Teresa Barker woke one morning with a sudden, gripping anxiety that felt unlike anything she had experienced before, and only later recognised it as linked to perimenopause. The Royal College of Nursing published her account on 9 July 2026. Barker is a mental health nurse and former chief nursing officer with more than 25 years’ experience, and she had never received training on hormone health.
The first sign of perimenopause is often a change in periods, with symptoms arriving years before the final period. Anxiety, low mood, brain fog, insomnia, hot flushes, night sweats, joint and muscle pain, vaginal dryness, and itchy or dry skin are all listed as possible symptoms. Symptoms can begin in the late 30s or early 40s, while some local guidance puts the start point in the mid-30s or earlier.
The RCN, the world’s largest nursing union and professional body, represents more than half a million nurses, midwives, nursing support workers and students. A YouGov poll commissioned by the Royal College of Psychiatrists found that only 28% of women knew a new mental illness can be associated with menopause, while 93% linked menopause with hot flushes and 76% with reduced sex drive. In March 2026, the Royal College of Psychiatrists found only 21% of UK adults thought a new mental illness could be associated with menopause, and only 28% of UK women surveyed felt comfortable speaking to a male boss about the menopause.
Women are frequently prescribed antidepressants when HRT may be more appropriate, and menopause is not routinely considered in mental health assessments. The Health Services Safety Investigations Body’s community mental health investigation used the death of a 56-year-old woman, Ms A, as a reference event, and it said midlife is a period of increased risk of mental health deterioration, including increased suicide risk. The British Menopause Society’s 2026 practice standards recommend clinicians consider perimenopause or menopause in women aged 45 and over with menopausal symptoms on symptoms alone, without confirmatory blood tests unless diagnosis is uncertain.