Menopause is widely known for symptoms like hot flashes and changes in libido, but experts say its effects on mental health are less recognized. In a 2026 position statement, the Royal College of Psychiatrists (RC Psych) warns that hormonal changes at midlife can trigger or worsen psychiatric problems and calls for more research, training, and public awareness.
RC Psych reports that only about one in five women know menopause can be linked to conditions such as depression and bipolar disorder. By contrast, surveys cited by the college show 81% associate menopause with hot flashes and 64% with reduced libido. Clinicians are seeing more reports of insomnia, anxiety, low mood, concentration and memory problems, body image concerns, and other difficulties that appear to correlate with perimenopause and menopause.
Perimenopause—the period of fluctuating hormones before periods cease—commonly brings anxiety and low mood. RC Psych notes that some people in this life stage are at substantially higher risk of new, serious mental illness: perimenopausal individuals have been reported to be more than twice as likely to develop bipolar disorder and roughly 30% more likely to develop clinical depression. Hormonal shifts may also precipitate relapse or new onset of eating disorders, and suicide rates rise among people at menopausal age.
Clinicians and patient advocates say low awareness contributes to delayed help-seeking and stigma. Menijie Boduryan-Turner, PsyD, a clinical psychologist, describes working with clients who developed severe depression and suicidal thoughts during midlife and who had not linked those symptoms to menopause. RC Psych president Lade Smith framed menopause-related mental health as a societal concern, since menopause is a universal life stage for roughly half the population.
RC Psych’s statement outlines key priorities: expanded psychiatric training on menopause and mental health; better public and professional understanding of risks; equitable identification of and access to appropriate support and treatments; interdisciplinary care pathways across health systems; attention to family and social impacts; and targeted research to fill gaps.
On treatment, the statement and clinicians emphasize that hormone therapy (HRT) can be an important option for people with preexisting mental illness who enter menopause, because it may address both physical and psychological symptoms. Some experts recommend combining HRT with psychological approaches such as cognitive behavioral therapy (CBT) for perimenopausal anxiety and low mood, rather than relying solely on antidepressants. Older evidence suggests depressive episodes linked to menopause may respond less well to selective serotonin reuptake inhibitors (SSRIs) for some people and that discontinuation because of side effects can be higher.
Psychiatrist Nissa Keyashian, MD, advises seeking clinicians with women’s health expertise in HRT and menopause, noting there are many formulations to balance risks, side effects, and emotional benefits. OB-GYN Amy Roskin, MD, JD, stresses the role of healthcare providers in diagnosing and managing menopause-related mental health problems.
RC Psych also calls for priority research into how perimenopausal hormonal swings affect medication effectiveness in people with severe mental illness, how postmenopausal risks such as osteoporosis and cardiovascular disease intersect with psychiatric conditions, how to meet the needs of those experiencing menopause alongside substance use disorders, and a broader increase in psychiatric research on female hormones and their interactions with biological, psychological, and social factors.
Overall, RC Psych urges improved training, public awareness, interdisciplinary care, and focused research so mental health effects of menopause are identified and treated earlier and more effectively. Clinicians encourage people and their healthcare teams to recognize these links, reduce stigma, and seek tailored care during midlife transitions.
