Can menopause hormone therapy really help with mental health?

How menopause messes with your mood

When you reach perimenopause and menopause, your levels of estrogen, progesterone, and other hormones fluctuate sporadically, Dr. Bernstein says. They’re ultimately on a downward trajectory, but on the way there, they go up and down, she explains. And many neurotransmitters that impact your mood and emotions (like serotonin, dopamine, and GABA) are affected by estrogen and/or progesterone.

“These different neurotransmitters and receptor systems are critical for mood regulation, managing anxiety, and promoting sleep,” Dr. Bernstein says. They’re also the same ones involved with depression and anxiety, she adds. “So not having steady levels of the hormones that influence those systems can throw things off.”

This is why some people who have never experienced anxiety, depression, or mood swings feel off during perimenopause, Dr. Bernstein explains. It may also explain why people with a history of mental health conditions are at an increased risk of mood or mental health symptoms during perimenopause. Interestingly, one study found that the faster women went from perimenopause to menopause, the lower their risk of depression, possibly because their ovarian hormone levels stabilized more quickly.

Neurotransmitters aside, the physical symptoms of menopause can also do a number on your mood. A 2023 systematic review found that hot flashes and night sweats were a major risk factor for depression and anxiety during menopause. While researchers aren’t positive why, it could simply be that these debilitating symptoms can interfere with your sleep, your work, and your social life, which can all impact your mental wellbeing, says Yokarla Veras, M.D., a reproductive and general psychiatrist and instructor of clinical psychiatry at Columbia University.

There’s also evidence that estrogen fluctuations can mess with your memory and cognitive functions (see: brain fog) since there are estrogen receptors in the areas of the brain responsible for those tasks.

What exactly is menopause hormone therapy?

What used to be called hormone replacement therapy (HRT) was first approved by the Food and Drug Administration (FDA) to treat menopause symptoms in the early 1940s, per a paper in the American Journal of Medicine.

Back then, doctors were prescribing doses of estrogen-based medications that were much higher than ones today, Dr. Veras says. Hormone therapy was viewed more literally as a “replacement,” with the goal of restoring estrogen to levels seen in premenopausal women. Today, for women going through perimenopause or menopause, the goal of hormone therapy for women going through perimenopause or menopause is generally to use the lowest effective dose needed to treat symptoms, rather than trying to restore hormones to the levels of a premenopausal woman.

That may be why many researchers, healthcare professionals, and medical organizations (like the Menopause Society and the Endocrine Society) stopped calling it hormone replacement therapy and prefer the term “menopause hormone therapy,” Dr. Veras says.

Here’s how it works: We have estrogen and progesterone receptors in almost every organ, including the brain, bones, and cardiovascular system, Dr. Veras says. When those hormones start to decline in perimenopause, it can cause a number of symptoms involving those organs. Hormone therapy containing estrogen, progestogen (progesterone-like hormones), or a combination of both can help regulate those systems by providing the organs with the hormones they are no longer receiving consistently—or at all—during perimenopause and menopause.

Here’s a breakdown of the different types of hormone therapy available with a prescription, per the FDA and Dr. Veras.

Systemic hormone therapy

Systemic therapy means it’s designed to reach organs throughout your whole body, Dr. Veras says. It can come in the form of pills, patches, sprays, gels, or vaginal rings. Systemic hormone therapy can contain both estrogen and progestogen or just one or the other.

While hormone therapy pills might sound similar to birth control pills, the doses used are generally much lower, and the types of estrogen and progestogen used may also be different, Dr. Veras says.

Low-dose topical hormone therapy

Topical therapies—like estrogen-containing vaginal rings, creams, or sprays—contain a much lower dose of hormones than systemic medications. This way, the hormones are concentrated to the area you need them, Dr. Veras says. This is especially helpful for symptoms that affect the vaginal and urinary systems in perimenopause and menopause.

What the research says on hormone therapy and mental health

While the evidence on this is limited, there is some data suggesting that MHT can help with certain mental health symptoms. Here’s what the research says:

It’s possible MHT can help with depressive symptoms.

In one study using data collected from a menopause clinic in the U.K., people who used MHT in perimenopause and menopause reported an improvement in mood and depression after about three and a half months. That said, the study didn’t have a control group to compare these results to. Also, the women didn’t use the same kind of MHT, some were also on antidepressants, and some were using MHT before the study began.

In a more recent meta-analysis of 12 randomized controlled trials, researchers only found a small, “modest” improvement in the depressive symptoms of perimenopausal women using MHT compared to those who took a placebo.

Combining hormone therapy with antidepressants may be a more effective treatment for depression during menopause.

Though there isn’t a ton of data here either, a 2022 review of the research reported that estrogen-based MHT paired with a selective serotonin re-uptake inhibitor (SSRI) could be more effective than MHT or antidepressants alone for postmenopausal women. But, again, this is only based on a couple of studies.

Starting hormone therapy early may help prevent depressive symptoms.

One randomized clinical trial found that perimenopausal and early post-menopausal women who used the estrogen skin patch and progesterone therapies for a year were less likely to develop depressive symptoms than those taking a placebo.

People with physical symptoms of menopause may see the biggest benefit.

MHT is approved by the FDA to treat physical perimenopause symptoms like hot flashes and night sweats. While it’s not an FDA-approved treatment method for depression or mood changes that happen around the same time, a 2020 review of the research found that the clearest indication seems to be for people experiencing depression alongside the physical symptoms of perimenopause.

It’s definitely possible that reducing the physical symptoms of perimenopause could improve your overall mood, sleep, and, as a result, improve brain fog too, says Erika Banks, M.D., chair of the Department of Obstetrics and Gynecology at New York University Langone Hospital. This is something she’s seen happen with patients before.

MHT may also help you sleep better.

One area where there is a bit more research is the connection between hormones and sleep. In a 2022 systematic review of the research on the relationship between perimenopause, MHT, and sleep quality, researchers concluded that MHT was associated with fewer sleep disturbances overall.

It’s true that some of this could be because having fewer hot flashes and night sweats helps you sleep through the night. But the study authors also write that the brain systems responsible for helping you fall asleep and stay asleep have estrogen and progesterone receptors, which might mean that fluctuating hormone levels could mess with how they function. So, it’s possible MHT may mitigate that.

Who shouldn’t use menopause hormone therapy?

Despite the recent hype, there are plenty of reasons you shouldn’t use MHT to treat mental health or mood symptoms. For starters, your symptoms could be completely unrelated to menopause.

Dr. Veras says she sees a lot of patients who are going through a divorce, caring for kids and aging parents at the same time, and facing new health challenges. All of these, plus the stress of aging in general, can have an impact on your mental health.

As a psychiatrist who prescribes mental health medications and MHT, the first thing Dr. Veras does is assess the patient’s mental health symptoms. She takes a detailed history to find out whether they meet the criteria for a mental health condition like major depressive disorder. If that’s the case, she may prescribe a mental health medication, like an SSRI, instead. And, interestingly, research suggests that certain antidepressants—including citalopram (Celexa), escitalopram (Lexapro), and venlafaxine (Effexor)—can help reduce hot flashes and night sweats. “They’re not as effective as hormones for hot flashes, but they may help,” Dr. Banks says.

It’s also possible that treating sleep issues can resolve your mental health challenges without MHT. Oftentimes, Dr. Bernstein sees patients in their forties and fifties who come in because they’re having trouble falling asleep, staying asleep, or waking up too early. But if they’re not feeling sweaty or hot in the middle of the night, she’ll try to address the sleep problems with other medications before referring them out for hormone therapy.

A history of being sensitive to hormonal medications like birth control is important to consider when starting MHT, Dr. Veras says. For example, if different birth control formulations consistently made you feel more depressed or anxious, your doctor may want to approach MHT with caution and monitor you closely. However, since the types and doses of hormones used can differ in these two kinds of medications, having mood-related side effects from birth control does not necessarily mean you will have the same response to MHT.

The same is true if you’ve experienced hormone-related mental health conditions in the past, like premenstrual dysphoric disorder or postpartum depression. “In those cases where a patient has had symptoms severe enough to meet the criteria for a mental health condition, I’m more inclined to prescribe a psychiatric medication,” she explains.

There are also risks associated with hormone therapy, with studies suggesting that the dose and type of MHT can influence the risk of adverse side effects. But, in general, MHT isn’t recommended for people who have the following medical histories or risk factors, Dr. Banks says:

• Undiagnosed vaginal bleeding
• Currently undergoing treatment for breast cancer
• Current or recent blood clots
• A recent heart attack

Your doctor might also proceed with caution if you’re over 60, which may also increase your risk of damaging health effects. Same goes for if you’ve had ovarian cancer, have gallbladder disease, or have high blood pressure, according to a 2025 review of the research.

How to know if hormone therapy or mental health medications are right for you

The best way to tell whether MHT or mental health medications make sense for you is to talk to your doctor, Dr. Veras says. They can help you better understand what’s going on and what your options are based on your specific medical history and symptoms.

Overall, MHT is most effective for treating the physical symptoms of menopause, Dr. Banks explains. So if hot flashes, night sweats, and insomnia are impacting your mood or you began experiencing mental health changes at the same time as those symptoms, it could be worth talking to your doctor about MHT, she adds.

It’s also possible you might benefit from taking both, Dr. Bernstein says, and there are generally no contraindications between mental health medications and MHT.

Whether you end up using MHT or not, working with a mental health professional can also help you manage this season of your life, says Tori Lyn Mills, a licensed clinical professional counselor at Thriveworks. “We talk about how you can accept what’s going on in your body and how you can nurture yourself through this as you’re experiencing it.”

The bottom line

While there is some research showing MHT may help with mental health changes during menopause, the evidence isn’t as clear as it is for treating physical symptoms.

However, if you’re experiencing new or worsening mental health symptoms around the same time that your periods become less frequent, and you’re dealing with the physical symptoms of menopause like hot flashes, night sweats, and painful sex, it may be worth talking to your doctor about MHT. While it’s not a substitute for mental health care, MHT may make this phase of life a little easier to manage.