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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



Dr Haleema Sheikh

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:

  1. ‘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.
  2. B vitamins can be important to the mental and emotional well-being of perimenopausal women as they improve hormonal balance and support progesterone production
  3. 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
  4. 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.
  5. 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.


‘Women crave the quick fix of a silver bullet’: menopause experts have their say on talking therapies

Talking therapies could reduce symptoms that may not be otherwise relieved through HRT, specialists have argued



The new research showing talking therapies could help women through menopause is a “fantastic step forward” in the advocation of choice, experts have said, warning that HRT alone will not reduce all symptoms.

Talking therapies, such as mindfulness and cognitive behavioural therapy, have been found to effectively treat menopause symptoms, such as low mood and anxiety.

Researchers from University College London have shown that the practices, which focus on developing behavioural patterns, coping strategies and relaxation techniques, could have benefits beyond those of HRT, including improved sleep, memory and concentration.

The techniques, experts told Femtech World, could help dampen down women’s physiological system, reducing symptoms that may not be otherwise relieved through HRT.

“Our ability to regulate the stress hormone is hampered during menopause, meaning we sit further up the stress scale than we did before,” said Dr Bev Taylor, psychologist and menopause educator.

“Stress also makes many menopausal symptoms worse, either in frequency or severity. These techniques reduce symptoms by dampening down our physiological system and bringing us back down the stress scale.”

The beauty of them, Taylor said, is that they can be used by anyone.

“Whether you can or want to take HRT or whether you want to use them alongside treatments like HRT, you can. This research is a fantastic step forward in the advocation of choice.”

Catherine Harland, menopause educator, coach and founder member of MenoClarity, said talking therapies had received a lot of backlash since the UK’s National Institute for Health and Care Excellence (NICE) recommended them in their updated guidelines.

“Whilst I understand how life-changing talking therapies can be, I fully appreciate why so many women crave the ‘quick fix of a silver bullet’ in the form of HRT as we have been taught this from a young age,” she said. “We have been taught to turn to pharmaceuticals for any symptoms we experience.”

Modern women, Harland said, live stressful, fast-paced lives, juggling a multitude of things and often feel too busy to fit talking therapies into the mix.

“Menopause is a highly sensitive time and it’s vital women begin to understand the importance of self-care which includes talking therapies and mindfulness.

“HRT alone will not reduce symptoms of stress, trauma and metabolic disease caused by living in a high cortisol state for long periods of time.”

Around 15 per cent of women aged 45 to 64 in England are currently prescribed HRT, which has increased rapidly in the last two years from around 11 per cent and continues to increase.

The main benefit of HRT, according to the NHS website, is that it can help relieve most menopause and perimenopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.

Draft NHS guidelines recommend offering cognitive behavioural therapy, alongside or instead of HRT.

Dr Shahzadi Harper, menopause specialist and founder of The Harper Clinic, said talking therapies could benefit women experiencing menopause symptoms and help them feel more in control. However, she said they should not be it at the forefront of the menopause conversation.

Dr Shahzadi Harper, menopause specialist and founder of The Harper Clinic

“Talking therapies do not address the inherent hormone deficiency that arises due to perimenopause and menopause and the long-term consequences of declining hormone levels,” Harper explained.

“I don’t think they should be at the forefront and definitely not instead of HRT. However, I do think they could be a useful tool, especially as the symptoms of menopause can be quite debilitating and affect mental health and mood.”

Dr Clare Spencer, menopause specialist, GP and co-founder of My Menopause Centre, said while HRT could help many women manage symptoms of the menopause, there would be some women who may continue to experience symptoms, such as poor sleep, low mood and anxiety, despite being on it.

“Women may face other difficulties at the time of the menopause that may be additional causes of stress which can also impact on experience of symptoms of the menopause.

Dr Clare Spencer, GP, menopause specialist and co-founder of My Menopause Centre

“In these cases, there is a place for talking therapies, such as cognitive behavioural therapy and mindfulness, to help break some of the vicious cycles that can then exist.

“There is also a role for talking therapies in helping women who have been advised not to take HRT or do not wish to.”

She said, however, that long NHS waiting lists could prevent women from getting the support they need.

“There is an issue with access to cognitive behavioural therapy and mindfulness-based therapies through the NHS which does need resolving to allow more women access timely support,” she added.

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Drug that targets hot flushes approved in UK and EU

Fezolinetant could potentially benefit hundreds of thousands of women approaching menopause



A new drug that prevents hot flushes during menopause has been approved for use in the UK and the EU.

Veoza, also known as fezolinetant, has been given the go-ahead by the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) and the European Commission after it was approved for use by the US Food and Drug Administration earlier this year.

Hot flushes, also known as vasomotor symptoms, are a common symptom of menopause that often feels like a sudden flare of heat, paired with sweating and flushed skin. Worldwide, more than half of women between 40 to 64 years experience them, with rates in Europe ranging from 56 per cent to 97 per cent.

Before menopause, there is a balance between oestrogens and a protein made by the brain, known as neurokinin B (NKB), that regulates the brain’s temperature control centre. As the body goes through menopause, oestrogen levels decline and this balance is disrupted, which can lead to hot flushes.

Veoza, developed by the Japanese drug maker Astellas Pharma, reduces the number and intensity of hot flushes and night sweats by blocking neurokinin-3.

“Hot flushes and night sweats caused by menopause are common and can have a significant impact on a woman’s daily life,” explained Julian Beach, the interim executive director of healthcare quality and access at the MHRA.

“We are therefore pleased to have authorised Veoza (fezolinetant) for hot flushes and night sweats caused by menopause via our reliance procedure.

“No medicine would be approved unless it met our expected standards of safety, quality and effectiveness and we continue to keep the safety of all medicines under close review.”

Professor Rossella Nappi, associate professor of obstetrics and gynaecology and director of the gynaecological endocrinology and menopause unit IRCCS San Matteo Foundation, University of Pavia, said: “I’ve been awaiting the marketing authorisation of fezolinetant.

“I’m happy to see this advancement in women’s health and that my patients will soon have this new non-hormonal treatment option available to better control their moderate to severe vasomotor symptoms.”

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The coolest brand in hot flash relief: behind Femography’s menopause clothing revolution

In an era when menopause was seldom addressed, Femography courageously launched Become



Three women relax and chat donning Become’s signature Anti-Flush™ clothing line. (Femography by MAS Holdings)

In the realm of women’s health, an exciting revolution is underway, and at its forefront is Femography, a trailblazing brand in the femtech industry.

Backed by a formidable apparel conglomerate and embraced by women worldwide, Femography is more than just a brand – it’s a movement reshaping the menopause apparel industry. This feature dives into Femography’s journey and highlights a ‘cool’ gift idea for your friends and loved ones – figuratively and literally.

Powered by an apparel giant: a leap in women’s health

Femography distinguishes itself in the femtech space with the robust backing of MAS Holdings, a titan in South Asia’s apparel tech industry. This partnership propels Femography forward in a sector where a mere three per cent of women’s health-focused businesses have secured financing since 2011.

It marks a significant step in filling a gap in women’s health — a crucial but often overlooked area — positioning Femography as a visionary leader.

Scientific breakthrough meets lifestyle

The cornerstone of Femography’s success lies in its groundbreaking patented Anti-Flush™ Technology, ingeniously crafted to tackle the three stages of a hot flash, a predominant symptom of menopause.

This innovation transcends the boundaries of science, offering lifestyle solutions that blend seamlessly into everyday life. It’s this unique fusion of scientific ingenuity and practical utility that sets Femography apart, carving out its niche in the market.

Femography’s holistic product line

Femography’s product development approach is comprehensive and thoughtful. Their expansive product line, including Anti-Flush™ sleepwear, camisoles, panties, loungewear, tank tops, leggings and ultra absorbent underwear, is designed with the utmost care to ease menopause-related discomforts.

Each item in this diverse array is crafted to empower women, enabling them to lead fulfilling lives without the burdens of menopause symptoms.

Enter Become: pioneering change with Femography’s consumer brand

In an era when menopause was seldom addressed, Femography courageously launched Become, its consumer brand dedicated to menopause apparel. This bold initiative has led the way for seven years, transforming societal perceptions and dismantling stigmas around menopause.

Become has not only brought relief to countless women but has also been instrumental in evolving the market, cultivating a space where menopause is openly discussed and managed with dignity and understanding.

A cool gift idea: embrace the holiday spirit with Become

This holiday season, Femography invites you to reimagine gift-giving. Sharing Become’s revolutionary clothing with friends is a wonderful way to support those experiencing menopause. It’s more than a gift; it’s an expression of care, offering real comfort in daily life.

This thoughtful gesture of gifting cooling apparel is not only practical but also a symbol of empathy and unity. And what could be cooler than presenting a gift that brings literal and figurative coolness to someone’s life?

Femography’s broader impact as a leading B2B partner

Femography’s journey in the femtech revolution is marked not just by its technological innovation but also by its deep understanding of consumer needs.

While the holiday season offers a moment to focus on individual gifting, the broader, year-round scope of Femography’s impact lies in its role as a powerful B2B partner in the health and apparel sectors. This dual focus reflects Femography’s commitment to enhancing the lives of individual women and driving forward the industry as a whole.

By offering cutting-edge solutions like their Anti-Flush™ technology, Femography has set new standards in menopause apparel. Their innovative approach extends beyond product development to fostering meaningful collaborations with businesses and brands.

Femography amplifies its impact through these partnerships, making women’s health solutions more accessible and creating a global ripple effect of well-being and empowerment.

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