The menopause is a time of acute hormone fluctuations associated with diverse and sometimes disturbing psychological physical symptoms.
The menopause itself is defined as 12 months after the last menstrual period or at an iatrogenic intervention (such as a hysterectomy). However, symptoms can present perimenopausally (before menstruation ends) or post-menopausally.
The perimenopausal period can be associated with a relapse of severe mental illness or a first episode of mental illness, including depressive and/or psychotic episodes and the unmasking of underlying neurodiversity. The hormonal changes can affect neurobiochemistry, pharmacokinetics and pharmacodynamics, which can all contribute to a worsening of psychiatric symptoms and potential changes to drug efficacy.
The demographic likely to be in the perimenopause is associated with an increased risk of suicidality and completed suicide. A nuanced approach to risk is required, due to potential confounding factors (e.g. the psychological adjustment to the menopause, the association of life events and/or the changing roles in this demographic) and fluctuating symptoms which are seen in this population.
It is imperative for mental health professionals to understand the impact of the perimenopause on the physical and mental health of their patients in order to provide high-quality, effective treatment.
