Psychological symptoms in perimenopause and early menopause are common. The impact of menopausal hormone therapy (MHT) on menopausal mood symptoms is unclear.

To assess the impact of 17β-oestradiol ± micronised progesterone or the levonorgestrel-releasing intrauterine device, and/or transdermal testosterone, on depressive and anxiety symptoms in peri- and postmenopausal women.

A real-world retrospective cohort study set in the largest specialist menopause clinic in the UK. The Meno-D questionnaire measured mood-related symptoms.

The study included 920 women: 448 (48.7%) perimenopausal, and 435 (47.3%) postmenopausal. Following initiation/optimisation of MHT, mean Meno-D scores decreased by 44.59% (95% CI −46.83% to −42.34%, P < 0.001) after average 107 days follow-up. Mood symptoms significantly improved (P < 0.01 per symptom). Improvement occurred in peri- and postmenopausal women. All MHT regimens improved mental health including both progestogen types (body-identical progesterone and levonorgestrel-releasing intrauterine device), MHT initiation strategy (oestradiol ± a progestogen versus oestradiol ± a progestogen and testosterone, 45.38 v. 48.53%, respectively, P = 0.47) and MHT optimisation strategy (MHT users treated with a higher oestradiol dose versus testosterone added versus both a higher oestradiol dose and testosterone, 34.70, 43.93 and 43.25%, respectively, P = 0.38).

Use of menopausal hormone therapy was associated with significant improvement in mood in peri- and postmenopausal women. Prospective studies and randomised clinical trials are needed to assess the effects of different regimens in different patient populations over longer time periods.

Current NICE guidance (NG23) lists hot flushes and night sweats as the most common symptoms associated with the perimenopause and menopause. Consequently, many clinicians, and the public in general, often associate menopause primarily with vasomotor symptoms. However, psychological symptoms are also common in the perimenopause and menopause. Failure to recognise the link between menopause and mental ill-health means that many women are unable to access the support and treatment they need; women are often prescribed antidepressants and anxiolytics, but hormone replacement therapy (HRT) is more effective for symptoms rooted in hormone deficiency. The aim of this survey was to assess the prevalence of negative mood symptoms in peri- and post-menopausal women, and the response of mood symptoms to HRT.

We administered a modified version of the Greene Climacteric Symptom Questionnaire (Greene 1976) to all new patients attending the Newson Health Menopause and Wellbeing Clinic in Stratford-upon-Avon, between 1 November 2022 and 30 June 2023. Patients initiated on HRT were followed-up after 3 months and asked to complete the Symptom Questionnaire again. Data were collected from electronic health records and analysed using descriptive statistics.

978 women were included in the study. All patients were started on HRT. A third of patients (32%) of patients, were also started on transdermal testosterone. None of the patients discontinued their treatment during the study period. The five most prevalent symptoms were: feeling tired or lacking in energy (96%); memory problems (93%); difficulty in concentrating (91%); irritability (90%); and feeling tense or nervous (90%). Hot flushes and night sweats were much less prominent in this cohort, ranked at 18th and 14th place respectively. All symptoms improved after treatment with HRT +/- testosterone for 3 months. Overall, ‘profound low mood’ (loss of interest in all things) improved the most (69% improvement in symptom scores), followed by ‘attacks of anxiety and panic’ (61% improvement in symptom scores).

Understanding and recognising the common symptoms that women are likely to experience in the perimenopause and menopause is vital to reduce barriers to appropriate care. This study suggests that cognitive and mood-related symptoms are highly prevalent and may be more common than hot flushes and night sweats. For most women, these symptoms improved after a short course of HRT. Longer follow-up is needed to assess any additional response to HRT given for longer periods, after individualisation and optimisation of the dose and regimen.

Limited data suggest that negative mood symptoms in the menopause transition may be associated with a higher prevalence of alcohol misuse and other risk-taking behaviours in menopausal women. Excessive alcohol consumption can exacerbate menopausal symptoms, reduce quality of life and is associated with chronic morbidity that overlaps with the consequences of long-term oestrogen deficiency (such as osteoporosis and cardiovascular disease). The aim of this survey was to explore the impact of mental ill-health on alcohol consumption and gambling habits in menopausal women.

We constructed an anonymous survey consisting of multiple-choice and free-text questions. The survey was distributed online via social media channels on the 22 August 2023 and was open for 6 weeks. All perimenopausal and menopausal women were invited to participate. Responses were collected using the Qualtrics survey platform and analysed in Excel for descriptive statistics.

1,178 responses were submitted. One in three women reported drinking more alcohol during the perimenopause/menopause; 15% of women drink more than the recommended maximum of 14 units per week, and 24% (286) are spending up to £50 per week on alcohol. 70% (332) cited anxiety, stress, and/or depression as the reason for their increased alcohol consumption, whilst 29% (135) said they drank to alleviate menopause symptoms. Further, 5% (54) of respondents admitted gambling more since the onset of perimenopause/menopause; 43% (27) said it was due to anxiety, stress, and/or depression, whilst 13% (9) said they do so to help manage their menopause symptoms.

This anonymous, cross-sectional survey found evidence of an association between menopause and addiction. Increased awareness of this association should facilitate earlier recognition and more timely access to support and effective treatment for addiction, including hormone replacement therapy to treat menopausal symptoms that may underlie and/or exacerbate unhealthy lifestyle behaviours.

Low mood is a common clinical symptom during the perimenopause and menopause. However, the extent to which low mood in menopausal women intersects with thoughts of self-harm and suicidal ideation is largely unknown. In this study we aimed to explore these questions by using two different validated symptom scores.

We administered a modified version of the Greene Climacteric Symptom Questionnaire (Greene 1976) to all new patients attending the Newson Health Menopause and Wellbeing Clinic, Stratford-upon-Avon, between 1 September 2023 and 31 December 2023. Patients were also asked to complete the PHQ-9 symptom questionnaire, an instrument for diagnosing and measuring the severity of depression. Data were collected from electronic health records and analysed using descriptive statistics.

1,212 patients were included in the study and completed the Greene Climacteric and PHQ-9 questionnaires at baseline and after 3 months. Mood and mental health symptoms including self-reported anxiety and depression affected 98% of patients. 16% of respondents indicated that they had thoughts of self-harm or suicidal ideation on at least some days in the 2 weeks prior to their initial appointment (Question 9 of the PHQ-9).

The findings of our study demonstrate that negative mood symptoms are common in perimenopausal and menopausal women. 1 in 6 women reported thoughts of self-harm prior to initiation of HRT. Our observational data suggest that mood symptoms are highly prevalent and some women have severe symptoms and may experience suicidal ideation. Our findings should inform better mental health support and access to treatment for women experiencing negative mood symptoms in the menopause transition.