Menopause Psychosis: Key Signs & Symptoms to Watch Out For

Last updated 02.27.2024 | by Sabrina Johnson | 7 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.

According to the North American Menopause Society (NAMS), almost a quarter of women experience psychological changes as they journey through menopause. Emotional fluctuations are quite common, but they can still negatively impact your quality of life and affect your relationships with those around you.

However, sometimes, psychological changes can go beyond simple mood swings and irritability. Menopause-associated psychosis (MAP) is a rare but serious condition where the patient struggles to differentiate between what is real and what is not real. They may experience hallucinations or delusions, and in some cases, they may even have thoughts of harming themselves or others.

So, if you’re experiencing psychological symptoms that go beyond the usual irritability associated with menopause, it’s important to understand the warning signs of this condition and seek help.

In my work as an emergency room doctor, I’ve treated numerous patients with suspected psychosis, and a significant proportion of them have been women of menopausal age. But why does this type of psychiatric condition become more likely during this phase of life, and how can we spot the warning signs before it escalates?

In this post, I’ll share everything I’ve learned about menopause-associated psychosis during my career in medicine and my research in women’s health. Plus, I’ll explain the key signs and symptoms to watch out for in yourself and others.

What Is Psychosis?

Psychosis is a psychological disorder that causes a person to perceive reality differently. They may believe things that aren’t true (delusions) or see and hear things that aren’t there (hallucinations).

Psychosis during menopause, otherwise known as menopause-associated psychosis, follows the same definition criteria as regular psychosis. However, the hormonal shifts of menopause are part of the trigger.

How Can Menopause Cause Psychosis?

Scientists are still unsure how exactly menopause can trigger psychosis in some women. However, it’s clear that hormonal fluctuations can play a large role.

Shifts in the levels of estrogen and progesterone can cause a whole host of physical and mental symptoms during this phase of life. Menopause-related mood swings and menopause rage are both well-documented. Even the most laid-back women can experience unwanted changes to their mood and personality as they approach the end of their fertile years.

However, in some instances, an alteration in brain chemistry can lead to the development of a new and serious psychiatric disorder, such as psychosis.

Interestingly, women appear to have a lower risk of developing psychiatric disorders in earlier life than men. Many researchers believe this is due to the protective effect that estrogen has on the brain. Although men do produce estrogen, they have much lower levels than women. And so this explains why, before mid-life, women are less predisposed to developing conditions such as psychosis and schizophrenia.

However, during menopause, women’s estrogen levels begin to diminish, and the brain-protecting benefits of this hormone are no longer there. So this could explain why women are more prone to psychosis at this stage of life rather than in their earlier years.

That being said, several other underlying factors can contribute to the onset of psychosis, which I’ll explain below.

Other Causes of Psychosis in Women During Menopause

Other Causes of Psychosis in Women During Menopause

As we’ve learned above, a change in hormones during menopause can trigger psychosis in some women. However, in most cases, other unlying factors also contribute to the development of the condition. These include:

  • Genetic predisposition.
  • Psychological factors such as lack of sleep, severe depression, and extreme stress and anxiety.
  • Other mental health disorders include schizophrenia, bipolar disorder, and postnatal depression.
  • Certain chronic medical conditions, including Alzheimer’s disease, Parkinson’s disease, lupus, malaria, HIV, hypoglycemia, thyroid conditions, brain tumors, and multiple sclerosis.
  • Head injuries and acute illness leading to a high temperature.
  • Substance abuse, such as excessive drug and/or alcohol use.
  • Alcohol or drug withdrawal.
  • Certain prescription medications, including steroids and stimulants.
  • Certain vitamin and mineral deficiencies, particularly iron deficiency.

What are the Signs and Symptoms of Menopause Associated Psychosis?

It’s important to identify the warning signs of menopause-associated psychosis so that you can seek treatment right away. These include:

  • Visual hallucinations: seeing things, objects, or people who aren’t there.
  • Auditory hallucinations: hearing sounds or voices that other people cannot hear.
  • Irrational beliefs that do not match reality
  • Unwarranted paranoia
  • Intense mood swings
  • Confusion or disorientation
  • Slurred or jumbled speech
  • Memory loss
  • Extreme irritability and agitation
  • Aggression
  • Insomnia, or sleeping to excess
  • Nightmares
  • Appetite changes, leading to weight gain or weight loss

If you or a loved one is exhibiting the symptoms listed above, it’s important to seek medical advice as soon as possible. Remember, menopause psychosis also shares similar symptoms to other psychotic disorders, so a thorough psychiatric evaluation is essential in order to find a correct diagnosis and effective treatment plan.

What Risk Factors Can Increase the Likelihood of Developing Menopause Associated Psychosis?

Menopause-associated psychosis is a rare condition, but some women are at an increased risk of developing the disorder due to factors such as:

  • Genetic predisposition or a family history of psychiatric disorders
  • A personal history of psychiatric disorders
  • Pre-existing depression and anxiety
  • Estrogen sensitivity
  • Previous traumatic experiences
  • Extreme stress

What Treatment Options Are Available for Menopause Associated Psychosis?

When menopause-associated psychosis is diagnosed by a health professional, several treatment options can help. These include:

Antipsychotic Medication

Antipsychotics are the most commonly prescribed form of treatment for menopause-associated psychosis. These medications work by blocking neurotransmitters in the brain.

They can be extremely effective in reducing the frequency and severity of symptoms, but they’re not for everyone. Those who have underlying conditions such as epilepsy or cardiovascular disease are at an increased risk of experiencing negative side effects.

Hormone Replacement Therapy (HRT)

Hormones are a contributing factor to menopause psychosis. So, hormone replacement therapy (HRT) is sometimes used in conjunction with antipsychotic medications to reduce symptoms.

Talking Therapy

Talking therapy is often prescribed alongside antipsychotic medications to help manage the symptoms of menopause-associated psychosis.

Cognitive behavioral therapy (CBT) is one of the most commonly used forms of talking therapy. It works by encouraging patients to reframe their experiences and recognize unhelpful patterns in thoughts and behaviors.

Family intervention is another effective talk therapy that aims to help both the individual and their family members cope with the effects of menopause-associated psychosis.


Are there any lifestyle changes that can help women with menopause-associated psychosis?

Yes. Alongside the treatment plans listed above, lifestyle interventions such as regular exercise, improved nutrition, and stress management techniques (e.g., breathing and mindfulness) can all help to improve your symptoms and enhance your overall well-being.

Is it possible to make a full recovery from menopause psychosis?

Yes, absolutely. With the right treatment and support, most women can make a full recovery from menopause-associated psychosis.

How common is menopause-associated psychosis?

Psychosis is a rare condition; however, after the age of 40, it is twice as prevalent in women. Most women who do go on to develop menopause-associated psychosis tend to experience the peak of their symptoms during perimenopause (the build-up to menopause).


While menopause psychosis is rare, it can severely impact a woman’s life. So, it’s essential to know the signs and symptoms of the condition so you can seek professional support.

If you suspect that you or someone you know may have menopause-associated psychosis, contact a doctor or health care specialist right away. This serious condition can be extremely distressing. However, various treatments and interventions can help. And with the right support, you can go on to make a full recovery.


  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.