As menopause hormone therapy (MHT) gains renewed attention after the FDA lifted the black box warning on hormone replacement therapy in many cases in November 2025, a critical dimension of midlife care continues to receive insufficient focus: the mental and behavioral health of women navigating perimenopause and menopause.¹

Jessica Gaulton, MD, MPH, CEO, founder, FamilyWell Health, and Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, described the clinical reality: "Insomnia, depression, anxiety, [and] brain fog. These are the most common symptoms [that women come to their doctors about]. They're the most bothersome symptoms, and a lot of the discussion is around hormones, but hormones [are] just one piece of the puzzle. It's not a magic bullet, it's not going to fix everything."

These challenges prompted FamilyWell Health to launch “The Menopause Hub” on June 18, 2026, a platform designed to close that gap through provider education, a new professional certification, and a clinical white paper.^2,3

More than 80% of the more than one billion women worldwide in or approaching menopause will experience symptoms including sleep disruption, cognitive changes, depression, and anxiety, according to FamilyWell Health.²

Undertreated symptoms and a training gap

Gaulton traced part of the problem to a fundamental gap in medical education.

"I never received any training, formalized training on menopause or women's mental health at all," she said.

The result, she noted, is that women presenting with perimenopausal symptoms could often get dismissed or go unrecognized as menopause-related. Compounding this is the underuse of existing validated tools, according to Gaulton.

"There is a wonderful evidence-based screener out there called the MRS, the Menopause Rating Scale, and we just aren't using it," Gaulton said. “We need to start using it. We need to start learning what the symptoms are and then figuring out how to get women care connected to care.”

Cognitive behavioral therapy for insomnia (CBTI) is among the most evidence-supported non-hormonal options available, yet it remains underutilized in this context.

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"Eight sessions of CBT can be really effective at supporting and treating those symptoms and helping you sleep better, and so that's not talked about in the menopause story right now," Gaulton said.

Perimenopausal depression adds another layer of clinical complexity. Although it overlaps with major depressive disorder, it is often subclinical, partially hormonally driven, and may worsen cyclically around menstruation, but frequently falls short of DSM diagnostic criteria, Gaulton told Contemporary OB/GYN.

"Just because they don't meet it doesn't mean that the symptoms aren't bothersome functionally in their lives," she said. She also noted that MHT is not currently FDA-approved to treat perimenopausal depression, underscoring the importance of non-hormonal approaches, including CBT.

The benefits of peer support for mental health and menopause

Beyond clinical intervention, Gaulton identified peer support and coaching as an underappreciated component of comprehensive menopause care.

"At FamilyWell, we really believe deeply in coaching as a therapeutic modality to support women. What coaching does is it provides women with somebody who has lived experience, somebody who has gone through perimenopause or menopause and knows what to expect and can help support you holistically in every aspect of your life," she said.

"FamilyWell has written the first white paper that I am aware of, really highlighting how mental health conditions affect perimenopause and menopause; the pathophysiology, the need for screening, the need to think about holistic care," Gaulton said. The paper is free to women's health and behavioral health professionals.³

The Menopause Hub also formally opens enrollment for the Menopause Behavioral Health Certification (MBH-C), a 15-hour asynchronous program with 6 hours of mentored clinical case work, open to coaches, social workers, therapists, psychologists, and other behavioral health providers. A CME-accredited Menopause Behavioral Health Physician Certificate (MBH-PC), designed for OB/GYNs, primary care physicians, and nurse practitioners, is planned for fall 2026.¹

References:

1. HHS advances women’s health, removes misleading FDA warnings on hormone replacement therapy. News release. FDA. Published November 11, 2026. Accessed June 18, 2026. https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy
2. FamilyWell Health launches Menopause Hub, setting the standard for behavioral health in midlife care. News release. Published June 18, 2026. Accessed June 18, 2026. https://www.globenewswire.com/news-release/2026/06/18/3314216/0/en/familywell-health-launches-menopause-hub-setting-the-standard-for-behavioral-health-in-midlife-care.html
3. The Menopause Hub. FamilyWell. Accessed June 18, 2026. https://www.familywellhealth.com/menopause-hub