Okpete UE, Byeon H. Optimizing perimenopausal mental health by integrating precision biomarkers, digital health interventions, and psychosocial care. World J Psychiatry 2025; 15(7): 101906 [DOI: 10.5498/wjp.v15.i7.101906]
Corresponding Author of This Article
Haewon Byeon, PhD, Associate Professor, Worker’s Care and Digital Health Lab, Department of Future Technology, Korea University of Technology and Education, Director 1600, Chungjeol-ro, Cheonan 31253, South Korea. bhwpuma@naver.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Uchenna E Okpete, Department of Digital Anti-Aging Healthcare, Inje University, Gimhae 50834, South Korea
Haewon Byeon, Worker’s Care and Digital Health Lab, Department of Future Technology, Korea University of Technology and Education, Cheonan 31253, South Korea
Author contributions: Byeon H designed the study; Okpete UE involved in data interpretation and developed methodology; Okpete UE and Byeon H contributed to this paper and assisted with writing the article; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, No. RS-2023-00237287.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Haewon Byeon, PhD, Associate Professor, Worker’s Care and Digital Health Lab, Department of Future Technology, Korea University of Technology and Education, Director 1600, Chungjeol-ro, Cheonan 31253, South Korea. bhwpuma@naver.com
Received: September 30, 2024 Revised: November 12, 2024 Accepted: April 10, 2025 Published online: July 19, 2025 Processing time: 282 Days and 17.9 Hours
Abstract
This study addressed the critical need for an integrated, personalized approach to perimenopausal mental health, addressing both biological and psychosocial factors. Current research highlighted the influence of hormonal fluctuations, genetic predispositions, and lifestyle factors in shaping perimenopausal mental health outcomes. This transitional period is marked by significant hormonal fluctuations contributing to heightened anxiety, depression, and sleep disturbances, affecting the women’s quality of life. Traditional pharmacological treatments, including selective serotonin reuptake inhibitors and hormone replacement therapy, have limitations due to variable efficacy and side effects, emphasizing the need for precision medicine. Advancements in pharmacogenomics and metabolomics provide new avenues for individualized treatments, with genetic markers (e.g., Solute carrier organic anion transporter family member 1B1, estrogen receptor 1/estrogen receptor 2, and tachykinin receptor 3) guiding hormone therapy responses. Emerging digital health technologies, such as artificial intelligence-driven diagnostics, wearable monitoring, and telehealth platforms, offer scalable, real-time mental health support, though regulatory and clinical validation challenges remain. Furthermore, integrative treatment models combining hormone-based therapy with non-pharmacological interventions demonstrate significant efficacy in alleviating perimenopausal symptoms. Future directions should prioritize the clinical validation and ethical implementation of digital health solutions, ensuring safety, efficacy, and user accessibility. A multidisciplinary, patient-centric model, incorporating genetics, endocrinology, digital health, and psychosocial interventions, is essential for optimizing perimenopausal mental health outcomes.
Core Tip: This article highlights the critical need for an integrated, personalized approach to perimenopausal mental health, addressing biological and psychosocial factors. Hormonal fluctuations, genetic predispositions, and lifestyle factors significantly shape mental health outcomes, while traditional treatments like selective serotonin reuptake inhibitors and hormone replacement therapy have limitations. Advancements in pharmacogenomics, metabolomics, and digital health technologies offer promising, individualized solutions. Integrative models combining hormone therapy, cognitive behavioral therapy, and lifestyle interventions show strong efficacy. However, healthcare accessibility and stigma remain challenges. Future efforts should focus on clinical validation, ethical implementation, and equitable care to optimize mental health outcomes and overall well-being for perimenopausal women.
Citation: Okpete UE, Byeon H. Optimizing perimenopausal mental health by integrating precision biomarkers, digital health interventions, and psychosocial care. World J Psychiatry 2025; 15(7): 101906
Mental health challenges are prevalent among perimenopausal women, with many experiencing anxiety, depression, mood swings, and cognitive changes[1-3]. These issues are attributed to hormonal fluctuations, which contribute to emotional instability[2,3]. Psychosocial factors, such as changing roles and self-image, also contribute to mental health concerns[3]. Despite the prevalence of these symptoms, mental health challenges during perimenopause remain an underexplored aspect of women’s health[4]. Mental illnesses account for 13% of the global disease burden, with 80% of affected individuals living in low- and middle-income countries[5]. The highest suicide rate among United Kingdom females occurs between ages 50-54, coinciding with the average menopausal age of 51[4]. In addition, Chinese studies revealed an increase in depression and anxiety symptoms from perimenopause through postmenopause, emphasizing the importance of mental health screening during this transition. In a recent study, sleep quality, partially mediated by anxiety symptoms, was negatively correlated with subjective well-being. Poor sleep quality affects 38.6% of midlife Chinese women, with anxiety, comorbidities, stress, and vasomotor symptoms (VMS) identified as risk factors[6-8]. In addition to pharmacological approaches, studies have reported the effectiveness of non-pharmacological interventions in managing perimenopausal mental health challenges, especially in female dominated workplace where information, support and guidance are offered to older women by health and education professionals.
Women often accept menopause as an inevitable part of aging but struggle with the loss of femininity and complexities associated with menopausal care[9]. Healthcare support is perceived as insufficient due to a lack of information and empathy from professionals. While exploring these challenges, we advocate for a paradigm shift in the approach to perimenopausal care, promoting not only multidisciplinary integration but also the adoption of personalized mental health care (Figure 1). By integrating evidence-based medical and psychological interventions with digital health interventions, this approach could significantly improve the mental health outcomes of perimenopausal women, particularly those in underserved and culturally unique populations.
Figure 1 Illustrates the process of precision diagnosis leading to precision treatment for women with perimenopausal symptoms.
BMI: Body mass index; ECG: Electrocardiograph; EEG: Electrocephalogram; PK: Pharmacokinetic; PD: Pharmacodynamic; SNPs: Single-nucleotide polymorphisms; TACR3: Tachykinin receptor 3; SLCO1B1: Solute carrier organic anion transporter family member 1B1; ER: Estrogen receptor.
This narrative review explores the intersection of precision diagnosis and treatment in perimenopausal mental health, covering hormonal influences on psychiatric symptoms, genetic and neurobiological factors, and emerging biomarkers. It examines digital health innovations, including wearable technology, artificial intelligence (AI)-driven diagnostics, and telemedicine, to enhance personalized care. Additionally, it addresses challenges in implementation and future directions for integrating personalized care into clinical practice for perimenopausal women.
CURRENT CHALLENGES AND FUTURE DIRECTIONS IN PERSONALIZED MEDICINE FOR PERIMENOPAUSAL MENTAL HEALTH
The perimenopausal period, also known as the menopausal transition, is a crucial phase preceding menopause. It is characterized by hormonal fluctuations, particularly the decline in estrogen and progesterone due to a deterioration in ovarian activity, which significantly contributes to physical, emotional, and cognitive symptoms. This transition typically occurs over several years (between 45 years and 55 years), involving changes in menstrual cycle length along with associated discomfort[10]. The symptoms associated with perimenopause extend beyond vasomotor disturbances such as hot flashes and night sweats to encompass a spectrum of psychological and physiological manifestations, including depression, anxiety, cognitive impairment, insomnia, fatigue, musculoskeletal pain, and cardiovascular changes[11,12].
The psychogenic symptoms of perimenopause are particularly concerning, with up to 70% of women experiencing mood disturbances, including irritability, anxiety, and depressive episodes[13]. These mental health challenges arise from both hormonal shifts and sociocultural factors. Women navigating perimenopause often face external stressors such as career transitions, caregiving responsibilities, and societal pressures regarding aging, all of which contribute to emotional distress. Additionally, sleep disturbances, exacerbated by nocturnal VMS, further disrupt emotional stability, creating a cyclical relationship between insomnia and mental health decline[14]. Menopause is a sensitive topic associated with aging, which may intensify anxiety and depression among women who already face societal pressure to maintain youthfulness and vitality. Collective health and family well-being often take precedence over individual health needs. Thus, perimenopausal women prioritize family roles over self-care due to this cultural value, possibly causing mental health and sleep issues. Sleep fragmentation and oxidative stress further accelerate neuroinflammatory processes, potentially contributing to long-term cognitive decline. Cognitive symptoms such as brain fog is characterized by forgetfulness, difficulty concentrating, and mental fatigue, which may be early signs of mild cognitive impairment[15]. Poor sleep quality worsens anxiety and depression and vice versa, suggesting a cyclical relationship between sleep quality and mental health.
Beyond its impact on mental health, perimenopause also affects cardiovascular, musculoskeletal, and cognitive health. Estrogen’s protective effects on vascular integrity, bone density, and neuronal function decline, leading to increased risks of osteoporosis, cardiovascular disease, and cognitive impairment[11]. The decline in estrogen reduces its protective effects on vascular integrity, bone density, and neuronal function, increasing the risk of osteoporosis, cardiovascular disease, and cognitive impairment. Musculoskeletal issues, such as cervical pain, are common and have been identified as predictors of depression, likely due to their physical and psychological burden. Despite the high prevalence of these symptoms, awareness remains low, and many women fail to recognize the link between their mental health challenges and perimenopause.
Given the diverse symptomatology and individual variability in perimenopausal experiences, a one-size-fits-all approach to treatment is often inadequate. Traditional pharmacological interventions, such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, while commonly prescribed for perimenopausal depression, exhibit high failure rates and adverse effects[12]. Hormone-based therapies, while effective in alleviating vasomotor and mood symptoms, require careful consideration of an individual’s risk profile, particularly regarding cardiovascular and oncological predispositions. Research into selective estrogen receptor modulators and neurosteroids highlights the potential of individualized hormonal modulation to address perimenopausal depression and cognitive decline[16]. Advances in biomarker-driven interventions allow for more targeted estrogenic therapies that optimize benefits while minimizing risks.
Failing to address the mental health issues of perimenopausal women can have severe long-term consequences. If left untreated, depression and anxiety can diminish the quality of life, impair social and occupational functioning, and increase suicidal risk[4,17]. Moreover, the decline in estrogen is linked to neuroinflammation, increasing the risk of neurodegenerative diseases such as Alzheimer’s[12,13]. Therefore, timely interventions are not only crucial for immediate symptom relief but also for long-term health preservation. The integration of precision medicine and digital health technologies offers a comprehensive approach to managing perimenopausal symptoms by tailoring interventions to an individual’s unique genetic, metabolic, and behavioral profile. Table 1 below summarizes the correlation between perimenopausal symptoms, precision diagnosis and treatment strategies, and digital health interventions.
Table 1 Highlights of perimenopausal symptoms, precision diagnosis and treatment strategies, and digital health interventions.
Symptoms
Precision diagnosis and treatment
Digital health interventions
Physical symptoms
Mental and behavioural symptoms
Precision biomarkers identification
AI-driven symptom tracking apps
Vasomotor symptoms (hot flashes)
Anxiety
Genetic marker (SNPs in TACR3, SLCO1B1, ERα/ERβ)
Wearable technology (heart rate, temperature for hot flashes monitoring)
Night sweat
Brain fog
Metabolomic markers (targeted dietary intervention or supplements based on an individual’s unique metabolic profile)
Telemedicine, virtual consultations and remote monitoring
Weight gain (obesity)
Depression
Hormonal fluctuations (estrogen, neurokinin B)
Menopause education and support apps
Vaginal atrophy (vaginal dryness)
Exhaustion
Non hormonal (neurokinin 3 receptor antagonists) - fezolinetant
Genetic and metabolomic influences on treatment response
Research indicates that genetic and metabolomic factors significantly influence individual vulnerability to mental health disorders during this transition[17,18]. Studies have highlighted key genetic variations affecting estrogen metabolism and neurotransmission, influencing both symptom severity and treatment response. Among these, three genes, Solute carrier organic anion transporter family member 1B1 (SLCO1B1), estrogen receptor (ESR)1/ESR2, and tachykinin receptor 3 (TACR3) have been identified as crucial determinants of perimenopausal symptomatology and associated with differential responses to hormonal therapies.
SLCO1B1: This gene encodes a protein responsible for transporting estrone sulfate, a key estrogen metabolite, from the blood into liver cells. A polymorphism in SLCO1B1 (rs4149056) has been associated with differential treatment responses in menopausal women experiencing night sweats and sleep disturbances. In populations, where the T allele frequency is high (T = 0.877, C = 0.123), women with the TC genotype may experience greater symptom relief with menopausal hormone therapy compared to those with the TT genotype[19]. This suggests that estrogen metabolism variability could impact hormonal treatment efficacy.
ESR genes: Polymorphisms in ESR1 (ERα) and ESR2 (ERβ) have been linked to differential risks of depression in perimenopausal women[20-22]. Specific genetic variations in these receptors may modulate how estrogen interacts with neurotransmitter systems, affecting mood regulation and cognitive function. Understanding these genetic variations could guide the personalization of antidepressant or hormone-based therapies, improving mental health outcomes.
TACR3: This gene encodes the neurokinin B receptor, which is involved in hypothalamic regulation of VMS, including hot flashes and night sweats. Studies have identified TACR3 variants (rs75699757, rs11518608) as being associated with altered VMS risk[23]. While minor alleles of these variants were found to increase VMS risk in specific populations, they were inversely associated with VMS in others, highlighting the complexity of genetic influences. Additionally, neurokinin B signaling has been implicated in psychiatric conditions, further supporting the hypothesis that genetic variability in TACR3 may contribute to the interplay between VMS and mood disturbances in perimenopausal women. The emerging use of a non-hormonal drug, neurokinin 3 receptor antagonists (e.g., fezolinetant, approved by the United States Food and Drug Administration), for VMS treatment also suggests a potential avenue for addressing associated psychiatric symptoms, such as depression and anxiety[24,25].
Metabolomic biomarkers: Integrating metabolomic biomarkers into precision medicine could enhance perimenopausal care and mental health outcomes. Metabolomic treatment of menopause leverages personalized dietary interventions and supplements based on an individual’s metabolic profile to address imbalances in lipids, amino acids, and hormones. Notably, 28 metabolites have been identified as potential biomarkers of menopause, including increased levels of acylcarnitines, fatty acids, lysophosphatidylcholines, and lysophosphatidylethanolamines, alongside decreased levels of pregnanediol-3-glucuronide, dehydroepiandrosterone sulfate, p-hydroxyphenylacetic acid, and dihydrolipoic acid[26]. These metabolic shifts indicate significant changes in fatty acid β-oxidation, phospholipid metabolism, hormone metabolism, and amino acid metabolism in postmenopausal women. Metabolomics analysis of blood or urine can identify metabolic changes linked to menopause, guiding tailored nutritional adjustments and potential use of phytoestrogens, probiotics, and targeted vitamins.
Estrogen, depression, neuroticism and antipsychotic efficacy
Genetic studies have demonstrated positive correlations between estrogen use phenotypes, depression, and neuroticism. Women experiencing severe VMS are more likely to exhibit anxiety and depressive phenotypes. This aligns with evidence that depression and anxiety disorders are more prevalent in women with significant menopausal symptoms[27-29]. Interestingly, serotonin reuptake inhibitors such as Paroxetine, commonly prescribed for depression, are also used to manage VMS[30]. Similarly, estrogen therapy has shown efficacy in treating depressive symptoms, suggesting a shared biological etiology between mood regulation and menopausal symptomatology.
Estrogen exerts neuroprotective effects, modulating dopamine transmission, a key neurotransmitter implicated in schizophrenia pathogenesis and mood disorders[31]. The interaction between estrogen and dopamine is particularly relevant for perimenopausal women experiencing psychosis, cognitive decline, or mood instability as women exhibit higher D2 receptor density than men in critical brain regions, such as the frontal cortex and thalamus, influencing antipsychotic drug efficacy[32]. Postmenopausal estrogen decline is associated with worsening psychotic symptoms in women with schizophrenia, often necessitating higher doses of antipsychotics for symptom stabilization[33]. Studies suggest that estradiol modulates dopamine transporter activity, influencing drug metabolism and receptor occupancy. Adding estrogen or selective estrogen receptor modulators to antipsychotic regimens has shown enhanced treatment response, highlighting the potential of estrogen-based adjunct therapies in psychiatric care. In addition to pharmacogenomics, lifestyle and integrative approaches form a cornerstone of personalized perimenopausal care. Nutritional interventions, physical activity regimens, and stress-reduction techniques such as mindfulness and cognitive behavioral therapy (CBT) can be tailored to an individual’s specific metabolic, psychological, and genetic profiles, ensuring holistic management of symptoms.
INTEGRATING DIGITAL HEALTH TECHNOLOGY INTO PERIMENOPAUSAL MENTAL HEALTH MANAGEMENT
The integration of digital health technology into perimenopausal mental health management offers significant opportunities for improved care. From AI-powered symptom monitoring to telehealth consultations and metaverse-based interventions, digital platforms enable self-monitoring and management in ways traditional methods failed[34]. Mobile health applications equipped with AI algorithms could continuously monitor symptoms such as mood fluctuations, sleep patterns, and cognitive changes, providing real-time feedback to women and their healthcare providers. For perimenopausal women experiencing psychosocial symptoms, digital health technologies provide access to information, virtual consultations, and online support communities, potentially overcoming barriers like embarrassment[35]. Such digital technologies could alert women about potential risks and enable timely interventions (Table 2), preventing the escalation of mental health disorders[36]. Furthermore, the Internet of Things, referring to interconnected digital devices and sensors assist clinicians in personalizing treatment by integrating data from diverse sources[37], including genomics, hormonal profiles, and psychosocial factors into predictive models (Table 2).
Table 2 Digital health solutions for personalized perimenopausal mental health care.
Digital health technologies
Personalized benefits for perimenopausal mental health
Telemedicine and virtual counseling
Allows women with perimenopausal mental health symptoms remote access to counseling and consultations with a psychiatrist via telephone or videoconference
Wearable technology
Wearables like smartwatches or fitness bands can track sleep, heart rate, activity levels, and stress, offering data for both users and clinicians to monitor physiological symptoms associated with mental health
Digital CBT platforms
Provide access to evidence-based CBT interventions, helping women manage anxiety, depression, and mood swings associated with hormonal changes
Mental health chatbots
Artificial intelligence-driven chatbots can provide on-demand support, psychoeducation, and coping strategies for mood regulation and anxiety, offering support outside of therapy sessions
Medication management tools
Digital tools can provide reminders for HRT or other medications, track side effects, and alert users to potential adverse interactions, ensuring adherence at affordable terms regardless of location and patients insurance status
Virtual support groups
Online platforms can connect women experiencing similar perimenopausal symptoms, creating a supportive community to reduce feelings of isolation and share strategies for coping
RPM addressing behavioral health
RPM provides both continuous support through daily mood tracking, remote therapy sessions, and personalized mental health assessments. RPM also supports lifestyle adjustments, educational resources, and tailored guidance to improve mental health outcomes during this transitional phase
Sleep management apps
Sleep-tracking apps can offer insights and guidance to improve sleep hygiene and reduce stress and fatigue for many perimenopausal women experiencing sleep disturbances
Precision health platforms
Precision health platforms can suggest personalized treatments by incorporating genetic and metabolomic data
Telehealth and E-health solutions in perimenopausal care
Telehealth and e-health platforms have emerged as essential components of digital health strategies, offering convenience, improved access, and safety[38]. Women experiencing perimenopausal symptoms may hesitate to seek in-person care due to embarrassment, time constraints, or lack of available specialists. Online counseling, virtual support groups, and remote CBT sessions allow women to access mental health resources conveniently and confidentially[39]. During the coronavirus disease 2019 pandemic, the role of digital health strategies became even more pronounced as health systems worldwide adapted to remote consultations and virtual care. Participatory design studies have revealed that individuals experiencing menopause desire technologies to understand and prevent burdensome experiences, while healthcare practitioners focus on tracking and communication[40]. Complementary and integrative health practitioners suggested designs that reframe menopause positively and account for complex life factors[40]. The success of these interventions emphasizes the importance of expanding e-health solutions to support perimenopausal women, ensuring continuous mental health management regardless of geographic location.
The role of the metaverse and virtual reality in mental health support
Emerging digital environments such as the metaverse offer new possibilities for mental health interventions tailored to perimenopausal women. The metaverse, a three-dimensional virtual world, virtual reality, augmented reality and mixed reality technologies can create immersive therapeutic experiences that help women navigate emotional and cognitive challenges. Mixed reality technology within the metaverse enables personalized, adaptive therapies in familiar surroundings, potentially improving treatment efficacy and patient engagement[41]. AI-powered avatars can simulate therapeutic interactions, providing guided mindfulness exercises, stress management techniques, and psychoeducation in a personalized manner. For instance, studies on metaverse-based therapies have demonstrated effectiveness in treating mental health conditions such as anxiety and depression by fostering interactive, engaging, and supportive environments[42]. These digital interventions can be particularly beneficial for women who prefer privacy and flexibility in managing their mental health concerns.
PROJECTED CHALLENGES OF DIGITAL HEALTH PLATFORMS IN PERIMENOPAUSAL MENTAL HEALTH
Ensuring safe and evidence-based digital health solutions
Despite the rapid expansion of digital health technologies, challenges remain in ensuring the safety, efficacy, and ethical use of these tools. Key issues include underrepresentation, lack of evidence, and safety concerns[43]. The rapid development of digital health technologies outpaces regulatory efforts, exposing users to potential risks[44]. The unregulated nature of the digital therapeutic marketplace exposes perimenopausal women to misinformation and commercially driven interventions lacking scientific validation. Clinical validation remains a critical challenge, with existing frameworks often lacking pragmatic guidance and neglecting empirical evidence[45]. To address this, mental health practitioners must take an active role in evaluating, recommending, and integrating credible, evidence-based digital resources. Researchers emphasize the importance of co-designing digital tools with users, enhancing accessibility, establishing standardized reporting guidelines, and integrating decision-support tools into clinical practice[46]. The integration of Internet of Things-enabled healthcare presents additional challenges. While co-developing digital tools with users and considering their impact on human interaction and mental well-being are essential[34], the rapid evolution of technology necessitates rigorous, ongoing evaluation of digital interventions to ensure their safety, effectiveness, usability, and compliance with ethical and regulatory standards[34].
TOWARD AN INTEGRATED AND HOLISTIC FRAMEWORK FOR PERIMENOPAUSAL MENTAL HEALTH
Establishing a collaborative, patient-centric model requires the coordinated efforts of healthcare practitioners, researchers, policymakers, and digital health innovators to ensure the delivery of high-quality, adaptable mental health interventions for perimenopausal women.
Evidence-based interventions for perimenopausal mental health
Empirical evidence highlights the efficacy of psychological and mind-body interventions, including CBT, yoga, and clinical hypnosis, in alleviating menopausal symptoms and enhancing quality of life[47]. Hormone replacement therapy (HRT) (estrogen, progestogen or both) has also been shown to effectively alleviate both physical and psychological symptoms of menopause by stabilizing the hormonal fluctuations. By replenishing estrogen, HRT restores neurotransmitter function, reducing the severity of anxiety, depression, and cognitive impairments (e.g., brain fog)[48]. However, carefully evaluating each woman’s suitability for HRT based on health risks is crucial for healthcare providers.
In non-pharmacological approaches, CBT effectively addresses mood disorders by helping women challenge negative thought patterns. When combined with HRT, it provides a holistic treatment strategy targeting both biological and cognitive-emotional mechanisms[49]. Lifestyle modifications further enhance well-being during perimenopause. These include regular exercise, healthy eating during menopause, and good sleep hygiene. Regular exercise improves mood, sleep quality, and cognitive function, while reducing the risk of osteoporosis and cardiovascular disease, both of which are more prevalent post-menopause. A balanced, anti-inflammatory diet, rich in omega-3 fatty acids, fruits, and vegetables, supports brain function and mood stability. Optimized sleep hygiene, involves consistent sleep schedules, reduced caffeine intake, and relaxing bedtime routines. For severe insomnia, short-term use of sleep aids or melatonin may be beneficial.
Bridging gaps in accessibility and integration
Recent guidelines recommend a comprehensive approach to evaluating and treating perimenopausal depression, incorporating menopausal stage assessment, co-occurring symptoms, and psychosocial factors[12]. However, significant gaps persist in clinical practice. While antidepressants and psychotherapy remain front-line treatments, estrogen therapy has shown particular efficacy in women experiencing VMS[12]. Studies reveal suboptimal access to psychological interventions, particularly CBT, despite its strong evidence base and guideline recommendations[50]. Addressing this shortfall requires greater cross-specialty collaboration and expanded availability of CBT and other psychosocial interventions.
Digital, multimodal care platforms that integrate these evidence-based approaches within a culturally competent framework have the potential to improve healthcare accessibility and equity. The International Position Paper on Women’s Health and Menopause highlights the necessity of a comprehensive, globally inclusive strategy for menopausal healthcare, emphasizing the interplay between biomedical, sociocultural, and economic determinants[51]. By implementing an integrated, precision-driven approach, healthcare systems can transition towards a more robust and equitable model for managing perimenopausal mental health. Expanding access to psychosocial interventions, alongside hormonal and pharmacological strategies, will be key to optimizing outcomes across diverse patient populations[52].
CONCLUSION
The mental health challenges faced by perimenopausal women necessitate urgent attention. An integrated approach to perimenopausal mental health care involves leveraging precision medicine and digital health technologies to address both biological and psychosocial factors. By integrating modern medical treatment with traditional pharmacological interventions, we can enhance the quality of life for perimenopausal women and ensure they receive appropriate holistic care. This review lays the groundwork for refining the clinical practice and public health strategies aimed at managing the mental health of perimenopausal women. Addressing this issue with a multifaceted approach will ultimately enhance both immediate and long-term health outcomes for women globally.
Footnotes
Provenance and peer review: Invited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: South Korea
Peer-review report’s classification
Scientific Quality: Grade B, Grade C, Grade C
Novelty: Grade B, Grade B, Grade C
Creativity or Innovation: Grade B, Grade B, Grade B
Scientific Significance: Grade B, Grade B, Grade C
P-Reviewer: Chen IH; Ewers A; Karanović J S-Editor: Bai Y L-Editor: A P-Editor: Yu HG
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