Menopause
Perimenopausal depression: the symptoms to look out for and how to help employees
By Dr Haleema Sheikh, specialist in integrative women’s health and bioidentical hormone balancing, Marion Gluck Clinic
When the orchestra of hormones is not balanced, mood can be severely impacted. Dr Haleema Sheikh goes through everything you need to know about perimenopause.
Perimenopause is the lead up to menopause when the effects of hormonal changes start to become evident.
It refers to the menopausal transition phase when the levels of reproductive hormones become more variable, and the effects of these fluctuations are felt throughout the body including the brain.
Interestingly, perimenopause can last for 10 years or more, ending one year after the last menstrual cycle – which is the official date of menopause.
Thus, it is useful for women to know what to expect and equip themselves with knowledge and tools to empower themselves to navigate a path through.
Hormones are chemicals produced by your body’s glands, which signal the body to initiate certain physical processes like ovulation as well as mental functions such as mood regulation.
We have receptors in the brain for reproductive hormones and thus fluctuations and hormonal imbalances can have a profound impact on our mood and also through their impact on neurotransmitters
There are four main hormones that have a significant effect on mood: oestrogen, progesterone, testosterone and cortisol.
- Oestrogen can improve mood by supporting serotonin – the happy neurotransmitter – and noradrenaline levels in the brain.
- Progesterone is our soothing calming and sleep-inducing hormone which can alleviate mood swings, irritability, and depression.
- Testosterone is an uplifting hormone and helps with a sense of wellbeing, focus and confidence.
- Cortisol is a released as a stress response from the adrenal glands and when stress is chronic remains elevated at the expense of sex hormones, which in turn creates further imbalances. It can cause irritability, anxiety, and low moods when over or under produced – adrenal dysfunction.
When the orchestra of hormones is not balanced with glands producing too much or not enough of a particular hormone, mood can be severely impacted and, in some cases, lead to depression.
Women during perimenopause can be vulnerable to such mood issues with the fluctuations and dropping hormones.
Symptoms of depression may include fatigue and lack of energy, feeling restless or slowed down, struggles with focus and remembering things, apathy and lack of interest in activities previously enjoyed as well as feelings of helplessness, hopelessness or worthlessness.
Reduced levels of female hormones during perimenopause may also cause additional depressive symptoms such as mood swings, sleep problems, hot flashes, irritability and feeling profound despair and tearful.
Premenopausal depression may present somewhat differently than classical depression with more irritability and more frequent mood changes, while feeling sad and tearful are less often experienced.
There are additional risk factors associated with perimenopausal depression which include family history of depression, prior history of sexual abuse or violence, having a sedentary lifestyle, smoking, being socially isolated, struggling with self-esteem, having negative feelings about ageing and feeling disappointed about not being able to have children.
Awareness of these can be helpful to identify those women who are more vulnerable and may have difficulty adapting to the fluctuating levels of oestrogen and progesterone during the menopause transition.
A significant percentage of women going through perimenopause and menopause are prescribed medication such as antidepressants by their GP or a mental health specialist.
However, low mood around the time of menopause is very likely to have hormonal imbalance as a root cause and in women where there is no prior history of depression antidepressants may not be the most effective treatment.
A lot of women going through perimenopause are misdiagnosed with depression and can feel a lot better with lifestyle changes and bioidentical progesterone treatment especially early on in perimenopause.
Antidepressants regulate certain neurotransmitters like serotonin and noradrenaline that can affect mood but they do not address the underlying hormones imbalances associated with perimenopause or menopause which are often the important root causes.
There are a number of lifestyle factors that can help improve hormone balance and thus improve mood during perimenopause. And it would be ideal to work on these before accessing pharmaceutical medication.
Working on lifestyle to optimise hormonal balance and brain health will in turn help improve mood and emotional health:
- ‘When the body moves the brain grooves.’ Movement and exercise help the body release natural endorphins and BDNF (brain derived neurotrophic factor) that lifts our mood.
- B vitamins can be important to the mental and emotional well-being of perimenopausal women as they improve hormonal balance and support progesterone production
- Mindful breathing can help reduce anxiety. A common technique involves paying attention to your body’s response to natural relaxation as you slowly breathe in — from the abdomen — and then exhale. Doing this for 10-15 minutes a day will help bring down stress and cortisol levels which in turn improves reproductive hormone production
- Proper sleep-adopting good sleep habits such as going to bed at the same time every night in a quiet, dark, cool room and avoiding using electronics in bed.
- Valerian is an herb which has been shown to help perimenopausal depresstion and contains a number of compounds that may help promote calmness by increasing GABA (neurotransmitter) availability in the body and interacting with certain receptors involved in mood and sleep.
It is important for employers to understand the impact of hormonal fluctuations during perimenopause on mood, as it can have a profound effect.
Building awareness in the workplace and a having a framework to support women is essential to ensure the expertise and wisdom of this demographic is retained.
Open communication with sensitivity empathy and active listening as well as careful consideration of how employees can have access to high quality information and education about perimenopause/menopause are key.
This will encourage women to talk with honesty and engender self-compassion and agency.
It would be worth considering hosting an organisational campaign on the perimenopause to break taboos and to raise awareness.
This could be as simple as putting up posters or hosting a talk which could fit into a wider organizational well-being week.
Developing a healthy lifestyle culture within the workplace will mitigate a lot of the troublesome mood issues during perimenopause/ menopause.
It is important to lead by example and consider how to incentivise employees to look after themselves which will in turn lead to improved productivity.
Ensuring a balanced timetable for staff with breaks for movement and access to healthy protein-based snacks to balance blood glucose is helpful. A simple 10-minute walk can alleviate anxiety and improve mood
Hormone replacement therapy can certainly help alleviate the hormone fluctuations and help women rebalance their mood especially if there is significant flux.
HRT will work better with a good foundational lifestyle, and this is an important message to share.
Bioidentical hormone prescribing allows for a personalised approach to check hormone levels and ensure a balanced prescription is issued for each woman according to where they are in their perimenopausal journey.
Dr Haleema Sheikh is certified in functional medicine and uses her knowledge to complement hormone balancing. She has joined the Marion Gluck Clinic last year and is particularly well versed in women’s health issues including PCOS, PMS, perimenopause and menopause.
A non-hormonal therapy restored vaginal tissue in an animal study, suggesting a possible new treatment for menopause-related GSM.
Genitourinary syndrome of menopause, or GSM, is a chronic condition caused by falling oestrogen levels.
It affects the vulva, vagina and urinary tract, causing symptoms including vaginal dryness, painful sex and recurring vaginal or urinary tract infections.
Steve Nordeen, the study’s senior author and professor emeritus in the department of pathology at the CU Anschutz School of Medicine, said: “For too many women, the current options are either products that only provide temporary relief or hormone-based treatments they may not feel comfortable using.
“Our goal was to develop a therapy that addresses the underlying cause of the vaginal changes that follow menopause, not just the symptoms, without relying on steroid hormones.
“While more research is needed, these findings suggest we may have a promising new approach.”
Researchers at the University of Colorado Anschutz developed the treatment to restore oestrogen signalling only within vaginal tissue, without exposing the rest of the body to the hormone.
In a preclinical animal study, the therapy restored vaginal tissue structure and function lost through oestrogen deficiency.
The results suggest it could address the underlying cause of GSM rather than offer only temporary relief from symptoms.
An estimated 50 to 70 per cent of women experiencing natural or medically induced menopause develop one or more symptoms of GSM.
Women may have to choose between living with painful symptoms, using over-the-counter products with limited effectiveness or taking hormone-based treatments that replace oestrogen.
Some women cannot or choose not to use hormone therapy because of concerns about potential risks. This is particularly relevant to those with a history of breast cancer or an increased risk of hormone-sensitive cancers.
The researchers synthesised a novel non-steroidal oestrogen-signalling molecule called 3-fluoro 6,4′-dihydroxyflavone, or 3F.
Delivered as a vaginal suppository, the therapy regenerated the vaginal epithelium in a preclinical model of menopause. The epithelium is the layer of cells lining the vagina.
Researchers found no evidence of systemic oestrogenic activity, meaning the treatment did not appear to trigger oestrogen responses elsewhere in the body.
The team is seeking support to move the treatment into human clinical trials.
Nordeen said: “Our findings suggest the prospect of a safer and more effective therapy is within reach.
“The next step is securing the support needed to move this therapy into human clinical trials so we can determine whether it offers women a new treatment option.”
The researchers said the therapy could provide a new option for millions of women with GSM if future clinical trials confirm the findings.
Immunotherapy may temporarily restore fertility in women with autoimmune premature ovarian insufficiency, a pilot study suggests.
Three of the 10 women who received treatment later gave birth to healthy babies.
Premature ovarian insufficiency, or POI, affects just over three per cent of women worldwide and occurs when the ovaries stop functioning before the age of 40.
The condition significantly reduces fertility and can have several causes, including autoimmune processes and genetics.
Researchers at Karolinska Institutet examined whether immunotherapy could make the ovaries temporarily responsive to hormonal stimulation in women with POI caused by autoimmunity.
The study included 12 women aged between 18 and 35 with autoimmune POI.
Two withdrew before treatment began. The remaining 10 underwent ovarian hormone stimulation before receiving rituximab and again four to six months after treatment.
Rituximab is an approved and well-established medicine used to treat several autoimmune conditions and cancers.
None of the women responded to ovarian stimulation before receiving the drug.
After treatment, six developed follicles that made it possible to retrieve eggs in response to ovarian stimulation.
Follicles are small sacs within the ovaries where eggs develop.
Professor Angelica Lindén Hirschberg, the study’s first author and a professor at Karolinska Institutet’s Department of Women’s and Children’s Health, said: “The results show that in some women there remains an egg reserve that can be activated when the autoimmune process is suppressed.”
In five women, mature eggs could be frozen or fertilised.
Three later had embryos transferred and all three gave birth to healthy babies.
For safety reasons, the embryo transfers took place no earlier than one year after treatment.
One serious side effect was reported and was linked to the hormone stimulation rather than the immunotherapy.
Women with autoimmune POI commonly have other autoimmune diseases.
All six women who responded to the treatment also had autoimmune Addison’s disease, a condition in which the immune system destroys the adrenal glands.
The study was a proof-of-concept investigation without a control group and involved a small number of participants, meaning the findings must be interpreted cautiously.
A proof-of-concept study is an early investigation designed to assess whether an approach could work before it is tested more widely.
Professor Lindén Hirschberg said: “This is a first step. To determine whether the method is effective and safe, larger, randomised studies are required.”
The research team has launched a larger randomised study.
The work was carried out by researchers at Karolinska Institutet, Karolinska University Hospital and the University of Bergen.
It was funded by organisations including the Swedish Research Council, the Knut and Alice Wallenberg Foundation, the Novo Nordisk Foundation and Region Stockholm.
The researchers reported no conflicts of interest.
POI is also linked to long-term health risks caused by oestrogen deficiency, including osteoporosis, an increased risk of cardiovascular disease, cognitive decline and poorer mental and sexual wellbeing.
Hormone replacement therapy can relieve menopausal symptoms and reduce many of these risks, but no treatment has been reliably shown to restore fertility in women with POI.
Egg donation was previously the only option for women with the condition who wanted to become pregnant.
An EU committee has backed a report warning of systemic inequalities in women’s health research, diagnosis and treatment across Europe.
The European Parliament’s Committee on Women’s Rights and Gender Equality approved the report, which was initiated by Renew Europe.
Women remain under-represented in medical research and clinical trials.
Around 72 per cent of drug trials do not provide data separated by sex and gender, while only five per cent of global research and development funding is dedicated to women’s health.
The report was led by Renew Europe rapporteur Billy Kelleher MEP of Fianna Fáil in Ireland.
It calls for greater investment in women’s health research, stronger inclusion of women in clinical trials and gender-sensitive diagnostics and treatments, particularly for endometriosis, menopause and cardiovascular disease.
Kelleher, first vice-president of Renew Europe, said: “Women’s health remains one of medicine’s biggest blind spots.
“When research, clinical trials and medical data fail to reflect women’s experiences, the result is poorer diagnosis, treatment and care.”
The report also calls for improved access to sexual and reproductive healthcare, including follow-up to the successful European Citizens’ Initiative “My Voice, My Choice”.
Its recommendations include better support for women’s physical and mental health and access to high-quality care throughout pregnancy, childbirth and the postnatal period, free from discrimination.
It also highlights additional healthcare barriers faced by LGBTQI+ people and women in marginalised communities or vulnerable situations.
Kelleher said: “This report is about closing those gaps and ensuring that women’s health is recognised as a core measure of the quality and fairness of our healthcare systems.”
By placing women’s health higher on the political agenda, the report aims to support the implementation of the EU Gender Equality Strategy and shape future European health policies.
A final vote by the European Parliament is expected in September 2026.
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