Effective menopause management should be an urgent public health priority, according to a new research paper.

More than simply the end of menstrual cycles, menopause marks a time of profound hormonal change, which can cause a range of symptoms from poor sleep to anxiety, low mood, cognitive decline and memory difficulties.

Brain function relies on oestradiol, progesterone and testosterone, and these hormones impact neurotransmitters such as serotonin and GABA. Declining or fluctuating oestradiol, testosterone and progesterone levels can adversely impact mental health. Conditions such as ADHD can worsen or be unmasked, and symptoms of premenstrual disorders such as PMS and PMDD can escalate while hormones are in flux.

Recognising the roles of hormones in mental health is the first important step for both healthcare professionals and patients. Given that nearly 40% of women’s lives are spent in menopause, and women can also sometimes spend up to 12% of the lives in perimenopause, when mental health challenges are most acute, effective menopause management is key.

It’s also important to understand that menopause does not only occur in midlife. The average age of menopause in the UK is 51 years, but many experience early menopause because of medical treatment, surgery or a coexisting health condition.

Hormone replacement therapy (HRT) is the recommended first-line treatment for menopausal mood disturbance, and for most women the benefits of HRT will outweigh any risks.

Three hormones can be considered in HRT. Estradiol is a potent neurosteroid that is effective in treating depression when given transdermally. Progesterone has a key role at the GABA receptor where mood and anxiety can be influenced. Transdermal testosterone can also help transform psychological wellbeing, by helping to reduce symptoms of anxiety and low mood.

However, inconsistent clinical knowledge and awareness of the benefits of these hormones, and HRT, can leave women feeling unsupported and struggling to feel better.

The newly published paper, Menopause and Mental Health, calls for more action in this area – women need more support with replacement and optimisation of hormones alongside other treatment options. Finally, more research into women’s hormonal health is urgently needed to improve care and treatment for all.

Menopause and Mental Health is published in Advances in Therapy and is available to read [here].

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