is a lifelong condition, and nobody can promise exactly how your body will respond. But you don't have to choose between a steady mood and a body and a sex life that feel like yours. With a careful plan and the right treatment for your PCOS, many women get a lot closer to having both.
This is my experience and my reading of the research, not medical advice. Nothing here should replace a conversation with a clinician who knows your history.
Sources
- Antidepressant Medications and Weight Change: A Narrative Review — Gill et al., Obesity, 2020
- SSRI-Associated Sexual Dysfunction — American Journal of Psychiatry, 2006
- Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence — 2024
- Antidepressant Discontinuation Syndrome — American Family Physician, 2006
- Tapering of SSRI treatment to mitigate withdrawal symptoms — Horowitz & Taylor, The Lancet Psychiatry, 2019
- Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7 — Obstetrics & Gynecology, 2023
- The impact of metformin with or without lifestyle modification versus placebo on polycystic ovary syndrome: a systematic review and meta-analysis — European Journal of Endocrinology, 2023
- Metformin treatment of polycystic ovary syndrome improves health-related quality-of-life, emotional distress and sexuality — Hahn et al., Human Reproduction, 2006
- Practical diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder by psychiatrists and obstetricians/gynecologists in Japan — PCN Reports, 2024