This chapter summarises current guidelines for the assessment, investigation and management of menopausal symptoms and its pertinence to psychiatry. We explain the use of hormone replacement therapy including oestradiol, progesterone and testosterone to manage common symptoms of perimenopause and menopause. Reference is made to the current NICE prescribing guidelines and consideration given to management of genitourinary symptoms of menopause (GSM) as well as surgical menopause and primary ovarian insufficiency (POI). Specific attention is given to the management of menopause in breast cancer. Other hormonal treatments, non-hormonal treatments, psychological and lifestyle interventions are also reviewed. Overall, this chapter emphasises the importance of taking a holistic, patient-centred approach to the management or menopause. Through knowledge of treatment options and evaluation of individual risk factors, patients can be empowered to make decisions regarding preference and choice of treatment in order to create individual treatment regimens that optimise symptom management.

The spirituality of the psychiatrist is important because of the way that it may impact the well-being of the psychiatrist, clinical practice and the understanding of psychiatry more widely. In some cases, it may influence a psychiatrist’s sense of vocation to be a psychiatrist. The case study in this chapter draws on the author’s own experience of the ways in which spirituality and formation as a psychiatrist were entangled during training. Three historical examples are offered of different ways in which religion and psychiatry might be entangled in the life, work and thought of psychiatrists: a pragmatic atheism (Maudsley), religion understood as pathology (Freud) and religion as beneficial to mental flourishing (Jung). Three more recent examples are then considered, one of a Christian attempt to integrate theology and psychiatry (Frank Lake), one of reflections on how Buddhism influences practice as a psychiatrist (Mark Epstein) and one of a personal encounter of a psychiatrist with shamanism (Olga Kharitidi).

A 50-year-old man presents with fatigue and easy bruising. A complete blood count and peripheral blood smear shows leukocytosis with 56% circulating blasts. The patient has no previous history of myeloid neoplasm or treatment with chemotherapy. Which of the following findings would definitively establish a diagnosis of acute myeloid leukemia?

Women’s mental health has long been misunderstood, misrepresented and mistreated. Historically, women have been institutionalised, dismissed and subjected to clinical models that fail to account for the dynamic nature of female biology. The reliance on male-centric research and clinical guidance in mental healthcare is dated; we seek new models that incorporate and validate a woman’s experience of menstruation, menopause and other hormonal changes. Understanding the interplay between hormones and mental health, on biological, psychological and social levels, offers a vital lens through which to understand the complexity. Through explanation of the scientific underpinnings by experts in the field and real stories of women who have endured misdiagnosis, poor treatment and disability, this book exposes the consequences of neglecting to understand a woman’s hormonal experience, and the transformative potential when care is hormonally informed. We stand at the cusp of a revolution in women’s health. Emerging research and innovation promise a future where care is compassionate, evidence-based and attuned to women’s lived realities of menstruation, menopause and mental health.

Women’s mental health has been shaped by patriarchal societal biases in science, medicine and society. Early medical texts attributed women’s distress to their reproductive system or sexual deprivation. In the Middle Ages, mental illness was often misinterpreted as witchcraft, reinforcing harmful beliefs about female autonomy, and in the nineteenth century, male-dominated medical science pathologised women’s independence with diagnoses such as ‘moral insanity’ to justify institutionalising women who defied social norms. Twentieth-century feminism underpinned advances in medicine and social reform, shaping health policy and psychiatric practice, although controversies around research into hormone replacement therapy (HRT) disrupted momentum. Despite progress, persistent gender bias in research and access to mental health care persists, particularly for marginalised groups, although initiatives like the Women’s Health Strategy offer hope for a more equitable future.

This chapter examines the bi-directional relationship that exists between the menopause and society. It reflects on how a woman’s perception of the menopause is influenced by societal and cultural ideas about menopause, ageing and gender. It reviews how Western societal attitudes towards the menopause have developed over time, in response to scientific developments and medical trends. It also considers the viewpoint that this natural life transition has been over medicalised, and looks at how this life stage is viewed in other cultures. The chapter looks at how an individual woman’s experience of the menopause has an impact on her wider society. It considers the impact that menopausal symptoms can have in the workplace, and in personal relationships including partners, children and other family members. It also speculates about how health economics are affected by women in this life stage.

A case study of a patient diagnosed with obsessive-compulsive disorder demonstrates the entanglements of phenomenology of spirituality and psychopathology, and the implications of failing to properly understand the importance of these entanglements when planning treatment. The concepts of entanglement, pragmatic atheism, spirituality and religion are introduced. Spirituality and religion are both complex and contested concepts which elude simple definition, but a person-centred holistic model of psychiatry requires giving attention to the whole person, ‘body, mind and spirit’. The biopsychosocial model does not explicitly address spirituality, but spirituality is entangled with the biological, psychological and social aspects of the matrix. The chapter discusses the secular context within which psychiatry is generally seen to be practised (at least in the Western world), the perceived tension between science and religion that it often evokes, the nature of psychiatry as concerned with the study and treatment of mental illnesses, and the way in which these illnesses affect our self-understanding and identity as human beings.

This chapter provides a comprehensive review of benign hematopoietic disorders affecting white blood cells and platelets. The chapter focuses on acquired and inherited conditions that lead to qualitative and quantitative defects in neutrophils, monocytes, and platelets. Topics include reactive neutrophilia and lymphocytosis, acquired and congenital neutropenia, inherited bone marrow failure syndromes associated with neutropenia and/or thrombocytopenia, and sources of laboratory error in automated white blood cell and platelet counts.

The menstrual history is a key feature of a psychiatric assessment and must be approached with sensitivity, recognising that cultural beliefs surrounding menstruation and menopause may pose barriers to open discussion. A structured framework is outlined, including suggested questions, designed to simplify the process and support identification of links between hormonal fluctuations and psychiatric symptoms and to glean information about the practical management of menstruation. We suggest a culturally sensitive, trauma-informed approach to enquiring about female genital mutilation (FGM) and its psychological impact. By adopting a life-course approach and routinely incorporating menstrual history into psychiatric assessment, clinicians can provide more holistic, personalised care.

This chapter explores the interplay between common gynaecological conditions and mental health, focusing on polycystic ovary syndrome (PCOS), endometriosis and adenomyosis. It also examines the psychological impact of infertility, subfertility, miscarriage and baby loss: experiences that are often overlooked in psychiatric assessments but carry significant emotional weight. Drawing on the latest research, the chapter highlights the increased prevalence of mental illnesses in women with these reproductive health conditions. Designed for psychiatrists and mental health practitioners, this chapter provides evidence-based insights to support a comprehensive biopsychosocial approach to care. Each section concludes with practical, clinic-ready guidance to improve the support offered to women navigating both mental health challenges and gynaecological illness. Expert insights from individuals with lived experience are interwoven throughout, offering an authentic patient voice that underscores the psychological burden these conditions can impose. The goal is to deepen understanding and promote compassionate, integrated care in clinical practice.

This illustrates the theme of patient-centred spirituality by way of two case studies: one of a clinical encounter of the author with a patient in which neither spirituality nor religion was explicitly mentioned, and another in which the author was asked to see a patient because of a specifically religious concern. The first of these is interpreted in light of the work on spirituality in psychotherapy undertaken by Jeremy Holmes who, in turn, takes up the thinking of Donald Winnicott about transitional space. Spirituality is concerned with an ability to adopt a viewpoint outside oneself and to develop humility and a ‘negative capability’. The published views of patients suggest that spirituality/religion are explicitly important to many, even in a secular country like the UK, and that they would like them to be taken into account in treatment. It is proposed that there is ‘no such thing as a patient’, only encounters between human beings, one of whom is professionally identified as a physician (psychiatrist) and one as a patient. The authenticity of the human encounter, albeit within certain professional constraints, forms the basis for an effective therapeutic alliance.

With many women in perimenopause experiencing a subjective sense of change in cognitive function, understanding normal cognitive function in perimenopause is important for clinicians in day-to-day practice. This chapter aims to equip mental health professionals with the knowledge and confidence to appropriately explore cognitive concerns arising during the perimenopause. The chapter outlines normal cognitive function in perimenopause, exploring symptoms and how they may present, as well as aiming to identify who may be at greater risk from cognitive change. It then offers suggestions on how to support women to reduce symptoms of cognitive dysfunction as far as is practicable. The chapter later explores the role of hormone replacement therapy (HRT) on both cognition in perimenopause and beyond into postmenopause, as well as considering the impact HRT has on the brain and risk of dementia in later life. With up to 45% of dementia now felt to be preventable, the chapter discusses the role of the healthcare professional in identifying risks presenting around the time of perimenopause, allowing clinicians to then offer intervention and promote good brain health in mid-life leading into later-life.

Perimenopause is a period of heightened risk of onset and relapse of mental illnesses including depressive disorders, schizophrenia spectrum disorders and bipolar affective disorder, as well as a time of increased risk of psychological symptoms including low mood, cognitive problems and anxiety. Perimenopausal depression can be seen as a distinct diagnostic entity with specific clinical features and treatment pathways. The risk of suicide in the perimenopause is widely reported and we look at the nuances of this association and other possible confounding factors. Perimenopause may be a particularly challenging time for women with pre-existing severe mental illness; women with severe mental illness are at risk of substandard menopause education and care, and there maybe diagnostic overshadowing, with menopausal symptoms not being identified, exacerbation of psychiatric symptoms due to perimenopausal symptoms, and an impact of ovarian hormones on psychopharmacology. We explore the evidence base behind psychological, pharmacological and hormonal treatment strategies (including hormone replacement therapy and selective oestrogen receptor modulators) proposed for treatment of perimenopausal mental illnesses.