Clinical update

Mental health and menopause: how to identify symptoms and offer support

RCN guidance on the psychological symptoms of the menopause

RCN guidance on the psychological symptoms of the menopause

Picture: iStock

Essential facts

The National Institute for Health and Care Excellence (NICE) defines the menopause as the biological stage in a woman’s life when menstruation stops permanently. A woman is in the menopause when she has not had a period for 12 consecutive months.

The average age of the menopause is 51, although it varies between 45 and 57. Women may experience a variety of physical and psychological symptoms due to changing hormone levels.

Browse RCNi menopause resources

What’s new

The RCN has published a Menopause and Mental Health pocket guide to help nurses provide women with information on living well and managing menopause-related issues.

Sections include some common myths, tips on diet and exercise, prescribed medicines, sex and cultural factors, including attitudes to ageing and women’s health.    

It references mental health throughout, advising that some menopausal symptoms can overlap with depression.

Diagnostic overshadowing can occur if menopause symptoms are misidentified as those of mental illness.

‘Emotions related to life course are different to clinical symptoms of depression, but can easily be mistaken for each other,’ the guidance states.

On the other hand, some women with underlying mental health issues may find these are exacerbated by the menopause, but this may not always be recognised by those health professionals caring for them.

Signs and symptoms

Menopausal symptoms are individual and affect women in different ways. Some experience minimal symptoms for a short time, while others will have some or most symptoms for perhaps 20 years or more. The average duration is four years.

Physical signs and symptoms include: hot flushes, night sweats, tiredness, vaginal dryness, reduced libido, bladder weakness, joint pain, bloating, disturbed sleep and longer-term problems, such as osteoporosis and an increased risk of cardiovascular disease.

Women may also experience a variety of psychological symptoms. These include mood changes, low mood, anxiety, irritability, reduced self-esteem, poor concentration and memory problems. 

How you can help your patient

The guide suggests a number of ways that nurses can help their patients. These include:

  • Understanding the common symptoms of the menopause and any effects on mood and well-being.
  • Asking questions sensitively and compassionately about mood, well-being, vaginal dryness and any sexual issues.
  • Recognising the differences between hormonal low mood and depression, including the different treatment pathways – and not assuming depression.
  • Being aware of common menopausal treatments and any interactions with other medications.
  • Improving your knowledge of hormone replacement therapy (HRT), including its side effects and myths.
  • Thinking about how you can optimise your patient's long-term health.
  • Being positive – bearing in mind that the menopause is natural.

Expert comment

RCN women’s health forum chair Debra Holloway (pictured) says:

‘The guide is targeted at nurses who aren’t specialists in the menopause, including mental health nurses.

‘We know menopause can affect mood, but there is a difference between depression and menopause-related mood changes.

‘If you already have a mental health disorder, you’re more likely to be labelled with more mental health issues than issues related to the menopause. There is a need for these women to have their menopause needs addressed as well.

‘For nurses, the key is recognising, responding and referring. Being aware of the symptoms and where to signpost women for help is crucial, alongside talking about the psychological symptoms, as well as the physical.

‘Women will open up if someone asks the question. But if you don’t ask, they think it’s not important or worth mentioning. It can be as simple as having a checklist of symptoms, including mood.’


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