Emotional disturbances are more frequent in the years of transition to menopause. They have a hormonal explanation and can be treated. PHOTO: Cottonbro/Pexels.
Benefits of Hormone Therapy
We have estrogen receptors throughout our body. The hypothalamus is no exception. That is why the decline in estrogen affects mental health.
By Salomé García Gómez
6 September 2026 / 08:00
The years preceding menopause are characterized by a hormonal rollercoaster. Those usual fluctuations during perimenopause push well-known symptoms to astronomical levels, such as hot flashes, night awakenings, or brain fog. “But also the risk of suicide. A recent European study warns that this risk is higher than in any other stage of a woman’s life. That is why signs of risk should not be minimized,” warned in the recent edition of ASISA WeLife Menopause in A Coruña the gynecologist Diana López Freire, associate specialist in the Department of Gynecology and Obstetric Surgery at Hospital Ribera Povisa in Vigo and member of the Spanish Association for the Study of Menopause (AEEM).
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Low attention to mental health
The study referred to by the doctor was led in England by experts from the Liverpool John Moores University and Newson Research. The researchers worked with 957 menopausal women. Almost one in six reported having suicidal thoughts at their first consultation at the Newson Clinic, and more than 70% exhibited depressive symptoms of at least moderate intensity.
Treatments with psychotherapy or antidepressants did not work as they should in this age range. Something was wrong. And the error lay in not taking into account that those women were in perimenopause.
After providing them with personalized hormonal treatment, the mental health of those women improved and depressive symptoms were reduced by almost half. The suicidal thoughts decreased by more than 90%.
The greatest improvements were observed in women who used combined hormone therapy — especially regimens that included testosterone — although benefits were seen in most types of treatment.
Looking for causes where they are not
Dr. Louise Newson, a hormone specialist at the Newson Clinic and a member of the British government’s menopause think tank, reports that “mental health symptoms, such as low mood, anxiety and intrusive thoughts, are very common during perimenopause and menopause.”
They point out that “many women suffer unnecessarily” because medical practice addresses mental health in this stage without considering the hormonal fluctuations and their impact on emotional regulation.
“The most striking aspect of this research is the drastic reduction of suicidal thoughts after hormonal treatment,” adds. “Hence our concern that the lack of access to hormonal treatments leaves women underserved and with their lives at risk, when the consequences can be devastating.”
Standard questionnaires are not adequate
Her colleague Pooja Saini, professor of Suicide Prevention and Self-Harm at Liverpool John Moores University, emphasizes that the study results clearly show that perimenopause and menopause should be recognized as critical stages within national policies on mental health and women’s health.
And that is the issue: suicidal thoughts at this stage go under the radar when standard questionnaires are used to diagnose depression.
This implies that the screening tools routinely used by family doctors and psychologists could miss at‑risk women. “These questionnaires do not fully capture the hormonal factors that trigger suicidal thoughts. We are facing care gaps that are both avoidable and dangerous,” the expert adds.
Hormone therapy and revision of tools
Mental health, like many other things in medicine, is often treated with a general view and, in many cases, a male-centric one. It forgets that there is a stage in a woman’s life in which the decline of estrogens, as described by gynecologist López Freire, “affects all our systems. Gonadal hormones have an action on almost all of our organs. We have estrogen receptors from the head to the tip of the toes.”
The arrival of menopause is typically heralded by irregular periods. But also by emotional instability that, as studies warn, can have devastating consequences. “That is why it is so important not to minimize any symptom.” The hypothalamus also experiences this lack of estrogens, and it is the hypothalamus that modulates the functioning of the limbic system. Any hormonal change will alter emotional responses.
The apathy that precedes menopause
Many women, when arriving at the Galician gynecologist’s office, acknowledge having entered a kind of phase of life-weariness. And they do not understand why. “They tell me ‘I no longer feel like doing what I used to,’ ‘I have no desire,’ ‘I’ve been promoted and I don’t care’… They sense something they cannot interpret.”
The cause of that lack of motivation lies in the impact on the dopaminergic system caused by hormonal changes associated with menopause.
In addition to stressing the importance of seeking hormone therapy at this stage, López Freire urges those women who feel more down, stressed, or show unidentified feelings of sadness to “ask for help as soon as possible.” Especially those patients who already had mood disorders or very intense premenstrual syndromes.
