The Dr Louise Newson Podcast - 104 – What the research shows about menopause and suicide risk

Episode Date: September 24, 2026

In this episode, Dr Louise Newson is joined by Dr Pooja Saini and psychologist Dr Olivia Hendriks to discuss their important research into perimenopause, menopause and suicide risk. Together, they explore why hormonal changes during perimenopause and menopause can have such profound impacts on mental health, and why this connection is still often overlooked in both research and clinical care.They also discuss findings showing significant improvements in mental health and suicidal thoughts with appropriate hormone treatments, and why greater awareness, better research and more frequent prescribing of hormones are urgently needed to improve the health of women.This is a really important episode highlighting the important link between menopause and suicide risk that can’t be ignored.Let’s connect👉 Read the full research paper discussed in this episode: https://www.drlouisenewson.co.uk/knowledge/hormone-related-suicide-risk-going-undetected👉 More from Dr Louise Newson: https://linkin.bio/drlouisenewson

So on the podcast I've got two people who I've got to know really well. And I'm very excited about this episode because it's an area that's incredibly important that resonates with a lot of people. It might not be the most cheeriest of episodes, but it's one that's really important. So I've got Pooja and Live with me who I feel like I met Pooja about three or four years ago, it feels like. And I handed her one evening, I emailed her because she'd written an amazing article in their British Medical Journal. And the rest is history, as they say. So, Pouda, do you want to go first and introduce yourself? Yeah, I think I've spoken about office meeting to so many people, Louise.

But it was a great conversation I think we had. When I got that email from you, thinking about women in midlife and then potentially being, you know, in menopause, transitions and suicidal. It was just like a lightbul moment for all of the evidence I had seen nationally over a 10-year period where women in midlife were at high risk of dying by suicide. So, yeah, I think for me it was just where two kind of worlds collided and a really important area that we needed to look into. So tell me your background.

So you're a professor. I am. I'm a professor of suicide and self-harm prevention at Liverpool John Moore's University. I've been researching in the field now for 20 years and the focus was always on primary care and looking at people who talk about feeling suicidal in the community and what can be done to help them. And I'd say unfortunately there hasn't necessarily been that much progression actually in what is offered in the community. So it wasn't female specific and actually following that there was a lot of work. that I was involved in implementing for men,

for community-based centres for men with three-quarters of people dying, being male. But I think recently there's been a lot more focus on women as well, especially those going through kind of perinatal or around giving birth and maternity and even more recently now in menopause. Absolutely. And the article that I read was about men and,

that's why I emailed you to say, hang on. But you listened, which is great, which is so brilliant when people listen and are inquisitive. And then you introduced me to Liv. So, Liv, do you want to introduce yourself? Yes, of course. So I am freshly out of the NHS. I used to work clinically as a psychologist in primary and secondary mental health services. And then I saw a research physician open at John Mears, which I applied for.

and Pugia was interviewing me. And she said, you haven't got this one, but we do have a PhD going if you'd like to do that instead. It's with Dr. Belize News News News Newsome and it's on menopause and suicide risk. And because of my background, my clinical background working in secondary care and mental health services, I dealt with a lot of risk management. And I also did have a hormonal background as well in terms of academia in my undergraduate degree, a master's degree, I looked at gender dysphoria and the effect of sex hormones in terms of that. So I had a good foundational knowledge of hormones and then with my clinical

experience, it just kind of felt like a natural progression to move into that arena. And yeah, and then after that. You've just finished your PhD. I have. I've just finished. I was about to say a few months ago, maybe six months ago, I submitted it. And yeah, I have it now in my grasp. Which is fantastic. So you are a doctor but not a medical doctor. I am, yes. I always think people with a PhD are sometimes more clever than medical doctors.

And it's a lot of work. A lot of work. I've read your thesis and it took me a long time to read, but it took you a hell of a long time to write. Yeah. Absolutely. And I think that thesis actually, you know, we had that initial idea, didn't we, Louis?

of what can we do and what can we do within a reasonable budget as well. Yes. And then Louise, Liv obviously came for that interview where she really impressed me. So it all kind of just worked out really well. But I think so many more questions have come out of that research. Yeah. You know, which we need to now kind of keep following up really. Absolutely.

So I co-founded the research with your PhD, with Liverpool, John Mawls, which is a great privilege to be able to do this, but someone said ages ago, no one likes Wingers Louise, and other people have said, put your money where your mouth is. And so it sort of did both really because I'm really keen to instigate change. And I really, really enjoyed psychiatry as a medical student. I did it in a very deprived area of Manchester. And actually, I found my project a few weeks ago, just in a cupboard that I wrote. And it was a, we had to do a case and spent a long time with one person. And my case was a lady who had an eating disorder. She had bulimia and she had been abused as a child. She'd had a really difficult time and her

mental health was really bad. And it was a really, I got an A for it. I spent a lot of time. And I reread it recently and I've asked nothing about her periods. I asked nothing about what her pregnancy was like. I asked nothing about whether she had pacinatal depression. And she was 45. didn't even think about her perimenopause. And that's not because I was stupid. That was because I wasn't taught and you don't know what you don't know. And I think this is what's, this research is really unmast, actually. And it was, I still worked as a GP for 25 years without really knowing mental health and hormones. I always thought I was good at psychiatry. I thought I was good at hormones, but I didn't realise the huge impact of hormones in the brain. And it was one day when I'd only recently

open my clinic, a lady from Sheffield, came down to see me and she had become a houseband with her crippling mental health problems. She'd been in and out of a psychiatric hospital. She'd had lots of treatments, including electroconvulsive therapy. And the only way she could actually come down to the clinic was to come in a camper ban with all her belongings and her dog around her because it was so difficult for her to go outside. So she'd remorgeted her house to buy a camper van to come and see me. And I didn't know this at the time. I knew she'd struggled coming across the car park because she was 20 minutes late for her appointment. And the nurses told me it took her 20 minutes to just come out into the see me. And she was in a very difficult

place mentally, but she was 54. A period to stop quite a few years before. And she had recurrent urinary tract infections, palpitations, dry skin and joint pains. And I looked at her and I thought, my goodness, hormones are good, but they're not that good. And I'm never going to give any patients I don't now false hope about hormones. But I said to look, your menopausea, clearly you haven't had a period for a long time. You've got lots of physical symptoms. And I know from the evidence that taking hormones will reduce your risk of osteoporosis, for example. So I said, I'm going to give you hormones and we'll view you and it would be lovely if it helps some of your mental health conditions but they're quite extreme and I'm not you know what I don't want to give you false hope so a week later and I've still got

her email actually I was reading it last night in preparation for today and she wrote me this email to say I've started sleeping for the first time in many years my mind is feeling clearer I feel calmer I'm so happy that you believe me because for the last six years I've been telling my team there is a hormonal component to my mental health and no one has believed me. And it really struck me firstly that this lady knew more than I did about her own hormones and no one believed her. And it also struck me how her hormones were already having an impact. And it took me about two years for her to feel fully better. And she's been now to see me in the clinic, she's come independently. It's amazing. And I've seen this pattern recognition so often. But that was eight, nine years.

ago, moving forward, the stories that you heard really, it was still as bad, actually, in the clinic, which is really sad. Yeah, yeah, so I heard a lot of stories from women as part of my PhD. I had to interview as many as possible, really. And I got around 70 interviews, most of which were women, but I also interviewed clinicians from your clinic, Louise. And, and, and, the same stories were just coming up over and over and over again, feeling suicidal, feeling really low mood, being sort of passed around different departments in the NHS and sort of bounced from place to place.

Nobody was listening. Nobody was treating me, or if they were treating me, it was with things that weren't effective with antidepressants, really heavy antipsychotics to anxiety medication, and in some cases electroconvulsive therapy which is well as you know very sort of brutal

and invasive and none of it was working and then they sort of came to your clinic got HRT and within weeks even or months just the suicidal thoughts

completely disappeared and their mental health was a lot better and they said like it's the lights have just been switched back on again someone's just turned the lights back on. And yeah, it's just the same over and over and over again. Every single story was pretty much identical. And were you expecting that when you started the research?

I wasn't. So whenever I started in this research, I didn't know that it was actually an issue. Because you're not told, it's not public knowledge, really, that hormones affect mental health. Even yourself as a GP, weren't told about it in your training. and a lot of the clinicians that I interviewed in my PhD said the same thing just weren't told about it, didn't know about it.

In fact, menopause in general, they weren't really taught about either, maybe had one lecture in their whole medical degree about it. So it isn't really public domain, so I didn't have any clue that that was going to be as bad. I think reflecting on that as well, Liv, you know, I've been presenting at global suicide prevention conferences for over 12 years now. And suddenly it was hitting me as well when I was going to these conferences and I was chairing some of the gender-based studies.

And they were all on men. And it was all women presenting as well, which I found really interesting. And so what's really good to see, you know, for the first time last year we had a panel discussion on all issues related to women and suicide prevention, whether it was to do with menopause, which we presented or domestic violence and, you know, other kind of conditions. And we had talks to do with women and suicide prevention, but it's literally, you know, one of the first years. So that was in 2025. It's quite shocking, really, to think that that's happening. But on a positive note, you know, the dialogue is starting.

our research has been taken seriously. We've been invited to present it at numerous places. Liv's been asked to go and speak within the NHS as well about it. You know, we really are getting invitations. So that's been really good to see is as much as, you know, there's been some negative press as well in the field. One thing we did was collect data from women who weren't coming to the clinic. And they were saying pretty much the same things about all of the issues of not being

able to get help from the NHS. And for many women who did come to your clinic, a lot of them had tried within the NHS. And it was kind of a last resort. Yes. So I think there's something that needs to be thought about, you know, from services. Yeah. And I think it's really interesting. Yeah. I mean, our clinic people come because they've been underserved by the NHS. They certainly don't come first line because why would they when they've got that service available to them? But it's really interesting because when we think about hormones, as in progesterone, estradiol testosterone, they've been sort of denigrated to thinking about fertility and periods. So then gynecologists sort of have owned menopause, perimenopause, if you like, for many decades actually, even when

hormones were discovered, the researchers and the pharmaceutical companies paid gynecologists to work with them. So it's very much been about a gynecological issue. And so if I had mental health issues, I wouldn't go and see a gynaecologist about that. I would go and see my GP or I would go and see a psychiatrist. Psychiatrists have never been trained because they're not gynaecologists. And that's where medicine becomes very siloed. And so I've been told many a time by quite eminent gynaecologist Louise, you need to stop talking about mental health and hormones because there's no association. But they've never seen the results. They would never see. the lady I explained, and they certainly would never treat her either and see the improvement.

And then the psychiatrists are getting better, I think, at thinking about hormones and trying to piece it together, but they still, I've only met a handful of psychiatrists that actually prescribe HRT, and psychiatrists are medical doctors. They can prescribe any medication, really. So then they don't see the results. And it's only in medicine that, you know, when you see results, It's pattern recognition. You learn so much through your patients. And we're very experienced clinicians in this field. And the knowledge I have now compared to eight years ago is hugely different.

So joining those dots and psychologists, as many people might know listening, don't prescribe. But they often have a bit more time with people and their patients and often can unpick a bit more. So a lot of psychologists I talk to actually understand it more than psychiatrists. Yeah, that makes sense. And I remember actually when we had these first conversations, and I was kind of really emphasizing the point of we need to have some evidence to back what we think is happening. And we really worked hard, didn't we, to implement the kind of measures that are held up within our medical communities and the kind of valid instruments for us to use.

I think that's been really important to be able to use that, not just for the PhD, but actually more widely within the service. But I think it'd be really good if we speak about some of those findings as well, actually, with what was it, nearly a thousand women. Yeah. Yeah, so nearly a thousand women were surveyed. about feeling suicidal and any suicidal thoughts

that they might have had over the past two weeks so it was pretty imminent and it came back that nearly 20% of women said that they were having those thoughts so that's around what one in five

women suffering, going through menopause are feeling thinking of ending their lives which is higher than probably what most people think but interestingly on first following

up so around up to six months later, I think it was, after treatment, that dropped by 92%. 92%. Yeah. Which is just huge. So that was with treatment with HRT. And the most effective combinations of HRT were ones that included testosterone, interestingly enough. And women that were on all three HRTs. So estrogen, testosterone and progesterone had the best. And mental health outcomes out of any group of HRT. That's a dramatic improvement, isn't it? Yeah, it is. And that is better than any antipsychotic and antidepressant actually that I'm aware of.

Yeah. Yeah, huge, huge benefits. And in terms of general mental health as well, that improved by, I think it was around 50% as well. So it's not just suicidal thoughts. It's low mood as well. But it's interesting that those two were different. in terms of their outcomes

kind of suggests that maybe suicidality and suicidal thoughts can exist without low mood in menopausal women which is why some women might fall through the net because maybe some doctors think that suicidal is just the result of extreme low mood when that actually might not be the case in menopausal women it might actually present differently

Yeah, and that's a point I've been kind of arguing or trying to put out across the population, to be honest, that suicidality doesn't have to be related to mental health issues and often is related to social issues, you know, a relationship breakdown, a job loss, bereavement is huge as well. And then obviously now what we're talking about with hormonal changes, which are just, I think something that's come to light for me, which has been, little bit sad really is to see the real kind of lack of importance that's being given to women's health. This PhD and this project has really highlighted that to me across the board. And that's a bit worrying, isn't it? When half the population of women. I think it's petrifying. You've worked with me through very difficult and challenging times because the Panorama documentary was in the middle of your PhD live and you've had first-hand knowledge on the hostility that people, the perceptions that they have about who I am or what I'm doing. But all of these perceptions, all of this gossip, all of this

whatever, they think of me is actually harming women. And, you know, I've been to some very dark places myself with some of the things that have happened to me. But one of the reasons that I keep going with my work is I know it's making a difference. You know, these women with this huge improvements in mental I see them. And when I feeling particularly vulnerable, I do my clinic and I hear first-hand stories and I know that what I'm doing is right. And it's based on established research. We've got research even in the 80s showing that women with treatment resistant depression given HRT and psychiatric hospitals made a dramatic improvement with a randomized controlled placebo study. So we've got the studies.

It's just been ignored, but the way it's being ignored now as well is such a shame. Because just remind me, Pooja, the suicide rates in women. Yeah, so the rates in women for age groups. So we know that one in four kind of suicides in the UK is from women. That's normally around 1,500 suicides a year. And unfortunately, that number is increasing. but what we do know is that the high risk group, you know, is midlife women. And unfortunately, it's increasing in younger kind of girls and women as well,

which interestingly is another time where there's a lot of hormonal shifts. And I think it's very important that we think about hormones in that age group as well, which I know is something we've discussed before. But one thing I was going to say is even though women have researched, the impact of the work we've done together has been phenomenal. I mean, I wrote one article for the conversation recently on the mental health toll of menopause. And I mean, the way that's been read globally, you know, and it's the highest read article at the university, which I just thought that was normal how much it was read.

But with people globally, though, in America, I think it was three-quarter of the reading. were there so it's really reaching a wide audience but the comments as well from women whether it was on that article or our post that we put out on live's papers and things as just being massive and you can really feel what they're saying which I've not had that with any other research I have to say that I've been involved in which again highlights the importance of the research and it's it's wonderful actually because live is now working with us full time and we've got so many projects. But you're right, Pujia, we're extending a lot of the work I'm doing

is thinking about hormones in all ages for women. So a lot of people with PMDD premenstrual dysphoric disorder have suicidal thoughts, and some studies have shown 84% of women who have PMDD have these thoughts. And they can just be, I say Justin, in Berto Commons for a few days a month. But my daughter has PMDD, which is treated, so she has hormones. But she used to say to me, but, mommy, it's not just those three or four days because the rest of the month you're petrified those days coming because they're so awful.

So it affects you every single day regardless of how you're feeling. And this is where you're talking again about you don't have to have a mental health condition to have suicidal thoughts. And a lot of younger people, when they come on very quickly, they're more likely to have an impact. And we know about 50% of people with PMDD self-harm. And, you know, people do take their lives. But the thing is, one of those quotes from your research really resonated with me because the lady had said, if I had gone through and taken my life, I would just be a statistic. I would just be a number.

People wouldn't be thinking about the hormonal effect. And that really made me feel very cold reading that because it's true, actually, isn't it? Yeah. Yeah, I think a lot of women, after they take their lives, so they just get classified. as another woman with depression who has died and they get sort of siphoned off into that category of just having mental health issues when in reality it could be a hormonal issue. Yeah. So we need to make big changes and I think we need, we've done amazing, or we, you, especially, both of you have done amazing work over the last few years. But it still needs

to reach more people. I spoke to a gentleman on Tuesday who reached, out to me because he'd listened to some of our work and research, which is great, but it's not great his story because his wife had taken her life and just a couple of months before. And her grandmother had had postnatal psychosis and was in an asylum for all her life. His wife's mother had had awful depression in her menopause. And so she was dreading becoming menopausal. And when she was, did. She was given drugs. She was given electroconvulsive therapy and they really struggled to access hormones and she didn't receive all three hormones. And he said, I really blame the NHS actually because we tried and failed. And it's really sad to hear that story in 2026. It would be different if it was, you know, 1906. But we need some urgency with this. And we're not here, by the way, saying that all mental health is due to hormones. Of course it's not.

It's often multifactorial. But we need to be thinking more in a broader way so that people can have those conversations and seek the right people. And I think that's what those people that you had spoken to live. And your research really had tried hard to get the right information

and make the right choices as well. Yes, they definitely did. there's a lot of advocating for yourself. I think they figured out they had to do that the hard way after many failed attempts of seeking advice and getting help. They realised they just, they had to learn the information themselves and do the research and, you know,

come to the doctors prepared with stuff written down and say, look, this is happening to me these days a month, every month, what is going on here? There has to be something else because it's just not ad enough. And then, even then, some of the women were, like, laughed at, basically, by the doctors and said, no, hormones don't affect mental health. That's ridiculous. It has to be something else. Just thinking back to the stories that I heard, one lady self-identified as an alcoholic, and her GP advised that she had a glass of wine to help with her mental health symptoms that she was experiencing. A lot of doctors referred to, all women coming in to getting, for getting help suddenly with their menopause

is the divina effect, which is, you know, just crazy invalidating, sort of putting it down to just a mass effect that's, I haven't going through women, but a lot of invalidation and just not being listened to, not being believed. I'm hoping that, you know, I've got an invitation last year to be on the all-parliamentary group

for suicide and self-harm prevention. So I've kind of sat in a meeting now, seeing how they run and what the discussions are. And they were actually launching the suicide prevention in the workplace standards, which is fantastic to see, you know, it's really good they're trying to make this kind of everyone's business and for people to think about. But obviously I was there and I put my hand up and I said there's no mention of menopause in here considering a lot of women in the workplace, you know, maybe going through menopause or transition. and what was really good and interesting is the women who were there presenting this work

had also led the menopause in the workplace standards, which was great. And they were really welcoming to the kind of thought of, do you know what, we haven't done that? And what they suggested is they're going to be developing kind of shorter, if you like, small books for workplaces to add as add-ons. and they were saying about doing a combination to look at menopause and suicide prevention and kind of the effects of that

and making that topic discussed a lot more. So, you know, hopefully our research will be informing that as well and we can really get that conversation about hormones in there because we just can't rely on just mental health kind of treatments for anyone who's, in crisis. Absolutely not. We need to be thinking differently.

And thinking about others as well. This isn't just for if you personally have symptoms or experiencing symptoms, look around you, think who else could be suffering or could have hormonal changes. So I'm very grateful for both of your time. You're not going to go without me asking three take-home tips, but I can't divide three by two. So it's going to have to be two each, really. So two things that you would love to see happening with the results that you've had from your research.

So do you want to go first, Liv? Oh, that's a big question. I would love for suicide risk to be asked about in general practice, whenever a woman of a certain age who is experiencing other menopausal symptoms, hot flushes, brain fog, anything like that, comes in and talks about having bad mental health, the doctors need to be asking, have you had any thoughts of ending your life?

Because they don't ask the question, so it's never found out. So that seems like a kind of a simple solution, really, just asking the questions. And also, if a woman comes in in suicidal crisis to ask about periods, you know, when was your last period? So then there isn't this constant lack of communication and women falling through the net. Absolutely. And it takes two seconds, well, maybe 10 seconds to ask those questions.

So absolutely. What about you, Puja? Yeah, I think definitely echo what lives just said. And then I think listening to women, you know, actually when they come in and say there's an issue listening to them. Because I think all too often they're just ignored or they're just being. pacified in a way and kind of just go, you'll be fine. And I don't think that's just in health professionals. I think that's in our families and communities as well. I think as a woman, I've sometimes, and I've gone going through the kind of menopausal transitions myself,

I've had those days when I've said to my family, you know, I'm not well, I'm not right. You all need to support me here. And it can sometimes be made as humor. But actually, I think we've got to start listening. When somebody says they're not feeling right and they're not well, kind of validating their feelings and listening to them. And then I just think more compassion as well within the system. I think that has to be there. So yeah. Yeah, absolutely. And I would add to listening, believing women as well, because you have to listen and believe as healthcare professionals, we have a real duty to believe our patients. They don't make these symptoms up. So We've got a lot to do, but it's great.

And I'm really looking forward to seeing what we can do working together with new research. We've got amazing ideas. We've got lots of we're going to do. And really, hopefully, help a lot more people going forward. So thanks so much for your time today. It's been really great discussion. Thank you.