Menopausal Suicidality and Fragmented Care: A Qualitative Study of Carer and Clinician Perspectives

BACKGROUND: Emerging evidence indicates elevated suicidality during the menopausal transition, yet little is known about its impact on those providing support. OBJECTIVE: To explore how menopausal suicidality is experienced by informal carers and menopause-focused healthcare professionals, and to identify relational and service-level consequences. DESIGN: Qualitative study using semi-structured interviews and reflexive thematic analysis. SETTING AND PARTICIPANTS: Twenty-eight participants were recruited: 19 healthcare professionals working within a specialist menopause clinic and 9 informal carers supporting women who had experienced suicidality during menopause. Interviews were conducted online. MAIN VARIABLES STUDIED: Participants' accounts of menopausal suicidality, caregiving burden, clinical responsibility and experiences of healthcare systems. RESULTS: Five interrelated themes were identified. Menopausal suicidality was described as cyclical, hidden and sometimes acute, with hormonally patterned fluctuations and perceived impulsivity. Emotional labour shifted into families, generating vigilance, fear and exhaustion. Clinicians described managing suicide risk within services not designed for crisis care. Participants also reported fragmented pathways in which women fell between hormonal and psychiatric services, and called for more integrated, anticipatory support. DISCUSSION AND CONCLUSIONS: Menopausal suicidality exposes gaps between endocrine and mental healthcare, diffusing responsibility across services and increasing burden on carers and clinicians. Integrated care pathways, menopause-specific suicide prevention training and support for informal and professional caregivers are needed. To our knowledge, this is the first qualitative study to examine caregiving experiences in menopausal suicidality. PATIENT OR PUBLIC CONTRIBUTION: A Public Advisory Group with lived and professional experience informed the study focus and prioritised exploration of carer and clinician perspectives.