A specific sex hormone can serve as a biological marker of how well women in perimenopause are able to cope with personal challenges, a new study suggests. 

Published Feb. 26 in Psychoneuroendocrinology, the study by the University of Zurich researchers examined women's psychological health during perimenopause, a natural transition to menopause during which major biophysical changes occur. Progesterone could affect the well-being and mental health of women who are undergoing this transition, the authors concluded.

"We think it's an important phase for women, but there isn't much research about health during this transition phase," said first study author Hannah Süss, a clinical psychologist at the Psychiatric University Hospital Zurich. "I think it's very much a taboo, still."

The research builds on some previous studies, including several from Süss and colleagues, among others, by highlighting progesterone as a resilience marker that could ultimately lead to new hormonal treatments. About 1.3 million women in the U.S. become menopausal each year, and treating moderate to severe symptoms experienced by some can cost millions of dollars annually.

Representing a physiological transition from reproductive to non-reproductive life in women, perimenopause has been associated with several psychosocial changes affecting well-being and mental health.

The study focused on psychosocial health, or resilience, and associated risk factors in perimenopausal women. Researchers performed their analyses within the context of how a 2020 article defined the term psychosocial resilience: How people cope with personal challenges during their lifetime, as well as how they regain, maintain or improve their well-being and mental health.

Süss pointed to psychosocial changes during this life phase in stressing the importance of the role of resilience. One example relates to the so-called empty nest syndrome, where mothers' and fathers' roles change such that they have to reorient themselves after their last child leaves home.

There is a gradual decline in ovarian function that occurs in women during their transition from regular menstruation to the complete absence of menstruation. Estradiol and progesterone, in particular, have been thought to decrease significantly during perimenopause, Süss noted.

For the study, researchers collected saliva samples every fourth day over the course of four weeks from 129 perimenopausal women between 40 and 56 years old, examining the extent to which declining levels of the hormones estradiol and progesterone can serve as resilience markers.

"We found that changes of estradiol were responsible for depressive symptoms," Süss said.

But in contrast with other research, the team did not find an association between psychosocial resilience and estradiol in perimenopausal women. Progesterone, on the other hand, can reportedly be considered as such a resilience biomarker. This so-called "pregnancy hormone" also helps to establish a pregnancy in the uterus and to maintain a healthy pregnancy.

"There were no previous studies about resilience and progesterone," Süss said, underscoring the importance of having a biomarker for the life phase.

The results indicated that progesterone is linked to psychosocial resilience because women who had higher progesterone levels were seemingly more resilient than women with lower progesterone levels, regardless of the woman's perimenopausal status. Women in the study who had higher progesterone levels reported having higher life satisfaction, less perceived stress and fewer symptoms of depression than those with lower progesterone levels, as further analyses revealed.

"The problem we see during perimenopause is that there is a lot of loss of control for women," Süss said, citing hot flashes, night sweats and sleep disturbances as some examples that "represent a lot of control loss during this time." The study offered hope in that its results indicate that, "Women can monitor progesterone levels to regain some of this control," she added. 

But Süss noted that developing new treatments with an ideal balance of progesterone is a challenge because, "You have to find this exact balance [of progesterone], and this is quite difficult."

"Whether there is too much progesterone or not, either way, it will lead to poor outcomes for the patients," she said.

To support further research into the potential role of resilience in perimenopause, Süss suggested interventional studies that could include a training program to enhance factors such as optimism, emotional stability and self-esteem. The research could help uncover new and targeted approaches to hormonal contraceptives or hormone therapy, she said. 

The study, "Estradiol and progesterone as resilience markers? – Findings from the Swiss Perimenopause Study," published Feb. 26 in Psychoneuroendocrinology, was authored by Hannah Süss, Jasmine Willi, Jessica Grub and Ulrike Ehlert, University of Zurich.