July 7, 2026
#222 Perimenopausal Mental Health with Professor Jayashri Kulkarni
<p>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.</p> <p>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.</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">RESOURCES</span></strong></p> <ul type="disc"> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> "The primary care management of perimenopausal depression"</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— Kulkarni J et al. <span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">Australian Journal of General Practice</span> 2026;55(4). <a href= "https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww1.racgp.org.au%2Fgetattachment%2Fecf7a7ed-76d6-45b9-a2fe-1b802a8c8b7b%2FThe-primary-care-management-of-perimenopausal-depr.aspx&data=05%7C02%7Csam.manger%40jcu.edu.au%7Ca85ed71b9bc14eab37a308deda40676d%7C30a8c4e81ecd4f148099f73482a7adc0%7C0%7C0%7C639188167340335407%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=NWZWN3oibjUn6K1CgCmxc5Bc1igVfwL2G%2Bv2MnXHsz8%3D&reserved=0"> Read here</a></span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> HER Centre Australia</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— Research, clinical resources, and the Meno-D scale: <a href= "https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.monash.edu%2Fmedicine%2Fher-centre&data=05%7C02%7Csam.manger%40jcu.edu.au%7Ca85ed71b9bc14eab37a308deda40676d%7C30a8c4e81ecd4f148099f73482a7adc0%7C0%7C0%7C639188167340357766%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=eyqB05cJZWOF%2FeCbkq2GyIofBZqfrp%2Fd%2F25JqS1zl3g%3D&reserved=0"> monash.edu/medicine/her-centre</a></span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> Meno-D rating scale</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— Available via HER Centre Australia and as an appendix in the AJGP article above</span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> Healthy Hormones</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— GP-led community, resources, and webinars: <a href= "https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.healthyhormones.au%2F&data=05%7C02%7Csam.manger%40jcu.edu.au%7Ca85ed71b9bc14eab37a308deda40676d%7C30a8c4e81ecd4f148099f73482a7adc0%7C0%7C0%7C639188167340380202%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=ZcTbEzANlAwFu%2FJh1e11m1B9gY2oV23neCER%2Fti1uec%3D&reserved=0"> healthyhormones.au</a></span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> Australasian Menopause Society</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— Evidence-based guidelines and resources: <a href= "https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.menopause.org.au%2F&data=05%7C02%7Csam.manger%40jcu.edu.au%7Ca85ed71b9bc14eab37a308deda40676d%7C30a8c4e81ecd4f148099f73482a7adc0%7C0%7C0%7C639188167340401240%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=Npelv9QNsY2LUeoQpfn5nbYDOFx2yqjf0LE4STF3gmo%3D&reserved=0"> menopause.org.au</a></span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> Monash University women's mental health short course</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— <a href= "https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.monash.edu%2Fmedicine%2Fher-centre%2Feducation%2Fwomens-mental-health-short-course&data=05%7C02%7Csam.manger%40jcu.edu.au%7Ca85ed71b9bc14eab37a308deda40676d%7C30a8c4e81ecd4f148099f73482a7adc0%7C0%7C0%7C639188167340422533%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=y8zVXMx1%2FdUabs15YJHe7KAQeRaTRLuWb4PX5SnGKaw%3D&reserved=0"> Via HER Centre Australia</a> <span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">(</span></span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> PMDD companion episode</span></strong> <span style= "mso-fareast-font-family: 'Times New Roman';">— <span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">The GP Show</span> with Professor Jayashri Kulkarni <span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">(link once live)</span></span></li> <li class="MsoNormal" style= "mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;"> <strong><span style= "font-family: 'Aptos',sans-serif; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Aptos;"> Fast Facts in Sexual and Reproductive Health</span></strong> <span style="mso-fareast-font-family: 'Times New Roman';">with Dr. Sara Whitburn — <span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;"><a href="https://aus01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fthegpshow.libsyn.com%2Fwebsite%2F219-fast-facts-in-sexual-and-reproductive-health-with-dr-sarah-whitburn&data=05%7C02%7Csam.manger%40jcu.edu.au%7Ca85ed71b9bc14eab37a308deda40676d%7C30a8c4e81ecd4f148099f73482a7adc0%7C0%7C0%7C639188167340444535%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=RhrUP%2FRUstUQMdfunIPsFE6TUE%2BN8YaMhf3oy9VgtLQ%3D&reserved=0"> The GP Show</a></span> </span></li> </ul> <p> </p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">TIMESTAMPS</span></strong></p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">00:00</span></strong> — Introduction, Welcome to Country, guest bio</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">03:40</span></strong> — Reproductive hormones as brain neurosteroids: neurochemical effects of oestrogen and progesterone across the perimenopausal transition</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">12:19</span></strong> — Risk factors for perimenopausal mood sensitivity: early life trauma, the HPA/HPG axis, and recognising hormonal sensitivity in clinical history</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">24:28</span></strong> — Diagnostic considerations: the Meno-D scale, distinguishing perimenopausal depression from MDD and bipolar disorder, and current gaps in psychiatric classification</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">37:29</span></strong> — MHT safety: reviewing the 2001 WHI study, absolute and relative contraindications, and monitoring in practice</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">45:33</span></strong> — Treatment approaches: hormonal contraception, transdermal oestradiol, micronised progesterone, tibolone, and tailoring to the individual</p> <p><strong><span style= "font-family: 'Aptos',sans-serif; mso-bidi-font-family: Aptos;">59:16</span></strong> — Further resources and preview of the PMDD companion episode</p> <p> </p> <p class="MsoNormal">...</p> <p class="MsoNormal">If you find this podcast valuable, please help by rating the podcast 5 stars and leaving a review in your podcast app.</p> <p class="MsoNormal">If you would like to request a topic, please contact us via <a href= "mailto:contact@thegpshow.com">contact@thegpshow.com</a> </p> <p class="MsoNormal">Thank you for listening and your support.</p> <p>... </p> <p><strong>Study and learn lifestyle medicine</strong>: Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science? Check out the JCU College of Medicine postgraduate degrees: <a href= "https://www.jcu.edu.au/courses/graduate-certificate-of-lifestyle-medicine">Graduate Certificate</a>, <a href= "https://www.jcu.edu.au/courses/graduate-diploma-of-lifestyle-medicine">Graduate Diploma</a>, and <a href= "https://www.jcu.edu.au/courses/master-of-lifestyle-medicine">Master</a> in lifestyle medicine.</p> <p class="MsoNormal">Dr Sam Manger on <a href= "https://www.youtube.com/watch?v=fBnhX7bIXrQ">YouTube: Using lifestyle as medicine: A new era in chronic disease remission</a> and <a href= "https://www.youtube.com/watch?v=5-jTEyadBoI">YouTube: Careers in lifestyle medicine</a></p> <p class="MsoNormal">The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available <a href= "https://www.futurelearn.com/courses/lifestyle-medicine-for-mental-health-services/2">here</a>. </p>
