Whilst menopause affects roughly half the population, there is still much to be understood about the impact on individuals, in particular on their mental health.
A key area explored in our investigation, Care delivery within community mental health teams, related to women being at an increased risk of developing serious mental health disorders at or around menopause.
Another key area was that menopause is not routinely considered as a contributing factor in those women with ‘low mood’ who are assessed by mental health services, and staff are not routinely trained in this area.
In this blog, we explore:
- why serious mental health disorders develop around menopause
- the impact of limited research into this important area
- the role of raising awareness.
Why do serious mental health disorders develop around menopause and what is the impact?
In our investigation, we found that midlife is a point of increased risk of mental health deterioration, which is supported by research that shows an increase in the risk of suicide at this time. Women are at an increased risk of developing schizophrenia or other psychotic disorders at or around menopause, when hormone (oestrogen) levels drop.
The Healthcare Safety Investigation Branch’s (HSIB) report (our legacy organisation), whilst quoting research studies, noted that there is a gap in evaluating research that may show links between the menopause and severe mental health symptoms. This lack of understanding could create a risk that the menopause is dismissed as being a possible contributing factor.
Our investigation was prompted by the referral of the case relating to Ms A, a 56-year-old woman who had first contact with a community mental health team (CHMT) following a hospital stay for an attempted suicide. She was discharged to the care of the CMHT in September 2019 with a diagnosis of psychotic depression. In May 2020 she attempted suicide for the second time and was again discharged to the care of a CMHT after being in hospital, and sadly in August 2020, she died by suicide.
In HSIB’s reference event case, menopause was a potentially unconsidered physical health factor. The patient’s sister told the HSIB team that the impact on Ms A was profound, both physically and mentally.
In our investigation report, we have recommended that the Royal College of Psychiatrists works with relevant people and organisations to identify the best way to consider menopause during mental health assessments.
Raising awareness of menopause symptoms being mistaken for depression
One of the key findings from HSIB’s report is that in women with low mood who are assessed by mental health services, symptoms are often mistaken for depression. This results in women frequently being prescribed antidepressant medication when hormone replacement therapy (HRT) may be a more appropriate treatment for their symptoms.
TV personality Davina McCall has been at the forefront of a sea change in the awareness of menopause symptoms and issues for women going through perimenopause, including low mood. This has led to more women seeking HRT to try and resolve their menopausal symptoms, in addition to a raised awareness amongst the general population.
Lack of research into the impact of menopause on mental health
There has historically been a lack of research into the impact of menopause on mental health. However, there has recently been some progress made in developing a better understanding of the impact of the menopause at a national level. The UK Menopause Taskforce was established in February 2022 to bring together ongoing work to improve support and care for menopausal women.
The Taskforce identified gaps in the current research about the impact of menopause and called for the government to fund and commission further research into:
- the benefits of hormone replacement therapy (HRT) in different ways and its long-term health benefits
- the link between menopause and health conditions, including serious mental health illness.
As part of our investigation, we recommended to the National Institute for Health and Care Excellence that research is evaluated relating to the risks associated with menopause on mental health and if appropriate, that it updates existing guidance.
In addition, the National Institute for Health and Care Research is funding a piece of work to look at the possibility of carrying out menopause research in the future. The aim of this is to assess the priority of such work as a means to improving outcomes for menopausal women.
The way forward
There is still a long way to go in improving systems to ensure that wider women’s health needs and menopause are considered in planning and delivering mental health care.
Our report supports the idea that HRT should be considered as a treatment option when women describe low mood during midlife. Additionally, the menopause needs to be considered during mental health assessments of women in midlife, by staff who have been trained in this area.