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Menopause

Why hormones can affect your mental health during menopause and how to take control

By Sarah Williamson and Victoria Keith-Roach, co-founders at WomenWise

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Sarah Williamson and Victoria Keith-Roach, co-founders at WomenWise

For many women the changes in mental health experienced during the menopause are the most significant of all their symptoms.

Around 70 per cent of women experience some sort of mental health issue around menopause. They may experience mood swings, feeling overwhelmed, anxious, and struggle with low confidence, cravings, brain fog, fatigue, and insomnia.

It’s important to remember when discussing the menopause that it is a natural transition as the ovaries begin to retire. It usually begins in a woman’s early 40s and is marked by the changing levels of the three sex hormones – oestrogen, progesterone, and testosterone.

Some women find adapting to this change difficult. Your sex hormones follow a downward trend overall but alongside this, progesterone and oestrogen levels fluctuate up and down dramatically. The types of symptoms women experience change as they progress through perimenopause and menopause because of these fluctuations.

Women have oestrogen receptors on virtually every cell in and on their bodies. In the brain, oestrogen plays an important role in the production of serotonin, which influences mood. Adequate levels of serotonin give a sense of positivity, helps balance appetite, and supports a heathy libido.

Both relatively high and low levels of oestrogen can lower the availability of serotonin. This can leave women experiencing less joy, lower resilience to stress and with intense cravings or disrupted eating habits.

For some women, HRT (which replenishes oestrogen) can help balance serotonin levels and help with overall mood. However, for many this isn’t enough.

Hyper-personalised support and testing can highlight specific areas and identify potential dietary changes required and targeted supplements needed to make a striking improvement.

Beyond mood, changing oestrogen levels can impact cognitive function. Low oestrogen contributes to brain fog, fatigue, migraines, difficulty concentrating and forgetfulness. All of these symptoms can lower self-confidence and increase the risk of making mistakes that further damage confidence.

Another common change in mental health through menopause is increased anxiety. Early in perimenopause it can show up as premenstrual tension (PMT), disturbed sleep and feeling overwhelmed just before their periods.

As the perimenopause progresses this anxiety may become a more constant feature. Simple tasks such as planning travel, packing bags, or juggling appointments might start to feel overwhelming.

These feelings are caused by the drop in progesterone that impacts the brain’s ability to move from anxious overthinking to a calmer state. The changes in progesterone explain why anxiety is diagnosed twice as often in women compared to men.

Sometimes women unconsciously self-medicate this anxiety with alcohol or sugary foods which temporarily provide a sense of calm, but at a cost to long term health.

Genetic differences play a role here, genetic alterations to brain receptors can make women more susceptible to using higher levels of alcohol to feel relaxed. Dietary changes and targeted supplements or herbs can help women achieve a sense of calm in a healthy way.

Testosterone levels drop steadily into old age and its most notable impact is on libido, but testosterone is important too for muscle building and self-confidence.

Testosterone levels can be boosted naturally with dietary changes such as avoiding foods that bind testosterone like soya and flaxseeds. Weight training or resistance exercise can also improve symptoms of low testosterone.

During menopause, the adrenal glands should be able to take over from the ovaries as they retire. They have the potential to make hormones that can be converted into oestrogen, progesterone, and testosterone. It’s this hormone production that smooths the menopause transition in healthy women.

Modern life, however, can take its toll on the adrenal glands’ ability to make these hormones. Working too hard and experiencing persistent stress, having children later in life and other factors can all impact the adrenal glands’ ability to supply sex hormones.

This exacerbates both menopause symptoms and mental health issues. Building stress resilience, for example by using techniques such as breathwork, yoga and mindfulness, can help.

A greater understanding of the impact of menopause on mood, motivation and sleep is important while knowing that for most women there is more to regaining mental health than taking HRT alone is essential.

Tailored recommendations and lifestyle measures such as nutrition and exercise can go a long way in helping modern women feel and function at their best.

Sarah Williamson and Victoria Keith-Roach are co-founders at the London-based women’s health platform WomenWise.

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Government and NHS urged to work with pharmacies on menopause support

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The government and NHS England should work with pharmacies to show how the sector can help women experiencing menopause symptoms, according to a joint statement released by several pharmacy bodies.

A consensus statement endorsed by the Royal College of Pharmacy warned there remains significant unmet need for clear, evidence-based guidance and advice on the condition.

The statement, ‘Menopause, unmissed’, published on 24 April 2026, was endorsed by bodies including the Royal College of Pharmacy, the Company Chemists’ Association and the National Pharmacy Association.

Amandeep Doll, director for England at the Royal College of Pharmacy, said: “Pharmacy teams are highly accessible and already support people experiencing menopause with advice, self-care and signposting to other services.

“We endorsed this statement because improving access to clear information and joined-up care is essential, particularly for those facing inequalities.”

According to the NHS, around 75 per cent of women experience some symptoms during perimenopause and menopause, while 25 per cent report that their symptoms are severe.

In the joint statement, the pharmacy bodies welcomed increased awareness of menopause in recent years but warned this had also led to a sea of misinformation and that there remains significant unmet need, particularly for clear, evidence-based and accessible information and guidance.

The document set out eight recommendations to improve menopause care, including a public awareness campaign on menopause symptoms and opportunities for self-care, alongside guidance on how pharmacies can support women with menopause.

It also recommended that integrated care boards and women’s health hubs should report progress on implementing the upcoming equity framework in menopause care.

In its renewed women’s health strategy for England, published on 15 April 2026, the Department of Health and Social Care set out plans to publish an equity good practice guide to help integrated care boards better understand and reduce inequalities in heavy periods and menopause.

The joint statement asked that the Department of Health and Social Care and NHS England work with champions in minority communities to ensure menopause materials reflect a diverse range of experiences.

It added that women living in areas of high deprivation and those from Black, Asian and minority ethnic communities can experience menopause differently and are more likely to face health inequalities in their care.

Doll said: “With the right support, training and commissioning, community pharmacy can play a greater role in delivering timely, convenient menopause care closer to home, working as part of neighbourhood health teams and in partnership with women’s health hubs.”

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HRT maker censured by regulators for ‘systemic failures’ that risked patient safety

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Theramex has been censured over HRT failures that regulators said jeopardised patient safety.

The UK producer of HRT drugs, including Evorel and Intrarosa, was found to have breached fundamental compliance standards.

These included not updating crucial prescribing information, in some cases for several years, and not making clear that one drug must not be used during pregnancy.

The Prescription Medicines Code of Practice Authority issued the public reprimand after Theramex staff blew the whistle over what it described as “alarming” compliance issues and incomplete prescribing information for Evorel and Intrarosa that “jeopardise patient safety”.

Evorel patches, which contain estradiol, are among the most prescribed forms of transdermal HRT, meaning hormone treatment delivered through the skin. More than 250,000 items were issued in the last financial year, according to NHS Business Services Authority figures.

Overall, nearly 10m items of estradiol, including gels, were prescribed in the 2024/25 financial year.

The employees’ concerns included failing to provide comprehensive side-effect information in Evorel’s prescribing information, and not updating Intrarosa’s product information since 2019.

The PMCPA also reprimanded the company over failures to specify in advertising at a reproduction and advertising conference that Yselty, used to treat uterine fibroids, should not be taken during pregnancy.

In total, the PMCPA found Theramex had breached the Association of the British Pharmaceutical Industry’s code of practice 21 times.

The panel said the breaches not only jeopardised patient safety, but that Theramex had “brought discredit upon, and reduced confidence in, the pharmaceutical industry”.

The PMCPA also condemned Theramex’s decision to leave the regulator’s jurisdiction.

“By leaving the self-regulatory framework and requiring the Medicines and Healthcare products Regulatory Agency to assume full responsibility for regulating it, Theramex has inevitably delayed any regulatory action and oversight,” it said.

Dr Amit Aggarwal, medical director of the ABPI, said: “Theramex has fallen seriously short of the standards expected under our strict ABPI code of practice, and it’s right that the PMCPA took action.

“It’s also disappointing that as a result, the company has decided to leave the pharmaceutical industry’s self-regulatory system, which holds companies to standards above and beyond the law.”

Julian Beach, MHRA’s executive director of healthcare quality and access, said he was disappointed Theramex had left the PMCPA, but that the MHRA would take any necessary steps to ensure patient safety.

He said: “Leaving the jurisdiction of the PMCPA does not mean a company escapes scrutiny.

“The MHRA has legal powers to investigate and act on concerns about medicines that may impact public safety. Breaches of regulations can amount to criminal offences.”

A spokesperson for Theramex said: “Upholding ethical standards, compliance, and patient safety is very important to us. We acted promptly to address these historical matters as soon as we became aware of them.

“We take these matters seriously and have undertaken a comprehensive review of our compliance framework, including commissioning an independent external audit and implementing a broad programme of enhancements.

“As part of this process, we concluded it is most appropriate to be regulated with respect to UK medicines legislation by the MHRA, while continuing to uphold the spirit and principles of the EFPIA and ABPI codes of practice.

“Therefore, we withdrew from the PMCPA’s jurisdiction in January 2026. This approach allows us to focus our resources on maintaining high standards of ethical and compliant behaviour, with patient safety.”

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Menopause

Uni initiative tackles women’s health crisis

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A University of Sheffield initiative is tackling overlooked women’s health problems by helping students develop solutions to delays and inequalities in care.

In a first-of-its-kind collaboration bringing together students, clinicians and industry leaders, new ideas have been developed to address health challenges that leave millions of women facing years-long delays in diagnosis and care.

The Women’s Health Innovation Challenge saw 50 students from across disciplines and year groups work in teams on issues including fragmented care across the female health lifecycle and the widespread normalisation of serious symptoms.

Among the key challenges explored was endometriosis, a condition affecting one in 10 women globally, where patients in the UK face an average diagnosis time of more than nine years.

Other innovations addressed gaps in menopause care, cardiovascular health in women and the fragmentation of digital health solutions across different life stages.

The initiative reflects the university’s growing work in women’s health innovation, a field widely recognised as underfunded and underserved despite affecting half the global population, and its commitment to turning research and ideas into meaningful impact.

Rachel Kovacs, a final year biomedical engineering student at the University of Sheffield and organiser of the event, said: “I was lucky enough to be one of the students to take the first Women’s Health in Biomedical Engineering module in the UK, right here in Sheffield, and it really opened my eyes to how under-innovated the field is.

“I only discovered this in my final year and I wanted other students to find it sooner.

“The event itself has already made a huge difference. Students now see women’s health as a space worth innovating in.

“If even a handful take their ideas further, we could genuinely change women’s lives.

“Having personally experienced some of these gaps, I know the impact this could have on women across the globe.”

The event was supported by experts from across research, industry and healthcare, including panel members from Health Innovation Yorkshire & Humber, an NHS England organisation which acts as a bridge between healthcare providers, commissioners, academia and industry.

Participants explored a range of possible solutions to some of the sector’s most complex challenges.

The event culminated in students pitching their ideas to a panel including clinicians, academic researchers and founders of women’s health startups, creating a direct link between emerging innovation and real-world application.

The challenge forms part of the university’s wider activity in this space, including its Women’s HealthTech Innovation Network, which brings together regional and national expertise to translate research into solutions that address longstanding inequalities in care.

Dr Vanessa Hearnden, senior lecturer in biomaterials and tissue engineering at the University of Sheffield and co-chair of the Women’s HealthTech Innovation Network, said: “The Women’s Health Innovation Challenge gave students a rare opportunity to work directly with clinicians, researchers and industry partners to tackle real-world problems.

“The quality of ideas and level of engagement demonstrated the impact this kind of interdisciplinary, challenge-led learning can have.”

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