The Menopausal Transition and Suicide Risk: A Mixed Methods Investigation of Lived Experiences and Contributing Factors

Hendriks, O (2025) The Menopausal Transition and Suicide Risk: A Mixed Methods Investigation of Lived Experiences and Contributing Factors. Doctoral thesis, Liverpool John Moores University.

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Abstract

This thesis aimed to make a critical contribution to the understanding of suicidality during the menopausal transition, a topic that remains underexplored in both research and clinical practice. Despite increasing recognition of menopause-related mood disturbances, suicidality is often overlooked, poorly recorded, and inadequately addressed in both mental health and menopause care. Gaps in the literature include a focus on hormonal mechanisms without consideration of lived experience, minimal integration of suicidality into menopause research or screening frameworks, and a lack of data capturing how hormone replacement therapy (HRT) may influence psychological outcomes. To address these gaps, this thesis comprised four interrelated studies, utilising systematic review, qualitative and quantitative approaches. First, a systematic review of 19 papers examined suicidality among menopausal women, highlighting limitations in conceptual frameworks, diagnostic criteria, and the neglect of suicidality as a standalone outcome. Building on these findings, a quantitative study then analysed routine clinical data from 957 patients accessing specialist menopause care. This study assessed the impact of different HRT regimens on depressive symptoms and suicidality (PHQ-9 and MENO-D), revealing significant improvements over time, particularly for those receiving oestrogen, progesterone, and testosterone combinations. Additionally, a thematic analysis of interviews with 42 women explored the lived experience of perimenopausal distress and suicidality, revealing cyclical symptomology, embodied distress, and fragmented care experiences. Then, a qualitative study was conducted with 28 informal and formal carers to understand how suicidality during menopause is recognised, interpreted, and supported by those close to the women directly affected. The final chapter integrated findings across studies, offering a novel framework for understanding menopausal suicidality that considers hormonal, psychosocial, and systemic factors. Collectively, this thesis highlights that suicidality during menopause is both underrecognised and under-researched, often falling between service thresholds and clinical categories. The findings suggest that HRT may support psychological recovery for some women, but also emphasise the need for earlier detection, better training for healthcare providers, and integrated models of care that do not treat suicidality in isolation from the 12 hormonal context. The thesis concludes by calling for policy and education reform, targeted screening, and gender-informed suicide prevention strategies that reflect the realities of menopausal distress.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	Menopause; Suicidality; Hormones; Mental Health; HRT
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Psychology (from Sep 2019)
Date of acceptance:	20 November 2025
Date of first compliant Open Access:	1 December 2025
Date Deposited:	01 Dec 2025 15:05
Last Modified:	01 Dec 2025 15:05
Supervisors:	Saini, P, McIntyre, J and Rose, A
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27596

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