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Fact check: Is menopause related to mental issues, and if so, what are the prevalence of "crazy" mental issues in women brought on by menopause?
Executive Summary
Menopause is clearly linked to increased risk of mood, anxiety, and cognitive symptoms for a substantial subset of women, with multiple reviews and studies reporting depression prevalence around one-third and anxiety or mood symptoms affecting up to half or more during the menopausal transition [1] [2] [3]. Severe new-onset psychosis during menopause appears uncommon but is reported in case reports and is the subject of growing clinical attention because hormonal changes plausibly raise risk in susceptible women [4] [5].
1. Big Claim Breakdown: “Menopause causes mental issues” — what the evidence actually says
Multiple recent syntheses and empirical studies converge on the claim that the menopausal transition is associated with elevated rates of mood disturbance, anxiety, and cognitive complaints. A global meta-analysis pooled depression prevalence at about 35.6% across perimenopausal and postmenopausal samples [1]. Cross-sectional work and reviews likewise report high rates of mood swings, anxiety and “brain fog”, with some articles citing up to 70% experiencing mood variability and roughly 45–60% reporting depressive symptoms in some samples [3]. These claims are consistent across summaries and original studies included in the provided dataset, indicating a robust association between menopause and common mental-health symptoms, though the magnitude varies by study design, population, and measurement methods [1] [2].
2. How common are these problems — separating common symptoms from severe illness
The numerical picture shows that common mental-health symptoms are frequent: pooled depression rates near one-third and anxiety rates reported in some studies above 50% point to high burden [1] [2]. Cognitive complaints such as “brain fog” are reported by many women in clinic-based and survey data, with some accounts estimating nearly 60% prevalence in certain cohorts [3]. At the other end, new-onset severe psychiatric disorders like psychosis are uncommon but documented, primarily through case reports and focused reviews that highlight a potential midlife rise in psychosis risk linked to ovarian hormone changes [4] [6]. In short, common mood, anxiety and cognitive complaints are frequent; frank psychotic disorders are rare but clinically important [1] [4].
3. Why might menopause affect the brain — the hormonal and psychosocial story
The analyses emphasize fluctuating and declining ovarian hormones—notably estrogen—as the leading biological hypothesis linking menopause to mood, anxiety, cognition, and in rare cases psychosis. Narrative reviews and recent work argue that the menopausal transition’s hormonal volatility can unmask vulnerability to mood disorders and may plausibly increase psychosis risk in a subset of women [6] [5]. Psychosocial factors that commonly coincide with midlife—caregiving stress, sleep disturbance from hot flashes, chronic medical problems, and social role changes—amplify risk and complicate causal attribution. Thus, biological and social drivers interact, and available studies call for longitudinal designs to parse direct hormonal effects from these concomitant stressors [6] [3].
4. Contested territory: psychosis, rare events, and gaps in evidence
Recent publications, including a review from October 29, 2025, raise the possibility of perimenopause-associated psychosis and call for clinician awareness but stop short of quantifying population risk precisely [5]. Case reports document first-episode psychosis during the menopausal transition, but these are inherently limited for prevalence estimates [4]. Systematic evidence for midlife increases in psychosis is incomplete: narrative reviews identify critical knowledge gaps and emphasize the need for rigorously designed epidemiological and mechanistic studies to disentangle rare hormonally mediated psychosis from coincident psychiatric illness [6]. Consequently, claims that menopause routinely causes “crazy” or psychotic behavior are unsupported by population-level data, even while rare severe presentations merit attention [5] [4].
5. Clinical implications and differing recommendations for care
Analyses uniformly recommend screening and treatment rather than stigmatization: regular screening for depression and anxiety in perimenopausal women, attention to sleep and vasomotor symptoms, and multimodal treatments (lifestyle, psychotherapy, and hormonal or non-hormonal pharmacotherapy) are proposed across sources [3] [7]. Some clinicians and reviews endorse hormone replacement therapy as one component that can alleviate mood and cognitive symptoms for selected patients, while others emphasize CBT and social support as effective non-hormonal options [3] [7]. These divergent emphases reflect different clinical priorities and concerns about HRT risks, indicating no single universal treatment and the need for individualized care [3] [7].
6. Bottom line for the question “Are women made ‘crazy’ by menopause?” — words matter
The evidence shows menopause is associated with substantial increases in common mood, anxiety, and cognitive complaints, affecting a large minority to majority of women in some studies; however, the pejorative label “crazy” is inaccurate and stigmatizing. Severe psychiatric disorders like new-onset psychosis during menopause are documented but rare and remain an active area of research with important gaps [1] [4] [5]. Clinicians should screen, validate symptoms, and offer evidence-based treatments, while researchers should prioritize longitudinal, mechanistic, and population-level studies to refine prevalence estimates and causal pathways.