Menopause, Perimenopause and Suicide: Why We Need to Talk About This
By Rosie MacLennan-Crump, strength coach and menopause specialist, Stapleford, Nottinghamshire
Menopause nearly broke me.
I was 42 when it started. The crying came first; daily, unprompted, sometimes without reason. Then the anxiety, my thoughts would race at 3am, and I'd lie awake wondering how I could keep going. I couldn't sleep properly and I didn't understand what was happening to me. I reached out to my family, my GP, and eventually I got help. I was lucky. I had a supportive family, a GP who listened, and access to HRT quickly. Not everyone has that safety net or even knows that they need it, and that's why I'm writing this.
The neurobiology of perimenopause and depression
We talk about postpartum depression as a recognised medical reality caused by hormonal shift. We understand that the dramatic drop in oestrogen and progesterone after birth can trigger depression, anxiety, and in severe cases, suicidal ideation. That's accepted science and accepted conversation.
Perimenopause and menopause work the same way. The same hormones that plummet after birth are fluctuating wildly during perimenopause; sometimes spiking, sometimes crashing, with no predictable rhythm. Your brain is being given constant changing levels of oestrogen and progesterone. These aren't just reproductive hormones; they're neurotransmitters that affect serotonin, dopamine, and your whole mood regulation system.
The symptoms are real, they're neurobiological. They're not a character flaw or a sign of weakness. And yet, for many women, they're dismissed as stress, burnout, or 'just what happens when you get older.'
The data we need to see
Suicide rates are particularly concerning for women aged 45 to 54, this is the perimenopause to menopause age bracket. The link between menopause, depression, and suicide is not a coincidence or a hypothesis. It's documented, it's real.
And yet, when a woman in her late forties or early fifties reports suicidal thoughts, menopause is often not even mentioned in the conversation. Her symptoms are described as depression, or anxiety, or stress. The hormonal component, the thing that's actually driving the neurochemical shift is invisible.
This matters. Because if you don't identify the cause, you can't address it properly. You can end up in the wrong treatment pathway, or no pathway at all, while your symptoms worsen.
Why symptoms get dismissed
Many women spend perimenopause exhausted, overwhelmed, and not even realising what's happening to their bodies and minds. They're in senior positions at work, managing households, supporting partners through ill health, caring for elderly parents, raising teenagers. Their thirties and forties are the busiest seasons of life. And then, just when they might expect some ease, their hormones begin a shift that can feel destabilising.
The symptoms are wide-ranging: mood changes, exhaustion, anxiety, insomnia, brain fog, hot flushes, night sweats, joint pain, changes to metabolism. They're often dismissed because they're invisible, you don't look sick and because they're attributed to other things: stress, age, burnout, a busy life.
But when the mood piece is severe, when the anxiety becomes unbearable, when someone starts having thoughts of harming themselves, we need to stop treating this as a mental health crisis in isolation. We need to ask: could this be perimenopause?
If you're struggling right now
You are not alone. You are not imagining it. Your symptoms are real, they are physiological, and they can improve.
If you're having thoughts of harming yourself, please reach out as soon as you start to think something might be wrong. You deserve and need support. Here's what matters right now:
Talk to someone you trust. A partner, a friend, a family member. They can’t fix it, but isolation makes everything darker.
Reach out to your GP. Tell them you're experiencing suicidal thoughts. Be specific about when they happen, how intense they are, and whether you have a plan. This is urgent information, and your GP needs to know it. If they dismiss perimenopause as a factor, ask directly: could this be related to hormonal changes?
Call Samaritans. They're available 24/7 on 116 123 (free, won't appear on your phone bill). You don't have to be in immediate crisis to call. You can call if you're struggling, if you're scared, if you need someone to listen.
The Campaign Against Living Miserable also have a phone line, live chat and whatsapp access as well as useful resources.
Download and explore the Stay Alive app or similar suicide prevention apps. They're designed to help you work through the moment when thoughts are overwhelming.
If you’re reading this it’s worth noting these, you never know when you might need them (they aren’t women menopause specific). It’s always s better to let someone know about the support that’s available than not.
What can actually help
HRT isn't a magic fix, but for many women, restoring oestrogen and progesterone levels can be genuinely life changing. It won't solve everything; if there are other life stressors, they still need addressing but it can stabilise the neurochemical foundation so that everything else becomes manageable again.
Therapy or counselling helps you process what's happening and build coping strategies. Talking to someone trained to help is not weakness; it's wisdom.
Movement matters. Strength training in particular not because it's a cure, but because it's one of the most reliable ways to boost serotonin and dopamine naturally. It gives you something you can control when so much feels out of control. It reminds you that your body can do hard things.
Sleep, where possible. Connection with people who don't require you to be fine. Reducing unnecessary stress where you can. These aren't luxuries; they're load-bearing parts of recovery.
Why I'm talking about this
I work with women in midlife. I coach them through their forties and fifties. A lot of them are in that perimenopause window. Many of them are struggling with mood, anxiety, and fatigue that they don't understand. Some of them have mentioned suicidal thoughts, almost in passing, as if it's just something they're managing, not realising it's a medical emergency dressed up as normal.
As a strength coach, I'm not here to diagnose or treat depression. But as a menopause specialist with mental health first aid training, and as a woman who lived through this, I can recognise the signs. I can listen, I can help someone see that what they're experiencing might not be a personal failing or a life problem, it might be a hormonal one, with possible solutions.
We need to talk about menopause and suicide in the same breath we talk about postpartum depression. We need GPs to ask about perimenopause symptoms when a woman in her late forties presents with suicidal ideation. We need women themselves to know that if they're struggling, there's a physiological reason, and that reason can be addressed.
You are not alone, and there is a way forward
Menopause doesn't have to mean suffering in silence. There is help. There are treatments. There are people who understand. And there are resources available right now, today, if you need them.
If you're struggling: please talk to someone. Please call Samaritans. Please reach out to your GP and be honest about how dark things feel. Please download the Stay Alive app. Please don't carry this alone.
There is a way forward. You don't have to see it yet. You just have to reach out.
Rosie
Resources
Samaritans: 116 123 (available 24/7, free, confidential)
Campaign Against Living Miserably:support and resources
Stay Alive App: suicide prevention app with coping strategies and crisis support
Your GP: If you're having thoughts of suicide, contact your GP urgently. Ask specifically about menopause or perimenopause screening.
Important call 999 or go to A&E now:If yours or someone's life is at risk – for example, they have seriously injured themselves or taken an overdose
About the author
Rosie MacLennan-Crump is a strength coach and certified menopause specialist based in Stapleford, Nottinghamshire. She holds qualifications as a personal trainer, women's coaching specialist, and mental health first aider. She is trained to work with clients living with long-term conditions and is currently completing her Level 4 Strength and Conditioning qualification. She runs The Refectory, a small strength studio in Ilkeston, and works with women across Nottinghamshire, Derbyshire, and online. She is also a senior manager in adult education and has personal lived experience of perimenopause and early menopause.
