Chapo: Across the UK, thousands of women report feeling “not themselves” for years, yet many never hear the word menopause in the consulting room.
New research suggests that while hot flushes are widely recognised, the potential for menopause to spark serious mental health conditions remains largely invisible, with stark consequences for women in midlife and beyond.
Most women link menopause to hot flushes, not mental illness
New polling commissioned by the Royal College of Psychiatrists (RCPsych) indicates a major knowledge gap around menopause and mental health.
Nearly three in four women in the UK do not know that menopause can trigger a new mental illness.
The YouGov survey, carried out for RCPsych, found that only 28% of women were aware that menopause could be associated with a new mental illness. By contrast, 93% linked menopause with hot flushes and 76% with reduced sex drive.
That mismatch means many women recognise physical changes but miss, or dismiss, emerging psychiatric symptoms. As a result, potentially treatable conditions are going unrecognised, and women are not being offered appropriate support or treatment options.
Psychiatrists issue first-ever menopause and mental health warning
The figures have prompted the Royal College of Psychiatrists to publish its first targeted position statement on menopause and mental health. The college, which represents more than 20,000 psychiatrists, rarely issues such focused guidance.
Its president, Dr Lade Smith, describes menopause as a “societal issue”, stressing that every woman will go through it and that mental health outcomes during this stage are not receiving adequate attention in healthcare or policy.
The college argues that failing to link menopause with mental health is leaving women “without vital help when they are most vulnerable”.
The statement highlights how hormonal shifts in perimenopause and menopause can destabilise existing psychiatric conditions or trigger new ones. It calls for menopause to be seen as a critical window for assessing mental health risk, not just a phase of physical symptoms.
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Perimenopause: a high-risk period for serious mental illness
While low mood and anxiety are already recognised as common during perimenopause, the new report underscores that, for some women, the stakes are far higher.
- Perimenopausal women are more than twice as likely to develop bipolar disorder.
- They are around 30% more likely to develop clinical depression.
- Hormonal and physical changes at this stage can trigger or worsen eating disorders.
- Suicide rates are higher among women of menopausal age.
Psychiatrists warn that, for women who already live with bipolar disorder, perimenopause can be a period of particular clinical danger, especially if they previously experienced postnatal depression or severe premenstrual mood symptoms. These women are at significantly higher risk of depressive relapse as they move through menopause.
Invisible risk in the consulting room
Despite these figures, many GPs and mental health professionals still do not routinely consider perimenopause or menopause when women present with new or worsening psychiatric symptoms in their late 30s, 40s or early 50s.
Instead, women may be prescribed antidepressants alone, with no discussion of hormonal factors, lifestyle strategies or hormone replacement therapy (HRT) where clinically appropriate. For some, this leads to years of trial-and-error treatment without addressing an underlying menopausal transition.
The college warns that mental health symptoms are frequently mislabelled as “ordinary stress” or “just depression”, while the menopausal context goes unrecognised.
Black women face an even bigger information gap
The knowledge gap is not evenly spread. A study from University College London, published in the journal Post Reproductive Health, focused on the experiences of Black women in the UK and found an even deeper lack of information and support.
In that research:
- 58% of Black women said they felt completely uninformed about menopause.
- More than half (53%) reported anxiety symptoms.
- Many described the experience as “psychologically damaging”.
- Just 23% had used HRT to manage symptoms.
Many participants reported being misdiagnosed with anxiety or depression when they sought help from their GP, with menopause rarely discussed as a potential driver. That meant they missed out on treatments, such as HRT, that could have addressed hormonal changes contributing to their mental health difficulties.
Calls for training, workplace policies and joined-up care
The RCPsych position statement lays out a series of concrete proposals aimed at closing this diagnostic gap and improving care for women.
| Area | Proposed action |
|---|---|
| Medical training | Mandatory teaching on menopause and mental health for all doctors and psychiatrists. |
| Health services | Routine consideration of menopause in assessments of women presenting with mood or anxiety symptoms in midlife. |
| Workplaces | Clear menopause policies that address mental as well as physical symptoms. |
| Research | More studies into how hormonal changes interact with serious mental illness. |
Women’s health charities have backed the call, arguing that symptoms have been dismissed or misunderstood for decades. They want integrated care that connects gynaecology, mental health services and primary care, so women do not bounce between services without clear answers.
Government response and ongoing policy changes
The Department of Health and Social Care has acknowledged that women still face barriers accessing the care they need. In response to rising pressure from campaigners and clinicians, ministers have pointed to several measures already underway.
These include adding a menopause question to NHS health checks, renewing the national women’s health strategy, investing another £688m in mental health services, and recruiting 8,500 additional mental health workers. Training for new doctors is also being updated to improve recognition of menopausal symptoms and speed up diagnosis.
Officials say women should now have access to “a wider range of treatments” and better-informed clinicians, though campaigners argue that change remains uneven in practice.
“Too young” to be perimenopausal? One woman’s seven-year delay
Behind the statistics are women who spend years feeling unwell, without a name for what is happening to them. One such experience, shared publicly, sheds light on how easily menopause-linked mental health problems can be missed.
At 35, Sonja Rincón visited her GP with crushing fatigue and an unexplained low mood. She sensed that something had shifted dramatically in how she functioned. She was caring for her young daughter and holding down a job, but felt emotionally flat and exhausted by the smallest tasks. Daily life became a performance of coping.
The response was a series of antidepressant prescriptions, then dose increases, then different medications. Nobody mentioned perimenopause. Rincón says she had never been told it could start in the mid-30s, nor that it could cause depression-like symptoms.
For seven years she was treated for depression alone. Only when she began experiencing hot flashes, and heard friends of a similar age talk about menopause, did she start to question the diagnosis. After reading about menopause and pushing for answers, she finally received a formal perimenopause diagnosis and began HRT. She reports that the change felt like “rediscovering” herself and has since come off antidepressants.
Her story underlines a key concern: women in their 30s and early 40s are often told they are “too young” for perimenopause, leading to long delays in appropriate treatment.
What women and clinicians can watch for
The overlap between menopausal and psychiatric symptoms can be confusing. Symptoms such as low mood, anxiety, poor concentration and sleep disturbance might look like classic depression or generalised anxiety at first glance.
Clinicians suggest that certain patterns should prompt a menopause conversation, especially in women over 35:
- New or worsening mood symptoms alongside irregular periods.
- Night sweats, hot flushes or changes in libido appearing with emotional changes.
- A history of postnatal depression or severe premenstrual mood swings.
- Sudden difficulty coping at work, with “brain fog” or memory lapses.
When these features cluster together, assessment that includes hormonal factors, life context and mental health history is more likely to lead to useful support. That might mean a combination of talking therapy, medication, lifestyle changes and, where suitable, HRT.
Key terms that shape the debate
The discussion around menopause and mental health often uses terms that are not widely understood outside clinics:
- Perimenopause: the transition phase before periods stop completely. Hormone levels fluctuate widely and symptoms can appear years before the last period.
- Menopause: defined as the point 12 months after a woman’s last menstrual period.
- Postmenopause: the years after menopause, when hormone levels remain lower but more stable.
- Hormone replacement therapy (HRT): medication that replaces falling levels of oestrogen and, for many women, progesterone. It can ease symptoms and may influence mood.
Understanding these stages helps women make sense of what might otherwise feel like a sudden psychological collapse, and gives clinicians a framework for asking more targeted questions.
Everyday scenarios that show the stakes
Imagine a 42-year-old woman visiting her GP with panic attacks, crushing fatigue and trouble focusing at work. She is prescribed an antidepressant, told to “reduce stress” and sent home. Nobody asks about her menstrual cycle, hot flushes or night sweats.
Now imagine the same appointment where the GP does ask those questions, recognises a pattern suggesting perimenopause, and refers her to a menopause clinic while also offering mental health support. She receives HRT, CBT for anxiety and adjustments at work. The symptoms ease, her risk of severe depression falls, and she avoids unnecessary years on medications that were never the whole answer.
The difference between those two paths often comes down to awareness: whether menopause is even on the list of possibilities when a woman says, “I just don’t feel like myself anymore.”
As psychiatrists, researchers, campaigners and women themselves push this issue into the open, the challenge now is to ensure that every consultation, workplace policy and training programme reflects the same basic reality: hormonal change can affect mental health as profoundly as physical health, and ignoring that link carries a quiet but heavy cost.
Originally posted 2026-03-03 14:32:25.