I tucked my notebook away as Dr. Sarah Chen finished our interview in her sunlit Vancouver office. The psychiatrist had just spent an hour explaining how her practice has evolved to address what she calls “one of the most overlooked mental health transitions in women’s lives.”
“Many of my patients come in thinking they’re experiencing early-onset dementia or a sudden anxiety disorder,” she told me, adjusting her glasses. “When I ask about hot flashes or irregular periods, there’s often this moment of revelation. No one had connected their mood changes to perimenopause.”
This disconnect between reproductive health and mental wellbeing represents a significant gap in Canadian healthcare. While most Canadians associate menopause with hot flashes and night sweats, the psychological symptoms—including anxiety, depression, brain fog, and irritability—often go unrecognized, undiagnosed, and untreated.
Last month, I spoke with Diane Lavery at her home in North Vancouver. At 52, the former marketing executive described how perimenopause had blindsided her three years earlier.
“I’d always managed stress well, but suddenly I was having panic attacks in grocery stores. My concentration vanished. I couldn’t sleep. I thought I was losing my mind,” Lavery recalled, pouring tea in her kitchen. “My doctor suggested antidepressants, which didn’t help. It took finding a specialist and doing my own research to realize what was happening.”
Lavery’s experience mirrors that of thousands of Canadian women navigating the psychological terrain of menopause. According to the Canadian Women’s Health Network, approximately 80% of women experience some psychological symptoms during perimenopause or menopause, yet fewer than 25% receive appropriate support or treatment.
Dr. Vivien Brown, past president of the Federation of Medical Women of Canada, explains that the connection between hormonal changes and mental health remains poorly understood, even among healthcare providers.
“Estrogen doesn’t just affect reproductive organs—it affects neurotransmitters in the brain like serotonin and dopamine, which regulate mood,” Dr. Brown explained when we spoke by phone. “The fluctuations during perimenopause can be particularly destabilizing to mental health, even more than the sustained lower levels after menopause.”
Walking through Vancouver’s Pacific Spirit Park with Maria Gonzalez, a 49-year-old teacher, I listened as she described feeling “emotionally raw” for nearly two years. Rain misted through the towering cedars as she recounted her journey.
“The rage was what shocked me most,” she said. “I’d never been an angry person, but suddenly I’d find myself furious over small things. I started to question my identity—who was this person I’d become?”
Gonzalez found community in a local perimenopause support group, which she credits with preserving her mental health. “Just knowing I wasn’t alone, that I wasn’t imagining things—it saved me,” she said.
The Canadian Menopause Society reports that while 100% of women experience menopause, training for healthcare providers on this transition remains minimal. A 2022 survey by the Society found that the average Canadian medical student receives less than four hours of education specifically on menopause management, with mental health aspects receiving even less attention.
Indigenous women face additional challenges. Loretta Wilson, a health navigator with the First Nations Health Authority in British Columbia, describes how colonial disruption of traditional knowledge about women’s life stages has created gaps in cultural support.
“Historically, our communities had ceremonies and specific roles for women entering this phase of life,” Wilson told me during our meeting at an East Vancouver community center. “That knowledge was systematically dismantled. Now we’re working to rebuild those supports while navigating a healthcare system that often misunderstands both our cultural needs and menopause itself.”
Statistics Canada data shows that women aged 45-54 have among the highest rates of antidepressant use in the country, yet menopause-specific screening remains rare in mental health assessments. This gap leads to what Dr. Chen calls “diagnostic overshadowing.”
“When everything gets attributed to depression or anxiety without considering hormonal factors, we miss opportunities for more effective treatment,” she said. “Hormone therapy can dramatically improve mood and cognitive symptoms for many women, but it’s rarely the first approach considered.”
The economic impact is substantial as well. A 2023 report from the Canadian Labour Congress estimated that menopausal symptoms, including psychological effects, cost the Canadian economy approximately $237 million annually in lost productivity and healthcare utilization.
In my conversations with women across Vancouver, a common theme emerged: the sense of having to become their own health advocates. Catherine Winters, a 55-year-old software developer, described bringing research articles to her doctor.
“I basically had to convince her that my insomnia and anxiety were related to menopause,” Winters said as we sat in a Commercial Drive café. “She was skeptical until I started hormone therapy and saw improvement within weeks.”
The landscape is gradually changing. In March 2023, the Canadian Psychiatric Association released its first position paper acknowledging the significant impact of hormonal transitions on women’s mental health, including specific guidelines for treating perimenopausal depression and anxiety.
Innovative models are emerging as well. In Toronto, the Women’s Age Lab at Women’s College Hospital has established Canada’s first integrated menopause and mental health clinic. The program, which combines psychiatric care with menopause expertise, has a waiting list stretching months.
Dr. Sheryl Ellsworth runs a similar program in Victoria, BC. When I visited her clinic last week, she showed me a wall covered with thank-you cards from patients.
“Women tell me the same story over and over—they felt dismissed or misdiagnosed for years,” she said. “Mental health symptoms are often the first sign of perimenopause, appearing even before irregular periods. But because we separate reproductive health from mental health in our medical system, these connections get missed.”
Community-based solutions are filling gaps as well. The Menopause Foundation of Canada has trained over 1,000 peer supporters since 2021. These volunteers host virtual and in-person groups specifically focused on the psychological aspects of menopause.
As the afternoon light faded in Dr. Ellsworth’s office, she emphasized that improved awareness represents both a challenge and an opportunity for Canadian healthcare.
“When we properly address menopausal mental health, we’re not just treating symptoms—we’re preserving women’s quality of life, workplace participation, and relationships during a significant transition,” she said. “This isn’t niche medicine. It’s fundamental care for half the population.”
Back in her kitchen, Diane Lavery expressed hope that younger women might have an easier path. “If I could tell women in their thirties and forties one thing, it would be to learn about perimenopause now,” she said, clearing our teacups. “Knowledge is power, especially when the systems around you might not connect the dots between your hormones and your mental health.”
As Canada’s population ages, with approximately 5 million women currently in perimenopause or menopause, addressing this intersection of mental and reproductive health becomes increasingly urgent—not as a specialty concern, but as an essential component of comprehensive healthcare for women across the lifespan.
