A recent position statement from the Royal College of Psychiatrists highlights that menopause can be associated with the onset or worsening of mental health conditions, yet public awareness is low. The college found only about 21% of women knew menopause can be linked with conditions such as depression and bipolar disorder, compared with far higher awareness of symptoms like hot flashes (81%) and reduced libido (64%).
Symptoms and risks
Menopause and the perimenopause transition bring hormonal and physical changes that commonly produce sleep disturbance, anxiety, low mood, concentration and memory difficulties, and body-image concerns. For some people these changes remain mild; for others they substantially raise the risk of developing a new psychiatric disorder. Perimenopausal people are reported to be more than twice as likely to develop bipolar disorder and roughly 30% more likely to develop clinical depression. Hormonal shifts can also trigger relapses or onset of eating disorders, and suicide rates are higher in some groups at menopausal ages.
Clinical implications and treatments
The statement stresses that women with a history of mental illness who enter menopause may benefit from hormone therapy as part of a broader treatment plan, addressing both physical and mental health symptoms. Some experts recommend combining hormone therapy with psychological treatments such as cognitive behavioral therapy (CBT) rather than relying on antidepressants alone for perimenopausal anxiety and low mood. Older studies suggest depressive episodes during menopause may respond less well to selective serotonin reuptake inhibitors (SSRIs) for some women, and discontinuation due to side effects can be common.
A holistic approach — including a healthy diet, regular exercise, work–life balance, psychotherapy, psychiatric medications when appropriate, and hormone replacement therapy (HRT) — is often advised. Patients may benefit from clinicians with expertise in women’s mental health and HRT options that balance risks and benefits.
Recommendations and research gaps
The Royal College recommends: more training for psychiatric and primary care workforces; broader public education about menopause and mental health; equitable access to assessment and treatment for those with menopausal symptoms and pre-existing mental illness; and interdisciplinary services spanning gynecology, psychiatry, primary care and social supports. The statement calls for research into several key areas, including how hormonal fluctuations affect the effectiveness of psychiatric medications in people with severe mental illness (SMI); the interaction between menopause, SMI and higher risks of osteoporosis and cardiovascular disease; the needs of women who experience menopause alongside substance use disorders; and a deeper psychiatric focus on female hormones and their psychosocial impacts.
Why awareness matters
Greater public and clinical awareness would likely reduce stigma, encourage earlier help-seeking, and improve access to tailored care. For many women, recognizing the link between menopause and mental health can be the first step toward effective treatment and support. The college urges health systems and researchers to prioritize this under-recognized area so care can better match the complexity of biological, psychological and social factors at midlife.
