In a study of 128,294 women from the UK, a team from Cardiff University’s School of Medicine and Bipolar UK investigated whether perimenopause, the years surrounding the final menstrual period, is associated with an increased risk of developing psychiatric disorders for the first time.

The study was inspired by the firsthand experiences of women that Professor Arianna Di Florio, from the Division of Psychological Medicine and Clinical Neurosciences at Cardiff University, observed in her mental health clinic. She said “During perimenopause approximately 80% of people develop symptoms, but the impact on the onset of severe mental illness was unknown.

“In my clinic, I found that some women, previously living lives without any experience of severe mental health issues, developed severe mental illness around the time of the menopause.

“I feel a duty towards the women I work with. I wanted to provide them and other women with the answers to why this terrible thing happened to them.”

Cardiff University says the study is the first known investigation into the link between first onset psychiatric disorders in the years around menopause.

The team focused on the four years surrounding the final menstrual period and found that incidence rates of psychiatric disorders significantly increased compared to the period before menopause. An 112% increase in incidence of bipolar was observed at perimenopause, the largest of the disorders investigated. Onsets of major depressive disorder were found to increase by 30%.

Arianna Di Florio said “Research like this is vital, as women experience these profound changes in their lives and bodies and are currently let down by the lack of detailed understandings of these changes.

“We have been able to expand our knowledge of the mental health changes associated with perimenopause, which can help provide explanations, diagnoses and support for women who have previously been left in the dark about what is happening to them.”

Clare Dolman, Ambassador for Bipolar UK and Patient and Public Involvement Lead on the project, said “This study is extremely important as it demonstrates for the first time in a very large sample that the menopausal transition has a measurable impact on women’s mental health.

“For me, this confirms what we have observed and heard from women with bipolar themselves; that hormonal change is a very important factor in mood disorders and one that deserves to be researched thoroughly.

“As a woman with bipolar myself who has gone through menopause, I am looking forward to the research community recognising the importance of this finding. The studies will allow us to predict an individual woman’s risk of becoming unexpectedly ill at this time of life. That knowledge could be life-saving.”

The study focussed on first onset experiences of psychiatric disorders during perimenopause but didn’t investigate links with the recurrence of pre-existing psychiatric disorders in perimenopause. Further research focussing on people with a previous history of mental illness is needed.

Arianna Di Florio said “We are very grateful to the participants involved in the research, as their contributions have allowed us to broaden our understanding, and helped answer questions that explain women’s lived experiences.”

The research, “Exploration of first onsets of mania, schizophrenia spectrum disorders, and major depressive disorder in the perimenopause”, was published in Nature Mental Health and this study was funded by the Medical Research Council and the European Research Council. The research was conducted in collaboration with Bipolar UK and the UK Biobank.