Menopause is a stage of life no one prepares you for. It affects both the body and the mind—in ways you might not expect. 

Mental health-related menopausal symptoms aren’t something to just push through. They’re worth discussing with a doctor. As one intervention, your doctor may recommend hormone replacement therapy (HRT). HRT isn’t a first-line mental health intervention, but for many people, it serves as one support layer within a broader care plan. 

Here’s a guide to what the evidence says about the relationship between HRT and mental health, plus how you might benefit. 

The link between hormonal changes and mental health

Across the menopause transition, the changes to your hormonal environment can take a toll, both on the body and mind. For example, estrogen regulates serotonin levels in the body, allowing more of this feel-good neurotransmitter to remain available for use. And progesterone naturally converts into allopregnanolone, which enhances GABA-A receptor activity. GABA is a neurotransmitter involved in calming the nervous system. 

When these hormones fluctuate and decline, these systems can’t maintain your mood in the same way. In some individuals, this can trigger or worsen mental health-related symptoms of menopause, including: 

• Low mood
• Depression
• Anxiety
• Irritability
• Mood swings
• Reduced motivation
• Brain fog
• Trouble sleeping

Menopause-driven hormonal changes also influence mental health indirectly. For instance, over 40% of menopausal women have trouble sleeping, and sleep quality and mental health are closely linked. 

How can HRT help with mental health during menopause?

According to The North American Menopause Society, HRT is highly effective in managing common menopause symptoms. It works by supplementing the hormones that naturally fluctuate and decline during the menopause transition. 

The hormones you receive depends on the type of HRT:

• Estrogen-only therapy (ET) contains estrogen alone. Doctors prescribe ET for women who’ve had their uterus removed. That’s because estrogen alone can thicken the uterine lining (endometrial hyperplasia) and cause endometrial cancer. 
• Combined estrogen-progesterone therapy (EPT) contains both estrogen and progesterone. Part of progesterone’s role is to protect the uterine lining from the effects of unopposed estrogen. 

HRT may supplement other hormones, like testosterone. Your doctor will work with you to determine what you need. But by helping restore the hormonal environment, these interventions support positive mental health outcomes in some individuals. 

Let’s unpack the research behind HRT and mental health during menopause.

Mood swings, irritability, and rage 

Mood changes in menopause are totally normal. According to Obstetrics and Gynecology Clinics of North America, mood instability is a particularly common perimenopausal experience but can extend further into postmenopause. And a Journal of Women's Health report found that up to 70% of perimenopausal women experience irritability, which they define as “a proneness to anger, annoyance, or impatience.” Hormonal fluctuations may be a key driver. Some days can feel more emotionally unpredictable than others.

An observational study published in BJPsych Open looked at this effect. Researchers surveyed 978 perimenopausal and postmenopausal women starting HRT. These women reported many mood-related symptoms. Irritability, for example, affected 90% of the group. Following three months of HRT, mood-related symptoms saw meaningful improvements. 

Depression

Over 30% of women experience depression during menopause. Although HRT isn’t a first-line intervention for depressive symptoms, it can ease depression symptoms in part because estrogen regulates serotonin and supports sleep. 

In a study published in Archives of General Psychiatry, researchers gave 50 perimenopausal women with depression either HRT (an estrogen patch) or a placebo for 12 weeks. Depression outcomes were meaningful. For 68% of those on HRT, depression went into remission. This is compared to 20% on placebo. 

Anxiety

Anxiety and menopause often go hand-in-hand. Sometimes, hormonal changes are a key driver. Other times, they sit on top of anxiety that’s already present. 

Research on HRT for anxiety is mixed, but a four-year study in PLOS Medicine offers a positive signal. Researchers split 693 recently postmenopausal women into three randomized treatment groups: oral estrogen, transdermal estrogen, or placebo. Those on oral estrogen showed improvements in mood, which included measures of anxiety. 

Those on transdermal estrogen didn’t experience the same benefit. This is a reminder that treatment characteristics (like formulation and delivery method) influence outcomes. 

Insomnia

When sleep suffers, mental health challenges can follow. Poor sleep often happens because of vasomotor symptoms, like night sweats and hot flashes. Estrogen acts on parts of the brain that regulate internal body temperature. When estrogen levels fluctuate and decline, this system becomes less reliable. The body then triggers symptoms like night sweats.

You’re not alone in losing sleep during menopause. Over 80% of menopausal women share this experience. 

A systematic review and meta-analysis in Endocrine pooled data from randomized trials examining HRT and sleep. It found that HRT improved sleep quality in women with vasomotor symptoms, compared with placebo.

Other ways to support your mental health during menopause

Menopause care plans typically involve more than one approach to mental health. Lifestyle adjustments like these can also help:

• Exercise regularly: Movement is a reliable way to boost your mood. According to a JAMA Psychiatry study, walking for one hour a day or running for just 15 minutes a day decreased the risk of developing depression by 26%.
• Eat intentionally: Research shows eating more fruits and vegetables and avoiding highly processed foods might lessen depressive symptoms. A Mediterranean diet (a fish- and plant-forward diet) could be a good fit, as it’s associated with positive mental health outcomes. A nutritionist can guide you on the right dietary path for your needs.
• Improve sleep hygiene: Although much can get in the way of your sleep during menopause, proactive management helps. This can include limiting caffeine intake eight hours before bed and keeping your bedroom between 60–67 degrees.

Lifestyle adjustments matter because menopause care isn’t about prescribing a single solution for a single symptom. It’s about looking at your full health picture and learning what’s going on beneath the surface. 

Navigating menopause and mental health with Maven Clinic

Your health profile is unique. Treating your menopausal journey symptom by symptom doesn’t get to the root of the problem. At Maven Clinic, our specialists connect the dots between your symptoms and what’s actually driving them. 

Maven Clinic’s whole-person, personalized care supports sustainable outcomes. Want to learn more? Discover our approach to hormone care. 

FAQ

Do doctors prescribe hormone replacement therapy for depression?

HRT isn’t FDA-approved for treating depression. Doctors may prescribe it off-label for this purpose, but it isn’t a first-line intervention. 

How long does it take for HRT to improve mood swings?

On average, patients notice symptom relief within three months of treatment. But timing varies between individuals. 

Should I take antidepressants or HRT for menopause-related depression?

If appropriate, antidepressants (like SSRIs) and HRT both can be part of the same care plan. Your doctor will determine which makes sense for you.

How much does HRT cost without insurance?

Out-of-pocket costs vary depending on the specifics of your treatment. Prices can range from around $10 to hundreds or even thousands without insurance. But some manufacturers offer coupons, and you may qualify for patient assistance programs. 

What is the best HRT for perimenopause anxiety?

There’s no universal option, so talk to your doctor. The right choice depends on your unique health profile. 

Why is HRT making me depressed?

If HRT is affecting your mood, the causes can vary. Sometimes, depressive symptoms can stem from natural menopausal hormonal fluctuations, not HRT. Other times, HRT may be acting on the body in a way that promotes depressive symptoms. For example, researchers associate progesterone sensitivity (commonly part of HRT formulations) with increased risk of depressive symptoms in some individuals. 

Can HRT cause mental health issues?

When prescribed appropriately, HRT typically promotes positive mental health outcomes, but experiences vary. If you’re on HRT and notice that your mental well-being is getting worse, speak with your doctor.