Hot flushes aren't the whole story: the mental health side of menopause

Most of us are aware of hot flushes in menopause.

Ask almost any adult woman - and a fair percentage of men - what symptom they associate with menopause, and the answer will usually be the same.

Hot flushes.

They’ve become the headline act; the shorthand. 

But how many of us are truly aware of the impact that the menopause transition can have on our mental health?

A new study has prompted a response from the Royal College of Psychiatrists, reporting that nearly three quarters of women in the UK are unaware that menopause can trigger mental illness.

Let that sink in.

If we don’t know that menopause can exacerbate or even trigger significant mental health issues, why would we reach out for support? Why would we join the dots? Why would we advocate for ourselves?

The data behind this is sobering.

During perimenopause, there is a reported 112% increase in bipolar diagnoses. Clinical depression increases by 30%.

Around 80% of women will develop symptoms of some nature during perimenopause. Until relatively recently, the impact of menopause on the onset of severe mental illness has been largely unknown.

We might associate menopause with anxiety, low mood, irritability, cognitive changes and brain fog. We might talk about disrupted sleep or loss of confidence.

But we don’t often think of it as something that can tip into severe depression, significant anxiety disorders, bipolar presentations, or disordered eating.

Yet we are seeing a spike during this life stage in disordered eating and the onset of eating disorders.

We have to ask why.

How much of the emotional dysregulation that can accompany fluctuating oestrogen and progesterone contributes to this?

How much is driven by body image changes?

How much is influenced by a culture that places enormous value on youthfulness, a certain body shape, and an almost relentless pressure to “stay the same”?

If hormonal changes contribute to weight redistribution or weight gain, and if our identity is tightly bound to how we look, can those shifts exacerbate anxiety, low mood or disordered eating patterns?

These are not superficial questions. They are deeply significant ones.

We are also beginning to understand that menopause experiences are not felt equally.

Women with pre-existing mental health conditions.
Women who are neurodivergent.
Women from minority ethnic backgrounds.
Women who identify as LGBTQ+.
Women living with disabilities.

These groups often face greater barriers to care and poorer outcomes.

In one study, 88% of Black women reported receiving no menopause education at school. Well over half felt completely uninformed before the age of 40.

Friendship groups can be an invaluable source of support and shared experience. But culturally, family conversations about menopause are not always forthcoming. Some respondents describe mothers or aunts refusing to discuss it altogether - which only adds to isolation.

And when women do seek help, the experience is not always positive.

Many report being misdiagnosed with anxiety or depression without their symptoms being linked to menopause. Some are offered antidepressants without discussion of menopause-specific treatment. Others are told they are “too young,” despite experiencing significant perimenopausal symptoms in their mid to late 30s. Some encounter reluctance around prescribing hormone replacement therapy even when symptoms are severe.

So we are seeing barriers across the board:

A lack of awareness.
A lack of recognition.
Age-based dismissal.
Inequitable access.
Cultural silence.

It is little wonder that so many women feel confused, unheard or dismissed.

In response to this growing body of evidence, the Royal College of Psychiatrists has launched its first targeted position statement on menopause and mental health.

It is calling for:

• Greater awareness of the link between menopause and mental health

• Better training for psychiatrists and the wider healthcare workforce

• Fair access to diagnosis and treatment, including hormone therapy and mental health support

• Full integration of menopause and mental health into national women’s health strategies

We also need more supportive workplace policies.

We need ongoing research.

And we need to acknowledge something uncomfortable: this remains, in many ways, an area of relative privilege.

Those from more affluent backgrounds, those who are able-bodied, those with easier access to private healthcare, often experience smoother pathways to care. Women with additional physical or mental health needs, and those from minority communities, continue to face unnecessary barriers.

The good news is that awareness is growing.

In the last five to eight years, menopause has finally begun to receive the attention it has long deserved. But we are still playing catch-up. Decades of neglect do not get corrected overnight.

And while systemic change is essential, there is also power in personal awareness.

Understanding that anxiety, low mood, cognitive changes, disrupted sleep, and even more severe psychiatric symptoms can be linked to hormonal transition changes the conversation.

It means you are not “losing it.”

It means there may be a biological component worth investigating.

It means there may be targeted support available.

It means reaching out is not dramatic - it is informed.

As part of ongoing efforts to raise awareness, to share evidence-based information, and to give women practical strategies they can take into their own lives, another menopause event - Menofest - is taking place on March 31.

On the evening, I will be covering some of the mental health impacts of menopause, alongside:

• The pros and cons of menopause hormone therapy

• Sexual function and enjoyment

• The importance of movement and musculoskeletal health

• Pelvic floor health - a long neglected area.

We are bringing together experts to cover each of these areas with clarity and balance, & with the aum of leaving you feeling more informed, more positive, and more supported.

Because knowledge reduces fear & understanding your options restores a sense of control.

If you recognise yourself in any of this - if your mood has shifted, if your anxiety has intensified, if you feel unlike yourself and can’t quite explain why - please do not dismiss it.

And please do not struggle in silence.