#222 Perimenopausal Mental Health with Professor Jayashri Kulkarni

Professor Jayashri Kulkarni is one of Australia's leading psychiatrists and researchers specialising in women's mental health. She is the Director of the HER Centre Australia (Health, Education and Research for Women's Mental Health) and Professor of Psychiatry at Monash University. Professor Kulkarni's work focuses on mood disorders across the female lifespan, with particular attention to the neurochemical effects of reproductive hormones on brain function, including perimenopausal depression and premenstrual dysphoric disorder. She is the developer of the Meno-D rating scale and has been a leading voice for over four decades in the recognition and treatment of hormone-related mental illness in women.

In this episode, Dr. Ashlea Broomfield speaks with Professor Jayashri Kulkarni about the mental health impact of perimenopause. They discuss the role of oestrogen and progesterone as neurosteroids influencing mood, cognition, and behaviour; why mood symptoms often precede vasomotor changes by years; which women are most at risk and why; the distinct clinical profile of perimenopausal depression and how to avoid common misdiagnoses; and how to approach hormonal treatment in practice (including contraceptive options, transdermal oestradiol, micronised progesterone, and tibolone) alongside a review of the evidence around MHT safety.

RESOURCES

"The primary care management of perimenopausal depression" — Kulkarni J et al. Australian Journal of General Practice 2026;55(4). Read here
HER Centre Australia — Research, clinical resources, and the Meno-D scale: monash.edu/medicine/her-centre
Meno-D rating scale — Available via HER Centre Australia and as an appendix in the AJGP article above
Healthy Hormones — GP-led community, resources, and webinars: healthyhormones.au
Australasian Menopause Society — Evidence-based guidelines and resources: menopause.org.au
Monash University women's mental health short course — Via HER Centre Australia (
PMDD companion episode — The GP Show with Professor Jayashri Kulkarni (link once live)
Fast Facts in Sexual and Reproductive Health with Dr. Sara Whitburn — The GP Show

TIMESTAMPS

00:00 — Introduction, Welcome to Country, guest bio

03:40 — Reproductive hormones as brain neurosteroids: neurochemical effects of oestrogen and progesterone across the perimenopausal transition

12:19 — Risk factors for perimenopausal mood sensitivity: early life trauma, the HPA/HPG axis, and recognising hormonal sensitivity in clinical history

24:28 — Diagnostic considerations: the Meno-D scale, distinguishing perimenopausal depression from MDD and bipolar disorder, and current gaps in psychiatric classification

37:29 — MHT safety: reviewing the 2001 WHI study, absolute and relative contraindications, and monitoring in practice

45:33 — Treatment approaches: hormonal contraception, transdermal oestradiol, micronised progesterone, tibolone, and tailoring to the individual

59:16 — Further resources and preview of the PMDD companion episode

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