Menopause and mental health: clinical evidence and public discourse.

Abstract

The global discourse surrounding menopause has undergone a seismic shift, transitioning from clinical silence to a hyper-visible cultural phenomenon. However, this "menopausal turn" has introduced a significant paradox: while visibility reduces stigma, it frequently replaces clinical nuance with market-driven, reductive narratives. This paper provides a comprehensive bio-psycho-social synthesis of the menopause transition, bridging the gap between emerging neurobiological evidence and contemporary public discourse. We examine the neuroendocrine basis of perimenopausal mood changes, illustrating how fluctuating ovarian steroids - specifically oestradiol and progesterone - modulate serotonergic, dopaminergic, and GABAergic systems to create a window of psychiatric vulnerability. Challenging the "oestrogen deficiency" monocausal model, we integrate epidemiological data from major longitudinal cohorts, such as the Study of Women's Health Across the Nation, to highlight the "domino effect" of vasomotor symptoms, sleep fragmentation, and pre-existing psychosocial stressors. A critical focus is placed on the diagnostic attribution bias prevalent across medical specialties. We argue that primary care and psychiatry often operate through divergent "disciplinary lenses," leading to the misattribution of symptoms and fragmented care pathways. Furthermore, we critique the commercialisation of the "wellness" industry, which often leverages "femvertising" to promote non-clinical solutions that mask complex neurobiological realities. Ultimately, this paper advocates for a nuanced, interdisciplinary framework. By reconciling physiological evidence with the lived sociocultural experience, healthcare providers can move beyond superficial public narratives to deliver individualized, evidence-based care that addresses the holistic mental and physical wellbeing of women navigating this profound midlife transition.