In the debates about the association between mental illness and the menopause, the psychiatric approach contradicts assertions by the gynaecological and psychoanalytic literature that the menopause has a negative effect on mental health. General population studies show that, if at all, psychiatric morbidity is more common in women in the five years before menopause. Sociocultural and family factors are more important in the aetiology of mental illness in menopausal women than physiological changes. Anxiety and depression in such women do not respond to oestrogen therapy, although some cases respond to antidepressants.