Major international project aims to strengthen women’s mental health during menopause

Menopause is often associated with hot flushes and sleep disturbances. However, the years leading up to and surrounding menopause are increasingly recognised as a period when the risk of mental illness may increase. Even though around 725 million women worldwide are currently in this life phase, research in this area remains limited.

A new large-scale international research project will now examine whether the risk of mental illness increases in the years leading up to and around the final menstrual period – the phase known as the perimenopause.

- We will be investigating women’s mental health during the period surrounding menopause. We know that the risk of depression increases during phases of life characterised by major hormonal fluctuations. For example, we see a higher risk of depression around childbirth, explains Trine Munk-Olsen, Professor of Psychiatry at the Department of Clinical Research and Odense University Hospital.

- Menopause is a major biological transition that takes place over several years, yet our knowledge of its significance for women’s mental health remains worryingly limited.

The project will be carried out in collaboration with researchers in the United States, Sweden and England. It builds on existing partnerships and networks and brings together researchers and women with lived experience, who will contribute jointly to the project.

Unique Danish and Swedish health data

Researchers from the University of Southern Denmark (SDU) play a central role in the project, which is based on Danish and Swedish health data. By linking large population studies with national registers, researchers can follow tens of thousands of women over many years. This makes it possible to identify patterns and associations that would otherwise be difficult to detect.

- In Denmark, we have some of the best health registers in the world. This gives us a unique opportunity to examine whether there is a genuine link between menopause and mental illness, and to identify when the risk is greatest, says Trine Munk-Olsen.

- For this project, it is also essential to use data from several Danish cohorts, including the Danish Twin Registry, where information on the date of the final menstrual period has been recorded. This will help us define the timing of menopause more precisely.

Trine Munk-Olsen works with Danish health data and, as part of this project, will develop a tool to help doctors identify women at risk of deterioration in their mental health.

The project has three main objectives:

• To examine whether the risk of mental illness and reduced daily functioning increases during menopause compared with the years before and after – and compared with other women of the same age.
• To develop a tool to identify women at particular risk of mental illness during this life stage.
• To investigate whether hormone therapy can reduce the risk of severe psychiatric episodes.

From research to practical tools

The findings will result in concrete tools that doctors and women can use together in practice – including two online risk calculators and clearer evidence about when hormone therapy may be beneficial.

The aim is for women at risk to receive help earlier, before symptoms develop into severe illness. The project has the potential to change how the healthcare system identifies and prevents mental illness in women during menopause and to give women access to help at an earlier stage.

- We expect that the grant from Wellcome Trust will make a significant difference for many women. As all research projects are developed in collaboration with women who have lived experience, we hope to ensure that the findings are directly applicable to both women and clinicians, says Trine Munk-Olsen.

- It is striking that menopause has received limited research attention for many years. We hope that PROMIS will help draw greater attention to how menopause can be a challenging life phase for many women – and that it involves far more than hot flushes.