Improving detection and treatment of psychological distress during menopause: evidence from a clinical hormone replacement therapy cohort

Hendriks, O ORCID: 0009-0005-0990-318X, Kamal, A, Saini, P ORCID: 0000-0002-4981-7914, Rose, AK ORCID: 0000-0003-3267-7318, Reisel, D, Newson, L and McIntyre, JC ORCID: 0000-0002-5601-524X (2026) Improving detection and treatment of psychological distress during menopause: evidence from a clinical hormone replacement therapy cohort. BJPsych International. pp. 1-11. ISSN 2056-4740

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Abstract

Background
Menopausal transition is a period of psychological vulnerability, yet suicidality remains underassessed. Hormone replacement therapy (HRT) may influence mood symptoms, but its mental health effects – particularly regarding suicidality – are poorly understood.

Aims
To evaluate changes in depressive symptoms, menopause-related distress and suicidality among menopausal women attending a specialist clinic, and explore whether outcomes differed across HRT regimens and baseline risk factors.

Method
We analysed routinely collected data from 957 women attending a UK menopause clinic. All participants received some form of treatment following their initial consultation. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and Menopause Depression Rating Scale (MENO-D) at baseline and follow-up (2–6 months later). Mixed-design analyses of variance assessed changes over time, including interaction effects for HRT type and baseline risk factors (body mass index (BMI), smoking, suicidality, antidepressant use).

Results
Depressive symptoms and menopause-related psychological distress significantly declined over time (around 46% reduction on average). The largest improvements were observed among women receiving oestrogen–progesterone–testosterone combinations, although similar gains were also seen in oestrogen–progesterone and oestrogen–testosterone groups. Suicidality (PHQ-9 item 9) decreased by 92% among those with baseline ideation, but this was not moderated by HRT type. Self-worth (MENO-D item 4) also improved, but similarly showed no significant moderation by HRT regimen. Higher BMI was associated with worse baseline mental health, but did not moderate treatment outcomes.

Conclusions
Combined HRT, including formulations with testosterone, was associated with substantial improvements in mental health outcomes. Suicidality was a distinct symptom profile, often underdetected by general depression scores. However, findings are exploratory and should be interpreted cautiously because of the lack of a control group, observational design and small sample sizes in some subgroups. These results highlight the need for menopause-sensitive mental health assessments and integration of psychological screening into routine menopausal care.

Item Type:	Article
Uncontrolled Keywords:	32 Biomedical and Clinical Sciences; 5203 Clinical and Health Psychology; 4203 Health Services and Systems; 3202 Clinical Sciences; 42 Health Sciences; 52 Psychology; Serious Mental Illness; Depression; Mental Illness; Clinical Research; Mental Health; Menopause; Estrogen; Behavioral and Social Science; Aging; Women's Health; Contraception/Reproduction; Suicide; Brain Disorders; Prevention; Mental health; 3 Good Health and Well Being
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Divisions:	Psychology (from Sep 2019)
Publisher:	Royal College of Psychiatrists
Date of acceptance:	18 December 2025
Date of first compliant Open Access:	4 February 2026
Date Deposited:	04 Feb 2026 14:03
Last Modified:	04 Feb 2026 14:03
DOI or ID number:	10.1192/bji.2025.10094
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28042

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