How NHS is letting down menopausal women

Mental health services are letting down women by failing to account for the impact of the menopause, patient safety investigators have found.

Women are frequently prescribed antidepressants when hormone replacement therapy (HRT) would more appropriate, they said.

A new report into the suicide of 56-year-old NHS manager Frances Wellburn found staff working in community mental health teams are not trained in this area, and menopause is not routinely considered as a contributing factor among women with low mood who need help.

The report noted that midlife is a point when mental health can deteriorate, leading to an increased risk of suicide.

Plus, women can be at increased risk of developing schizophrenia or other psychotic disorders at or around the menopause.

The Healthcare Safety Investigation Branch (HSIB) report further warned that too many people are taking their own lives while being deemed as at low or moderate risk of suicide.

Despite national guidance telling staff not to rank people as being at low, medium or high risk, too many NHS trusts still use the system, leaving people without the right care, investigators concluded.

The report detailed the case of Ms Wellburn, from York, who was in contact with local mental health services between 2019 and 2020.

In a foreword to the study, her sister described her as a ‘kind, thoughtful, resourceful, funny and caring’ woman who ‘was loved and valued by her family, friends and the people she worked with’.

Doctors noted Ms Wellburn had ongoing psychotic depression and, while she was prescribed an oestrogen hormone just before she died, on the whole it was a ‘potentially unconsidered’ factor among those treating her

Ms Wellburn had a history of depression, which had been managed by her GP with medication, and had no contact with mental health services until September 2019 when she had suicidal thoughts and was admitted to hospital.

After being discharged, Ms Wellburn was in regular contact with community mental health services run by Tees, Esk and Wear Valleys NHS Foundation Trust.

However, there was then a long gap in care when the country went into a Covid lockdown, with no contact between Ms Wellburn and the trust between February and May 2020.

Ms Wellburn was admitted to hospital again in May after her mental health deteriorated and was then in contact with community teams until her death in August 2020.

Doctors noted she had ongoing psychotic depression and, while she was prescribed an oestrogen hormone just before she died, on the whole it was a ‘potentially unconsidered’ factor among those treating her.

This is despite her sister telling the HSIB team that the impact of the menopause on Ms Wellburn was profound, both physically and mentally.

The report warned mental health services are not taking the full effects of the menopause into account when assessing women, and are not looking at its potential impact on more severe mental health symptoms.

It said experts in menopause care had suggested the symptoms of menopause and perimenopause ‘are often mistaken for depression, resulting in women being prescribed antidepressants rather than HRT’.

The report added: ‘Staff also told the investigation that current mental health assessments do not prompt practitioners to consider menopause as part of the holistic assessment of an individual.’

The HSIB made a series of safety recommendations, including calling on Nice to evaluate the available research ‘relating to the risks associated with menopause on mental health and if appropriate, updates existing guidance’.

The Royal College of Psychiatrists should also form a working group to identify ways in which menopause can be considered during mental health assessments.

A spokeswoman for Tees, Esk and Wear Valleys NHS Foundation Trust said it could not comment on the care of individual patients but added: ‘We fully support the findings and recommendations in the HSIB report into care delivery within community mental health teams.

‘We will keep working closely with our partners in the wider health and social care system to make sure improvements are made.’