Menopause
Women with mental health conditions may struggle with menopause transition
Many women struggle to find resources to help manage their menopause symptoms. For women living with a serious mental illness, the need for additional support and education during the menopause transition is even greater.
A new scoping review has confirmed this research and suggested a need for more psychoeducation programmes. Serious mental illnesses are a group of mental health conditions often characterised by their chronicity and severity of symptoms that lead to significant functional impairment.
Although definitions may vary, conditions that are usually assessed include conditions such as schizophrenia, schizoaffective disorder, bipolar disorder, recurrent depression, severe anxiety and eating disorders, personality disorders, and post-traumatic stress disorder.
These conditions may be associated with a range of poorer physical health outcomes and higher mortality rates, with a lack of proper healthcare being a contributing factor to poorer outcomes.
The menopause transition can be a time of increased risk of depression and anxiety symptoms in nonpsychiatric people. Despite major advances in education around the menopause transition, this period in a woman’s life can often be filled with frustration over the lack of resources. For women also struggling with a mental health problem, the questions are often more numerous and the frustration more debilitating.
Although there has been considerable interest in understanding the effect of the menopause transition on mental health problems overall, little research has been undertaken to assess the effect of menopause on those living with a diagnosed chronic mental health condition. Earlier research had suggested that women with compromised mental health were more likely to report more significant menopause symptoms as well as more exaggerated mental health problems.
For example, a woman diagnosed with schizophrenia may have worse psychotic symptoms during the transition. Eating disorders may also worsen because of disturbances to body image during this transitional phase.
Despite the limited number of applicable studies identified, there seems to be consensus around the idea that women living with a serious mental health condition may be ill-equipped for the menopause transition. That is why the goal of this latest review was to assess the research literature regarding psychoeducation programs in the management of menopause symptoms for women living with a mental illness.
“Overall, we have improved our understanding of the menopause transition and its potential effect on women’s wellbeing and overall functioning. However, this study is confirming what we know from other areas in medicine and public health – that we need to do a better job in providing persons with severe mental illnesses with the information, resources, and care they need to manage their health throughout their lifespans – including their midlife years,” said Dr. Claudio Soares, a psychiatrist and president of The Menopause Society.
A low-insulin diet may help curb menopause weight gain, with researchers suggesting that avoiding four food groups could help women avoid gaining weight.
The findings suggest women who ate more vegetables and avoided red and processed meats, potatoes, salty foods and ultra-processed foods were most likely to prevent weight gain during menopause.
Weight gain and changes in body shape are common during perimenopause and menopause.
At least 50 per cent of women experience weight gain during this stage, according to the British Menopause Society.
Evidence suggests women gain an average of about 1.5kg a year during menopause, with average weight gain reaching 10kg by the time menopause is reached.
New research published in JAMA Network Open has identified dietary patterns linked to lower midlife weight gain and obesity during menopause.
The study analysed data from 38,283 women over a 12-year period, covering six years before and six years after menopause.
It used information from the Nurses’ Health Study II, a long-running US study into factors affecting women’s health between 1989 and 2019.
The NHS advises that eating well and exercising can help with menopause symptoms.
It also recommends calcium-rich foods, such as milk, yoghurt and kale, to support bone health.
Researchers assessed participants’ diets every four years and recorded changes in body weight each year.
They examined 11 dietary patterns, including plant-based diets, Mediterranean diets, low-carbohydrate diets and ultra-processed food intake, to see which were linked to less weight gain during menopause.
A low-insulinaemic diet focuses on foods that help keep insulin levels steadier. Insulin is a hormone that helps control blood sugar, and repeated spikes may encourage the body to store more fat.
The study found diets higher in natural, fibre-rich foods and lower in carbohydrates and sugary foods were linked to better weight control.
Researchers said red and processed meats, French fries and potatoes, high-sodium foods and ultra-processed foods were most strongly linked to insulin spikes and menopausal weight gain.
Red and processed meats, along with poultry, were positively associated with weight gain.
French fries were found to trigger hormonal signals that can encourage fat storage.
Researchers also found that higher sodium intake was associated with the greatest weight gain among participants.
Ultra-processed foods and sugary juices were also linked to a higher risk of obesity.
The researchers concluded that avoiding these foods and eating more nuts, legumes, wholegrain carbohydrates and vegetable proteins may help prevent obesity and support longer-term heart health in women.
By Sarah Bolt, Forth
Following recent approval from the Medicines and Healthcare products Regulatory Agency, testosterone is set to become much more widely available to women in the UK.
Offering greater access to testosterone treatment through their GP, the move marks a significant shift in how menopause symptoms are recognised and treated.
However, despite the increased access, many women are still in the dark about the role testosterone plays.
As conversations around women’s health continue to evolve, testosterone is becoming an increasingly important part of the menopause discussion.
Already licensed in Australia, New Zealand and South Africa, the UK becomes among only a handful of countries making testosterone more accessible for women.
The development marks a significant step forward in recognising the full impact hormonal changes can have during midlife and menopause and the benefits that taking testosterone can have.
Testosterone is often misunderstood, and more closely associated with men, but it also plays a vital role in women’s health.
From energy levels and cognitive function to mood and libido, its influence on the body is far-reaching.
Here are the eight things women need to know about testosterone:
1. Testosterone is a vital female hormone
Testosterone is essential for women.
Produced naturally in the ovaries and adrenal glands it supports a wide range of functions in women including maintaining libido, energy levels, mood, concentration and overall wellbeing.
It also contributes to muscle strength and bone health, both of which become increasingly important during later life.
For many women, low testosterone can leave them feeling a bit out of sorts, impacting confidence, memory, motivation and other areas of life.
Because symptoms are often gradual these are often dismissed as part of ageing or the pressures of life and juggling everything that comes with it.
2. Testosterone levels decline with age
Like oestrogen and progesterone, testosterone levels naturally decline as women get older, particularly during perimenopause and menopause.
Our research found that testosterone levels in women decline by more than 51 per cent with age.
These changes can have a significant impact on daily life, affecting everything from relationships and self-esteem to work performance and sleep quality.
Despite this, many women are unaware that low testosterone may be contributing to how they feel.
3. Signs of low testosterone can vary
Low testosterone symptoms show up differently for everyone. This is why diagnosis and treatment can sometimes be overlooked.
Common symptoms include fatigue, low energy, hot flushes, night sweats, thinning hair, dry skin, muscle weakness, weight gain, mood swings and difficulty concentrating.
Some women may also experience reduced confidence, lower motivation or a loss of interest in sex.
Because many of these symptoms overlap with menopause itself, it is important that women have access to informed conversations and personalised medical advice to determine whether testosterone could help.
4. Testosterone supports more than libido
One of the biggest misconceptions surrounding testosterone is that it is only linked to sex drive.
While testosterone can help improve libido, its benefits extend much further, helping to regulate energy, motivation, emotional wellbeing, muscle strength, bone density and much more.
For some women, restoring testosterone levels can contribute to feeling more energised, confident and mentally sharp again.
5. Testosterone can support cognitive function
One of the main struggles with menopause is brain fog and difficulties with memory and concentration.
Taking testosterone can help protect brain health by supporting communication between brain cells and increasing blood flow.
As awareness around the cognitive impact of menopause continues to grow, testosterone is increasingly being recognised as a tool that helps women better manage these symptoms.
6. Testosterone does not make women masculine
Many concerns around testosterone come from the misconception that it will cause women to develop masculine features.
However, when prescribed appropriately at the right dosage by a qualified healthcare professional, this is unlikely.
The aim of testosterone for women is to help restore hormones to a healthy female range, supporting wellbeing and symptom management.
7. Testosterone is not linked to an increased risk of breast cancer
Another common myth is that testosterone increases a woman’s risk of breast cancer. Current evidence does not support this.
Testosterone does not stimulate breast tissue growth and studies have not shown an increased risk of breast cancer linked to testosterone therapy in women.
In fact, some research has suggested a lower occurrence of breast cancer among women taking testosterone, although more long-term research is still needed in this area.
8. The benefits of testosterone can take time
Testosterone therapy tends to work gradually.
Many women will start to notice improvements in mood, motivation and energy levels within the first few months with the full benefits building over time.
Because testosterone has a cumulative effect, consistent use and regular medical monitoring is important.
Patience is key and ongoing support from healthcare professionals can help ensure treatment remains safe and effective.
Despite growing awareness around hormone replacement therapy, testosterone remains one of the lesser understood hormones.
Our own research shows that testosterone levels in women decline by more than 51 per cent with age with a debilitating impact for many.
Knowledge is power and it’s really important that women are aware of the role testosterone plays in their health, particularly in midlife, so they can see their GP armed with the information they need.
Hormones will fluctuate but hormone mapping is a great place to start and will give women a greater insight into what is happening in their bodies.
It’s imperative that women are able to advocate for themselves and having this information is crucial for this.
Making testosterone more accessible in midlife gives women another treatment option to consider beyond HRT, helping them to manage menopausal symptoms and improve their overall quality of life.
Wegovy is linked to lower risks of migraine and depression in menopausal women than hormone therapy alone, a study has found.
Women across all menopause stages taking semaglutide had a 42 to 45 per cent lower risk of migraine six months after starting the medication and a 25 per cent lower risk of depression than those who took menopausal hormone therapy alone.
The findings are based on a one-year real-world study of more than 34,000 menopausal women in the US who took hormone therapy, Wegovy or a combination of both.
They were announced by Wegovy manufacturer Novo Nordisk, alongside data from the randomised, double-blinded STEP UP and SELECT trials, at the European Congress on Obesity in Istanbul last week.
Semaglutide is the active ingredient in Wegovy, a weight-loss drug.
Dr Emilia Huvinen, a gynaecologist researcher and associate professor at the University of Helsinki, who was involved in two of the three studies, said: “Menopause, associated weight gain and unwanted changes in cardiometabolic markers can significantly impact long-term health and wellbeing of women.
“Still, they remain one of the most neglected areas in obesity research.
“Whether we look at cardiovascular outcomes or weight loss across menopausal stages, semaglutide appears to offer meaningful benefits for women with obesity that extend well beyond weight loss alone.”
Cardiometabolic markers are measures linked to heart and metabolic health, such as blood pressure, blood sugar, cholesterol and waist size.
Analysis of the STEP UP trial found that premenopausal women with obesity lost an average of 22.6 per cent of their body weight when taking a once-weekly dose of Wegovy compared with placebo.
A placebo is a dummy treatment used to compare results against an active medicine.
Researchers said the average waist circumference reduction in premenopausal, perimenopausal and postmenopausal women was 17.5 per cent, 15.6 per cent and 15.3 per cent respectively, indicating a major loss of dangerous visceral fat.
Visceral fat is fat stored around internal organs and is linked to a higher risk of heart and metabolic disease.
The STEP UP trial involved 1,407 adults with a body mass index, or BMI, of 30 or above and investigated the efficacy and safety of Wegovy 7.2mg jabs.
BMI is a measure that uses height and weight to estimate whether a person is in a healthy weight range.
The SELECT trial involved 17,604 participants aged 45 or older with a BMI of 27 or above and assessed the impact of Wegovy on cardiovascular health compared with placebo.
A post-hoc analysis of the SELECT trial found that perimenopausal and postmenopausal women with obesity and heart disease had a reduced risk of heart attacks, strokes and cardiovascular death.
A post-hoc analysis is carried out after a study has finished and can help identify patterns, although it is generally seen as less definitive than the original planned analysis.
Novo Nordisk said obesity affects nearly one in five women globally, and the burden intensifies during menopause because hormonal changes accelerate weight gain, redistribute fat to the abdomen and increase cardiometabolic risk.
It added that the three studies show that when women with obesity lose weight with Wegovy, they improve their body composition with reduced waist circumference, indicating less visceral fat, and also reduce their risk of heart attacks and strokes while improving quality of life, from migraine burden to depression and menopause symptoms.
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