Hormones and Mental Illness in Women – PMDD / Depression and the Pill / Perimenopausal Depression- Prof Kulkarni

Posted on: May 18, 2017
Last Updated: November 10, 2023

Prof Jayashri Kulkarni, Professor of Psychiatry and Director of Monash Alfred Psychiatry Research Centre discusses specific psychiatric illnesses that are hormone-related.

  • PMS
  • PMDD
  • Perimenopausal Depression / Late-onset Borderline
  • Psychosis Relapse
  • Depression and the Pill

The contraceptive pill has allowed women to live selected lifestyles; however, it is also important to remember the negative impacts of contraceptives on the brain.

Many times we have seen young women come in with depression who have not had any other changes in their life particularly… and she will say things like ‘it wasn’t until I started this particular brand of pill that things started to fall apart’

One of the highest propensity for side effects is Implanon. We’ve seen some profound depression which improves when the implant is removed.

Implanon is a contraceptive rod containing etonogestrel, which is similar to the naturally occurring hormone progesterone

Hormone sensitivity is an individual aspect. (hence not all women with Implanon become depressed)

Prof Kulkarni’s group is currently running a study looking at depression and the pill and they found that Low-dose estradiol (20mcg)was associated with more depression. Older progestins also associated with more depression.

If you have a patient that is more prone to depression, my suggestion is to prescribe Zoely

Zoely contains nomegestrol acetate (synthetic progesterone) and estradiol.

Premenstrual Dysphoric Disorder

  • 80% of women have some challenges relating to menses, 40% have PMS, 10-15% have PMDD
  • For PMDD hormone treatments are very important

Suggested 1st line

  1. OCP –continuous. We favor Zoely – natural estradiol + nomegestrol acetate
  2. OCP + estradiol

2nd Line treatments

  1. SSRI’s – use short half-life drugs, less agitating ones (citalopram, sertraline). Agomelatine.
  2. Pharmacogenomics testing to ensure sensitivity and reactivity to medication.

3rd line treatments

  • SSRI+ estradiol
  • SSRI + aldosterone

4th line treatments

  • GnRH agonist drugs (e.g Synarel) + add back estradiol (chemical menopause)

General Treatment Issues in Women:

Depression in Women

  • Short Half-life SSRI’s
  • SNRI’s more effective in postmenopausal women
  • Agomelatine & Vortioxetine is useful in women.

Perimenopause and Depression

Perimenopausal Depression

  • 16 times increased rate of depression in Perimenopausal period
  • The brain changes occur well before the body changes of menopause
  • The CNS changes may occur up to 5 years before hot flushes and amenorrhoea

Symptoms of Perimenopause

  1. Hot flushes
  2. Feeling sad, hopeless and in despair
  3. Feeling ‘grumpy’ and irritable
  4. No or decreased libido
  5. Low self-esteem especially about the appearance
  6. Weight gain between 3-8 kgs
  7. Concentration issues and poor memory

The Mono-D was developed by Prof Kulkarni to detect depression in menopause.


  1. Antidepressants or HRT
  2. Sleep Regulation
  3. Natural Medicines –
  4. Psychotherapy


Learn more

  1. Tibolone As Adjunctive Treatment in Perimenopausal Depression By Prof Jayashri Kulkarni
  2. HRT vs Antidepressants in Perimenopausal Depression by Prof Jayashri Kulkarni
  3. The Relationship Between Estrogen and Mood by Professor Jayashri Kulkarni
  4. Premenstrual dysphoric disorder (PMDD) and Hormonal Treatments by Professor Jayashri Kulkarni
  5. Gender Differences in Mental Health by Professor Jayashri Kulkarni
  6. Prof Jayashri Kulkarni’s Tips On Prescribing Antipsychotics in Pregnancy
  7. Trauma and Complex Trauma Disorder by Prof Jayashri Kulkarni
  8. Women’s Mental Health: A Bio-Psycho-Social Approach by Prof. Jayashri Kulkarni
  9. Schizophrenia in Women – Role of Estrogen and Novel Treatments