Journal of Clinical Case Studies and Reviews · May 29, 2026
Four Years of Menopausal Symptoms Treated as Anxiety: A Case Report and Review of Recognition, Attribution and Treatment Pathways
By Hensen C, Ramos B, Kern A
Fatigue, poor concentration, disturbed sleep, irritability and low mood in a woman in her forties will satisfy the criteria for adepressive or anxiety disorder. They are also the commonest features of the menopausal transition. The two descriptions are notdistinguishable on symptoms alone, which is the whole difficulty.Objectives: To review the published evidence on the overlap between menopausal symptoms and common mental disorder: howfar the diagnostic criteria coincide, what is known about misattribution, what treatment response shows, and how good thesupporting evidence actually is.Material and Methods: Narrative review of clinic cohorts, audits, prescribing data, society guidance and industry-sponsoredsurveys indexed in PubMed and the major obstetric, primary care and psychiatric journals. No new patient data were generated;every estimate quoted is one published by the original investigators, and the sponsorship of each source is stated.Results: In a cohort of 978 women attending a menopause clinic, the five most prevalent symptoms were fatigue (96 per cent),memory problems (93 per cent), difficulty concentrating (91 per cent), irritability (90 per cent) and feeling tense or nervous (90per cent); hot flushes and night sweats ranked 18th and 14th. Seven of the eight items on the PHQ-8 depression scale may beproduced by the menopausal transition. In an audit of women diagnosed with depression at a tertiary centre, 78 per cent hadsignificant perimenopausal symptoms that had been overlooked, 82 per cent were treated with antidepressants, and 45 per centreported satisfactory symptom management.Conclusion: The overlap is genuine and clinically important. The evidence describing it is unusually weak: single-clinic cohortswithout control groups, an audit in one hospital, and surveys funded by companies selling hormone therapy. Both statements needto be made together, because the strength of the argument does not match the strength of the data.Abbreviations: CBT – Cognitive Behavioural Therapy, HRT – Hormone Replacement Therapy, MENQOL – Menopause-SpecificQuality of Life questionnaire, PHQ-8 – Patient Health Questionnaire 8-item, SSRI – Selective Serotonin Reuptake Inhibitor, VMS– Vasomotor Symptoms