Treating the perimenopause and mental illness in parallel is likely to lead to speedier recovery and better long-term outcomes

Patients with a history of mental illness can have their perimenopausal symptoms misdiagnosed and face delays in receiving correct treatment, a new article finds

For women with pre-existing mental disorders, hormonal fluctuations experienced during the perimenopause may cause changes to their symptoms and their usual response to treatment. They may also be at risk of poorer longer-term physical health in the menopause.

A new article, published in BJPsych Bulletin [1], has highlighted that there is a danger of perimenopausal women with a history of mental illness having their perimenopausal symptoms misdiagnosed as a relapse of their pre-existing mental illness.

Co-author of the article Clair Crockett, a GP and menopause specialist at Newson Health, highlights that clinicians should be proactive in discussing perimenopause and menopause with their patients, and offering relevant lifestyle advice and HRT, if indicated.

The article states: ‘When patients experience a relapse of their mental illness in the perimenopause, clinicians often prioritise the treatment of the mental illness with a view to maybe considering the perimenopausal symptoms when the acute mental illness is optimised; we would argue that this reductionist method is unhelpful, and that treating the perimenopause and mental illness in parallel is likely to lead to speedier recovery and better long-term outcomes.’

Looking at mental illness during the perimenopause, the paper found that patients with schizophrenia are at risk of an exacerbation of their psychotic symptoms and often experience increasing resistance to antipsychotic therapy over the course of their menopause.

Patients with a pre-existing depressive disorder are at risk of relapse in the perimenopausal period and may find antidepressants which had previously helped are no longer effective.

While the evidence on the course of bipolar affective disorder through menopause is limited, preliminary evidence suggests that there may be an increase in the rate of mood disturbance.

Anxiety symptoms, which are often a hallmark of the perimenopause, are more likely to occur in those with a pre-existing diagnosis or sensitivity towards anxiety.

Discussion of symptoms through the prism of perimenopause may help patients understand their symptoms and treatment options. HRT can be used to restore declining levels of hormones in the perimenopause and to treat perimenopausal symptoms. This will optimise quality of life (for example, in improving sleep, reducing psychological distress and physical symptoms). If oestrogen levels are balanced with HRT, and testosterone and progesterone replacement considered, patients are likely to respond more consistently to medication and ultimately enjoy better health outcomes.

References

Behrman, S., Crockett, C. (2023). Severe mental illness and the perimenopause. BJPsych Bulletin, 1-7. doi:10.1192/bjb.2023.89