PSYCHOPHARMACOLOGY DURING THE CLIMACTERIC, MENOPAUSE, AND LATE MENOPAUSE: EVIDENCE, GOLD STANDARDS, AND EQUITY IN ACCESS TO TREATMENT FOR WOMEN AGED 40+

Abstract

Introduction: the menopausal transition — encompassing the climacteric, menopause, and late menopause — represents a period of heightened neuropsychiatric vulnerability for women from the age of 40, marked by an increased incidence of depression, anxiety, and vasomotor symptoms. Objective: to analyze, based on current scientific evidence and on the guidelines of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) and the Brazilian Psychiatric Association (ABP), the main psychopharmacological strategies used during the climacteric and menopause, correlating them with clinical benefits and with the reality of access within Brazil's Unified Health System (SUS) and the private healthcare network. Methods: narrative literature review, with searches in PubMed/MEDLINE, SciELO, LILACS, UpToDate, and the institutional platforms of FEBRASGO, ABP, the North American Menopause Society (NAMS), ANVISA, the Ministry of Health, and IBGE. Results: selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors (SSRIs/SNRIs) constitute first-line treatment for perimenopausal depression, while menopausal hormone therapy (MHT), when indicated within the window of opportunity, shows an antidepressant effect comparable to antidepressants in symptomatic perimenopausal women. SUS provides, through its Basic Pharmaceutical Care Component, fluoxetine, tricyclic antidepressants, and older hormonal formulations, whereas drugs such as escitalopram, desvenlafaxine, transdermal estradiol, and the new non-hormonal agent fezolinetant remain largely restricted to the private market. Conclusion: the correlation between correct nomenclature, evidence-based pharmacological choice, and recognition of the socioeconomic context is decisive for the quality of life of Brazilian women during this stage, making the expansion of the therapeutic arsenal offered by SUS urgent.