Opinion
Insight: Perimenopause, menopause and your mental health and wellbeing

By Dr Haleema Sheikh, a specialist in integrative women’s health and bioidentical hormone balancing for the Marion Gluck Clinic.
Perimenopause refers to the menopausal transition phase in women’s lives when the levels of reproductive hormones become more variable, and they can start to experience physical and mental symptoms related to these changes.
Menopause is diagnosed when a woman has not had a period for 12 consecutive months, and this usually happens between the ages of 45 and 55.
Hormones are our bodies chemical communication messengers which are carried in the blood stream around the body and are responsible for modulating and regulating activity in all our organs and tissues.
Women have receptors for the reproductive hormones produced in the ovary and adrenals (estrogen, progesterone and testosterone) in every tissue in the body including the brain. Thus, the hormonal imbalances during perimenopause and loss of hormones during menopause can have significant far-reaching consequences on our mental health.
Women are more susceptible to hormonal mental health issues as there is a complex interplay of reproductive hormones which need to be in sync to have a regular menstrual cycle.
This delicate interplay is often disrupted during perimenopause with estrogen not being balanced by progesterone (our soothing calming sleep supporting hormone) and then as we progress into menopause, we also lose the supportive effects of estrogen on the brain.
Women’s ovaries have a finite lifespan and during perimenopause which can start on average 6 years before menopause there can be significant hormonal disruption.
Women may start to have anovulatory cycles where they don’t ovulate each month and this results in estrogen being dominant as there is no progesterone rise in the second half of the cycle without ovulation. The lack of progesterone will also impact sleep quality and length which can further disrupt our mental health.
Progesterone enhances the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that promotes relaxation and reduces anxiety. This is why low progesterone levels can contribute to increased stress, irritability, and anxiety which are often seen in perimenopause.
Progesterone is generally the first hormone to be lost in perimenopause. Unfortunately, many women are diagnosed with depression and anxiety at this time and are given antidepressants which may be helpful but do no tackle the root cause which is hormonal disruption.
Estrogen has powerful positive effects on the female brain, affecting mood, memory, cognition, and emotional well-being. It
plays a key role in neurotransmitter activity and boosts serotonin (the happiness hormone) and dopamine which help regulate mood and motivation. Estrogen also enhances the stress response; it modulates cortisol, the stress hormone, helping women cope with pressure more effectively.
By regulating sleep patterns through its influences on melatonin and circadian rhythms it also improves sleep quality and resilience which are key for mental health.
Coming onto Testosterone – it is not just a male hormone and it plays a crucial role in women’s brain health, energy levels and mood. Though women have lower testosterone levels than men, this hormone is essential for mental clarity, motivation, emotional resilience, and overall well-being.
Testosterone levels can be maintained by some women till later in menopause, but a significant proportion of women will have symptomatic loss of testosterone in perimenopause and so it is important to be aware of symptoms and test blood levels if considering support.
Testosterone has a mood stabilising effect and improves emotional wellbeing. It is also involved in neurotransmitter regulation and thereby reduces mood swings, stress and depressive symptoms. It also helps with enhanced confidence and motivation which gives women a sense of self assurance and emotional resilience in their lives.
The brain also receives feedback from the body and the gut and brain are deeply connected through the gut-brain nerve axis.
Changes in the gut microbiome (the friendly bacteria which reside in the large intestines) during menopause can significantly affect mood, mental health, and cognitive function.
As estrogen declines, the composition of the gut microbiome shifts, leading to inflammation, neurotransmitter imbalances, and increased stress response, which ultimately can contribute to anxiety, depression, and mood swings.
The gut communicates with the brain ‘telling’ it that the body is in a hostile environment and puts the brain into a high alert mode which can trigger hypervigilance and anxiety.
Ninety per cent of serotonin (the ‘happiness hormone’) is produced in the gut. Gut dysbiosis (an imbalance of good and bad bacteria) which is more common in menopause can disrupt serotonin and dopamine production, leading to depression, anxiety, and mood swings.
Low estrogen also leads to increased gut permeability (leaky gut), allowing inflammatory molecules and toxins to enter the bloodstream. This triggers neuroinflammation, which is linked to brain fog, fatigue, and low mood.
Healthy gut bacteria help regulate cortisol, the stress response hormone. An unbalanced microbiome can lead to higher cortisol levels, making women more prone to stress, panic, and emotional ups and downs.
The gut microbiome also influences melatonin (our sleep hormone). Dysbiosis can lead to insomnia, night wakings, and poor sleep quality, worsening irritability and emotional instability.
There are many signs and symptoms that may indicate the need to support hormonal balance which make sense now that we understand the impact of the hormones on the brain and body
• Frequent emotional ups and downs that disrupt daily life.
• Overwhelming anxiety or panic episodes.
• Difficulty focusing or remembering simple things.
• Persistent sadness or loss of joy.
• Chronic fatigue and lack of motivation.
• Feeling disconnected or unlike yourself.
• Irritability
• Low self-esteem and loss of confidence
There are many ways to restore balance, and a multipronged approach often works well:
• Lifestyle changes – Regular exercise, a healthy diet, and stress management are key to happy hormonal balance.
• Hormone therapy or Supplements – can be very helpful to help cushion the loss of ovarian function. Body identical and bioidentical hormones have the same molecular and chemical structure to our own hormones and have been shown to support the mental health issues that many women face
• Mental health support – Therapy, mindfulness, or journaling can be helpful to process the changes and build resilience.
• Sleep hygiene – Create a relaxing bedtime routine to improve rest is key to remaining high functioning and rebalance the system.
• Social support – Connecting with friends, support groups, or loved ones is protective for women going through this period.
Perimenopause and menopause often hit women during a time in their lives when they are juggling many balls including challenging careers, teenage children, spouse/partner, running a house and possibly looking after elderly parents.
The reproductive hormones provide resilience in the system which diminishes at this time. It is helpful for women to understand what is going on in their bodies during this transitional time and be kind to themselves as they recalibrate to lower hormone levels which can most certainly be done successfully.
The Marion Gluck Clinic is a UK-based medical clinic which uses bioidentical hormones to treat menopause, perimenopause and other hormone related issues.
Wellness
Should men be talking about periods? Absolutely. Here is what every man should know

By Ruby Raut, founder, WUKA
Every time we post a dad talking to his daughter about periods, the internet seems to split in two.
One side says: “This is brilliant. I wish my dad had spoken to me like this.”
The other says: “Why on earth are men talking about periods?”

And I always find that second reaction fascinating.
- Because men might not menstruate, but they live in a world with people who do.
- Your daughter might get her first period while you are the only parent at home.
- Your teenage niece might bleed through her clothes while you are driving her somewhere.
- Your girlfriend might wake up at 3am with cramps.
- Your wife might suddenly realise she has run out of period products.
- A colleague might bleed through her trousers during a meeting.
- A girl you coach might quietly tell you she cannot play because she has started her period.
At some point in your life, there is a very good chance a woman or girl will have a period around you.
And at that moment, you have two options. You can be calm, informed and useful. Or you can stand there looking as if nobody ever taught you what a period actually involves.
So perhaps we need a Haynes manual for men and periods. Not a biology degree or a lecture.Just the information every man should probably know.
First: yes, men should know what a period actually is
Let us start with the basics. A period is not simply “a bit of blood once a month”.
Menstruation is part of the menstrual cycle. The lining of the uterus builds up and, if there is no pregnancy, that lining is shed.
That is the bleeding part. But for many women and girls, the experience can also involve cramps, back pain, headaches, bloating, tiredness, diarrhoea, tender breasts, mood changes and generally feeling pretty rotten.
Some barely notice their period. Others are completely floored by it. This is important because one of the least helpful things you can say to somebody struggling with their period is:
“Is it really that bad?”
You do not need to experience period pain to believe someone when they tell you they are in pain.
Second: if a girl tells you she has started her period, do not panic
This one is particularly important for dads.
Imagine your daughter gets her first period while Mum is out. What does she need from you? Probably not a horrified expression or you shouting across the house, “YOUR PERIOD HAS STARTED!”
She needs you to behave as though this is an entirely normal bodily function.
Because it is. Ask her what she needs. Find her a period product. If there is blood on her clothes, help her sort it out without making a huge fuss. If she does not know how to use a pad or period underwear, help her find clear instructions.
And please do not make jokes about her “becoming a woman”.
For a young girl, a first period can already feel confusing, embarrassing and frightening. Your job is not to make it into a ceremony but to make her feel safe. Sometimes the most useful sentence a dad can say is simply:
“Okay. No problem. What do you need?”
Third: learn what period products actually are
Pads.Tampons.Period underwear.Menstrual cups.Period swimwear. You do not have to develop strong opinions about all of them. You just need to know they exist.
If someone asks you to buy pads, do not behave as though you have been sent into a nuclear reactor without protective clothing.
Go to the period aisle. Text them a photo if you are unsure. Ask which absorbency they want. Buy the product. Come home.
And if you are the father of a daughter, having a few period products in the bathroom before she starts menstruating is a very sensible idea.
You keep toilet roll in your house before somebody needs it. Period products should not feel radically different.
Fourth: never announce a period stain
This should be basic human etiquette.
If you notice that a woman or girl has bled through her clothes, tell her quietly and discreetly.
Do not point, laugh, or whisper about it to someone else. And definitely never announce it to the room.
If you have a jumper or jacket she can tie around her waist, offer it. If there is somewhere she can clean up or change, help her get there. Then move on with your life.
Period leaks happen. The embarrassment surrounding them is often far worse than the actual blood.
Fifth: stop using periods as an explanation for every emotion
“Are you on your period?”
Four words capable of making almost any disagreement significantly worse.
Sometimes a woman is angry because she is angry and sometimes she disagrees with you because she disagrees with you. Sometimes you genuinely are being annoying.
Hormonal changes can affect mood for some people, but using menstruation to dismiss a woman’s feelings is patronising and incredibly unhelpful.
If your partner says she feels emotional before her period, listen to her. That does not permit you to diagnose every future disagreement as PMS.
Sixth: period pain is not something every woman should simply put up with
There is an extraordinary tendency to tell girls from a young age that painful periods are just part of being female. For some, mild cramps are manageable.
For others, period pain can be severe enough to disrupt school, work, sleep, exercise and everyday life. So if your daughter is doubled over in pain every month, repeatedly missing school, fainting, vomiting or unable to function normally, do not tell her to toughen up.
Take her seriously and help her seek medical advice.
Being a supportive dad does not require you to know what is causing her symptoms. It requires you to believe her when she says something is wrong.
Seventh: men talking about periods does not take anything away from women
This is perhaps the strangest objection to our Dads and Periods campaign. The idea that periods somehow belong in a conversation that only women are allowed to have.
Women should absolutely lead conversations about their own bodies and experiences. But understanding periods should not be restricted to people who menstruate.
We teach children about digestion even though they are not gastroenterologists and about first aid even though most people are not doctors.
We teach boys about pregnancy even though they will never be pregnant. Knowledge is not ownership. A father understanding periods does not make periods less female. It makes him a better prepared father.
A boy understanding periods does not mean he suddenly understands exactly what menstruation feels like. It means he is less likely to laugh when a girl gets a stain on her skirt.
A male coach understanding periods does not make him an expert on women’s bodies.
It means a teenage player might feel able to tell him why she needs five minutes off the pitch instead of inventing an excuse.
A male partner understanding periods does not mean he has to track every detail of his girlfriend’s cycle. It might simply mean that when she says, “My cramps are awful today,” his response is not, “Again?”
So should men talk about periods?
Yes.
But perhaps “talk” is not even the most important word.
Men should know about periods. Men should be comfortable hearing about periods. Men should know what to do when someone starts one unexpectedly. Men should know how to buy period products. Men should know not to make somebody feel ashamed about bleeding.
And fathers, in particular, should be able to talk about periods with their daughters without embarrassment.
Because there is a bigger point here. Girls learn very quickly which subjects make adults uncomfortable.
If Dad goes silent every time periods are mentioned, she notices. If he leaves every period conversation to Mum, she notices. If he wrinkles his nose at period products, she notices. And she may quietly absorb the message that this part of her body is something men find disgusting or embarrassing.
That is exactly the message we should be trying to dismantle.
At WUKA, we started our Dads and Periods campaign because we want fathers to feel capable of having these conversations.
Not perfectly. Not scientifically. Not with a PowerPoint presentation about the uterus over Sunday lunch. Just normally. Periods happen.
Roughly half the population will experience them at some point in their lives. The other half should probably know what they are.
And if the choice is between a dad who knows what a period is, knows where the period products are kept and can calmly help his daughter when she needs him, or a dad hovering helplessly outside the bathroom shouting, “SHALL I CALL YOUR MUM?”
I know which one I would rather have.
Learn more about WUKA at wuka.co.uk
News
We built Ema like a nurse: Here’s why that matters

By Claire Pettengill, science intern and Jade Anstine, clinical AI intern, Ema EQ
Every year, Gallup asks Americans which professions they trust most. Every year, nurses win. Not doctors. Not scientists. Nurses. And if you spend any time thinking about why, the answer is not hard to find.
Medicine runs on the nurse noticing first. In other words, the diagnosis follows the nurse sounding the alarm. They ask questions that feel human, not procedural. They explain what is happening in language you can understand.
And, critically, they know when something is beyond their scope and get you to the right person without making you feel like a burden for needing more.
That is the model we built Ema on.
When we set out to build an AI companion for women’s health, we could have just built something that answers questions efficiently. Pattern matching. Fast retrieval. Clinically accurate outputs.
Those things matter, and Ema does all of them. But accuracy alone does not build trust, and trust is the entire game in healthcare.
A woman asking about her postpartum recovery, her fertility, or her breastfeeding supply is not looking for a search engine. She is looking for someone who will take her seriously.
Women’s concerns don’t just need to be ‘validated’; they also need to be believed. Dismiss a woman’s pain as anxiety once, and you’ve taught her to doubt her own body.
The nursing model of care is built on exactly that premise. It is care that is shaped by her story. It asks about context and symptoms.
It treats the person as a whole, and it recognises that the right answer is sometimes a referral, not a response.
We trained Ema to escalate. That may sound like a small thing, but in AI, it is a deliberate design choice.
Most AI systems are optimised to answer and maintain engagement. Ema is optimised to help, and sometimes helping means saying “you need to speak to a clinician” and making that path easy.
This matters especially in women’s health, where the clinical trust gap is well-documented.
In a 2022 nationally representative survey of over 5,000 women, nearly 1 in 3 reported that their doctor had dismissed their concerns, and 15 per cent said a provider simply didn’t believe them.
Women are more likely to have their symptoms dismissed, their concerns minimised, and their pain undertreated. Among women under 35, nearly half reported at least one of these experiences.
They have had to learn how to advocate within systems designed for efficiency, built on men’s health.
With Ema, every conversation is an opportunity to make a woman feel heard, informed, and directed to the right level of care, neither over-triaged nor undertreated.
The goal is not to replace clinicians. It is to create a trustworthy first point of support that listens carefully, explains clearly, recognises limits, and helps women move toward appropriate care.
The nurses who top those Gallup rankings every year earn that trust through consistency. They show up, listen, follow through, and know their limits.
Ema is simply that trust, built into technology. That is the standard we hold Ema to: a trustworthy presence that knows when to answer and when to hand off.
Medicine spent a long time teaching women not to expect to be believed. Ema is built by the people who never stopped listening.
Bios
Claire Pettengill is a psychiatric nurse and DNP-PMHNP candidate at Columbia University School of Nursing, specialising in women’s mental health across the lifespan and algorithmic justice – ensuring the AI tools shaping women’s care are built to actually listen. She joined Ema EQ as a science intern focusing on clinical safety standards for evaluating AI in women’s health.
Jade Anstine is a senior nursing student at Gustavus Adolphus College looking to bridge the gap between frontline medicine and digital health innovation. He joined Ema EQ as a Clinical AI Intern to assess the Ema AI model across different clinical populations, specifically pediatrics and LGBTQ+.
Insight
The technology exists: Why are women still waiting?

By Jane Lewis, chief operating officer, chief financial officer and women’s health lead, ABHI
For years, the conversation around women’s health has rightly focused on recognition.
Recognition that women wait longer for diagnosis. Recognition that symptoms are too often dismissed or normalised. Recognition that healthcare systems have historically been designed around male biology, leaving gaps in research, evidence and care.
That recognition matters. But awareness alone will not improve outcomes.
The challenge facing women’s health today is no longer simply identifying the problem. It is acting on the solutions already available.
At ABHI’s Women’s Health Summit earlier this year, leaders from across healthcare, government, academia and industry came together to discuss the future of women’s health.
One message emerged repeatedly throughout the day: we do not have an innovation problem.
Across medical devices, diagnostics, digital health and genomics, there are already technologies capable of transforming outcomes for women.
From self-sampling approaches for cervical screening and non-invasive diagnostics to AI-enabled tools and advanced imaging, innovation is happening. The question is whether healthcare systems can adopt it quickly enough.
Too often, promising technologies become trapped in pilot programmes, fragmented procurement processes or lengthy implementation pathways. Evidence generation, commissioning and adoption are frequently treated as separate challenges rather than part of a single journey.
The consequence is that innovations capable of improving quality of life and reducing pressure on health services take years to reach the women who could benefit from them.
This matters because women’s health extends far beyond reproductive health.
Historically, many discussions have centred on fertility, pregnancy and gynaecological conditions. These remain critically important, but they represent only part of the picture.
Women experience cardiovascular disease differently to men. They are disproportionately affected by autoimmune conditions. They face distinct health challenges throughout their lives, from adolescence to healthy ageing.

Jane Lewis
Yet healthcare systems often continue to approach these issues in isolation.
A woman does not experience her health in separate compartments. Pregnancy, cardiovascular risk, menopause, mental health and musculoskeletal conditions are interconnected.
Healthcare systems need to reflect that reality through more integrated, life-course approaches to care.
There has never been a better opportunity to do so.
Across the NHS, the shift towards prevention, community-based care and digital transformation aligns closely with the needs of women’s health.
Women’s Health Hubs are already demonstrating the benefits of bringing services together around the needs of women rather than organisational boundaries. Digital technologies are helping to identify risk earlier and support more personalised care.
Innovation can help deliver all three of the NHS’s major transformation ambitions: moving from treatment to prevention, from hospital to community, and from analogue to digital care.
But innovation alone is not enough.
Closing the women’s health gap also requires us to address longstanding gaps in research and evidence.
Women remain underrepresented in many areas of clinical research, and sex-disaggregated analysis is not always applied consistently. The result is that clinical pathways and treatment decisions are often based on evidence that does not fully reflect female physiology.
Better data, stronger research participation and greater focus on female-specific and female-predominant conditions will be essential.
There is also a compelling economic case for action.
Women’s health is often framed as an equality issue, and equality remains central. But poor health affects workforce participation, productivity and economic growth.
Improving outcomes for women benefits not only patients, but employers, healthcare systems and wider society.
Yet despite this, women’s health innovation continues to attract only a fraction of the investment directed towards other areas of healthcare.
That is beginning to change.
Across the UK and internationally, momentum is building. Governments, investors, researchers and innovators increasingly recognise that women’s health is both a societal necessity and an economic opportunity.
The conversation has moved on significantly in recent years. Topics that were once overlooked are now firmly on the policy agenda.
The next challenge is ensuring that awareness translates into action.
The technologies exist. The evidence is growing. The policy direction is increasingly clear.
ABHI is increasingly taking this agenda beyond national boundaries. Through our engagement with international industry associations, policymakers and healthcare leaders, we are working to ensure that women’s health is recognised as both a health and economic priority.
We are helping to shape discussions on innovation, regulation, investment and adoption, while sharing lessons from the UK with partners around the world.
Whether addressing the gender health gap, improving access to diagnostics or accelerating the uptake of new technologies, international collaboration will be essential.
The challenge now is not recognising the need for change, but delivering it.
Women have waited long enough for acknowledgement of the problem. They should not have to wait any longer for the benefits of the solutions that already exist.
ABHI is the UK’s leading industry association for HealthTech. Its members, ranging from multinationals to small and medium-sized enterprises (SMEs), develop and supply technologies spanning everything from syringes and wound dressings to surgical robots, diagnostics, and digitally enabled healthcare solutions. ABHI’s 400 member companies represent approximately 80% of the UK HealthTech sector by value.
News1 week agoUK femtech investment surges 194% in a decade, research finds
Entrepreneur1 week agoTidalSense raises £14m to expand five-minute COPD test across NHS
Wellness2 weeks agoCancer patient receives ‘landmark’ treatment in world-first
News1 week agoCross-Border Impact Ventures raises US$58m for women and children’s health
Insight2 weeks agoWomen urged to be wary of menopause misinformation on social media
Insight2 weeks agoJohnson & Johnson offers to pay US$5.5bn to settle talc cancer lawsuits
Menopause1 week agoCultural stigma is a barrier to menopause help, black women say
Motherhood1 week agoOne in eight mothers diagnosed with gestational diabetes, research finds











