FIGO best practice recommendations for the mental health of women at menopausal age

Mental health during the menopausal transition requires focused attention to ensure supportive experiences for women. This review presents the International Federation of Gynecology and Obstetrics (FIGO) recommendations and summarizes the evidence, addressing 13 key questions framed by members of the FIGO Committee on Women at Menopausal Age. Although the literature on mental health during menopause is extensive, a gap exists in consolidated best practice recommendations. The FIGO committee members assessed the evidence quality and recommendation strength using a 5-point Likert scale. Over 70% of the experts agreed with a strong recommendation level (score of 5) for eight questions, while five questions were agreed with high and moderate recommendations. Symptoms of anxiety and depression are prevalent during the perimenopause. Menopause-related mental health issues are often overlooked in low- and middle-income countries. Mental health issues impact quality of life, necessitating psychological support during menopause care. Early detection requires training primary care providers to identify symptoms. Treatment should be individualized and may include lifestyle changes, cognitive-behavioral therapy, and hormone therapy. Transdermal estradiol is preferred for managing mood swings, particularly in women with metabolic risks. Escitalopram and venlafaxine effectively manage depressive symptoms and vasomotor instability in patients with major depressive disorder. Non-pharmacological interventions, such as lifestyle changes, therapy, mindfulness, and exercise have shown benefits. Partner and family support helps reduce the stigma associated with mental health issues during menopause. Advocacy is required for policies that support menopause awareness and mental health.