Women using menopausal hormone therapy who suicide have multiple risk factors

To describe the characteristics, clinical presentation, documented risk factors for suicide, circumstances of death and toxicology of deaths by suicide in Australia, 2000-2024, among people known to be receiving menopause hormonal therapy.

A retrospective descriptive study.

National population-level data retrieved from the National Coronial Information System.

Characteristics, clinical presentation, circumstances of death, documented risk factors for suicide and toxicology in all cases of death by suicide among people known to be receiving menopause hormonal therapy at their time of death in Australia, 2000-2024.

63 cases were identified with a mean age of 54 years (range 50-59). Mental health diagnoses were present in almost all cases (93.7 %), with a preponderance of anxiety and depression. Prior suicidal behaviours were present in over half (52.4 %) and chronic pain in one-third (30.2 %). Almost all of these women (96.8 %) had at least one risk factor for suicide and 79.3 % had two or more risk factors. The most common circumstances of death were drug toxicity (39.7 %) or hanging (36.5 %). Psychoactive drugs were present in blood in the majority (93.5 %), most commonly antidepressants (53.2 %), hypnosedatives (50.0 %) and opioids (29.0 %).

Menopause hormonal therapy remains the most effective treatment for management of vasomotor symptoms and this study does not demonstrate any causal risk for suicide. Rather, it highlights that women prescribed menopause hormonal therapy who suicide have multiple risk factors for suicide including psychiatric complexity, prior suicidal behaviours, physical health comorbidity and concomitant psychoactive substance use.