Hormone Therapy Eases Severe Menopause Mood Symptoms
An observational study found menopausal hormone therapy significantly improved psychological symptoms like depression and anxiety, with severe symptoms
A new study suggests systemic hormone therapy for menopause can significantly improve psychological symptoms like depressive mood, irritability, anxiety, and mental exhaustion. The research, led by Dr. Samantha Fairweather of NYU Grossman School of Medicine, found the proportion of patients with severe mood symptoms dropped sharply after starting treatment.
At a mean follow-up of 4.5 months, women starting hormone therapy showed significantly improved scores on the psychological subdomain of the Menopause Rating Scale. The mean difference was -2.7. Those who began with severe psychological symptoms saw the greatest improvement, with a mean change of -3.85, compared to smaller changes for those with mild or moderate symptoms.
Symptom Severity Before and After
The study's data shows a dramatic shift in the severity of mood symptoms among participants after initiating hormone therapy.
| Symptom Severity | Baseline | Follow-up (4.5 months) |
|---|---|---|
| Severe Mood Symptoms | 62.3% | 24.6% |
Sleep scores also improved significantly, with a mean difference of -1.0. Subgroup analyses found no significant differences in psychological improvements based on antidepressant use, history of anxiety or depression, menopause stage, race, or age.
The Current Treatment Landscape
Menopausal hormone therapy, consisting of systemic estrogen with progestogen, is FDA-approved for treating vasomotor symptoms, genitourinary syndrome of menopause, and osteoporosis prevention. However, it is not FDA-approved for treating mood-related symptoms. Dr. Fairweather's team noted there is no current consensus on standardized screening or treatment protocols for mood disturbances during the menopause transition.
An estimated 60% to 86% of women report symptoms severe enough to seek medical care during the menopause transition. The study authors suggest a biochemical link may explain the improvements. "Low estrogen status has been linked to metabolic and functional changes in brain structure and activity, while estrogen repletion has been associated with improved cortical blood flow, normalized activation patterns, and partial reversal of serotonin imbalance," they wrote.
Expert Commentary and Study Details
Dr. JoAnn E. Manson of Harvard Medical School, a past president of the Menopause Society, told MedPage Today that recent randomized trials "have confirmed favorable effects" on mood with hormone therapy. She called the new study important for generating hypotheses but cautioned that its observational nature precludes cause-and-effect conclusions. "We need additional randomized trial research on the effects of different formulations of hormone therapy on mood and other mental health outcomes," Manson said.
The single-center retrospective cohort study included 260 perimenopausal or postmenopausal patients who presented at NYU Langone from January 2023 to April 2025. Most patients were between 40 and 59 years old, with a mean age of 52.1. A majority were white and received transdermal estradiol. About half had a history of anxiety or depression, and a quarter were on antidepressant therapy at baseline.
Women completed the Menopause Rating Scale before and after initiating systemic hormone therapy for FDA-approved indications. The authors acknowledged limitations, including the study's observational design, lack of a placebo control, and a participant pool that was mostly commercially insured and used one type of estradiol, which may limit how widely the results can be applied.
The findings were published in the journal Menopause.
