Does hormone therapy improve mood during menopause?
It may. Among 260 women who started hormone therapy at a New York menopause center, the share with severe mood symptoms fell from 62.3% to 24.6% after an average of four and a half months. That is roughly 38 fewer women out of every 100 with severe symptoms. Every woman in the study took hormones, so there was no untreated group to compare against, and the result shows a link rather than proof.
Depressed mood, irritability, anxiety, and mental exhaustion are common in the menopause transition, affecting up to 68% of women, according to the researchers. Hormone therapy is FDA-approved for hot flashes and night sweats, along with vaginal and urinary symptoms. Its role in treating mood is much less well understood.
A team at NYU Langone Health, publishing in the journal Menopause, reviewed records for 260 women seen at an urban academic menopause center between 2023 and 2025. None had used hormone therapy before, and all of them started it for one of its FDA-approved uses.
What the data show
The researchers used the Menopause Rating Scale, a standard questionnaire about menopause symptoms. Its psychological section covers four symptoms: depressed mood, irritability, anxiety, and mental exhaustion. Each woman filled it out before starting hormone therapy and again at follow-up, an average of 4.5 months later.
Scores on that mood section dropped significantly, with less than a 1 in 1,000 chance that a drop this size was a coincidence (P<0.001). Before treatment, 62.3% of the women scored 7 or higher, the cutoff the researchers used for severe mood symptoms. At follow-up, 24.6% did. That is an absolute drop of about 38 percentage points, or a relative drop of about 60%.
The women who started out worst improved the most. Among those with severe symptoms at the start, the mood score fell by an average of 3.85 points.
Who improved
This was not a group of women free of mental health history. About half (51%) had a history of anxiety or depression, and 24% were already taking an antidepressant when they began hormone therapy. Their response to treatment was no different from that of the other women. Age and menopause stage did not change the response either.
The women averaged 52.1 years old, and 96.5% of them used transdermal estradiol, a form of estrogen absorbed through the skin. So these results mostly describe that one form of treatment, in women with a wide range of mental health backgrounds.
Dr. Kumar’s Take
Mood symptoms around menopause often get pushed into one of two boxes. Either they are brushed off as “just hormones,” or they are treated purely as a psychiatric problem while the hormonal change is ignored. This study suggests the two overlap more than either view allows. After women started estradiol, severe mood symptoms became far less common, and that was just as true for women with a history of depression or anxiety.
Still, this is a look back at clinic records, not a trial. Every woman got hormone therapy, so there is no way to separate the effect of the hormones from the passage of time, the hope that comes with starting a new treatment, or the extra attention of being seen at a specialty center. These women also started treatment for approved reasons like hot flashes, and the study cannot tell us whether mood lifted directly or because those other symptoms eased. It is a strong reason to run a proper randomized trial, not a settled answer.
How strong is the evidence?
The drop in severe symptoms was large, not borderline, and it was measured with a standard questionnaire rather than an informal impression. The weaknesses are just as clear. The study was retrospective, meaning researchers reviewed records after the fact rather than setting up an experiment in advance. It came from one urban academic center, so the women may not reflect the general population. Follow-up averaged only 4.5 months, which says nothing about whether the benefit lasts. And only women who completed the questionnaire both before and after starting treatment were included, so anyone who stopped treatment or never came back is not part of these numbers.
Practical Takeaways
- If your mood has shifted around menopause, raise it with your doctor along with any hot flashes or other symptoms, since mood improved in this study when hormone therapy was started for those approved reasons.
- A history of depression or anxiety, or current antidepressant use, did not change how well women responded here, so neither one alone should end a conversation about hormone therapy.
- Do not stop an antidepressant on your own after starting hormone therapy, because this study looked at adding hormones, not swapping one treatment for the other.
- This study measured mood, not safety, so weigh the risks and benefits of hormone therapy with your doctor.
Related Studies and Research
- Why perimenopause triggers first-time depression in healthy women explores why the years before menopause can bring on mood problems for the first time.
- Women’s Health Initiative: what 20 years of follow-up really shows about HRT and breast cancer covers the long-term breast cancer data that belongs in any hormone therapy decision.
- Real-world brexanolone outcomes: 12-month follow-up shows sustained benefits looks at a treatment for depression after childbirth, another time of major hormonal change.
- Light therapy for dementia: meta-analysis shows benefits for sleep, depression, and cognition reviews a non-drug approach to mood and sleep in people with dementia.
FAQs
Is hormone therapy FDA-approved to treat menopause depression?
No. Hormone therapy is FDA-approved for hot flashes and night sweats, along with vaginal and urinary symptoms of menopause. The women in this study all started it for those approved reasons, and their mood was tracked along the way. So the mood benefit seen here came from treatment given for something else. Depression that is severe or lasting still needs its own evaluation, whether or not hormones are part of the plan.
How long does it take for hormone therapy to help menopause mood symptoms?
In this study, women were rechecked an average of 4.5 months after starting hormone therapy, and by then the share with severe mood symptoms had dropped from 62.3% to 24.6%. That shows a meaningful change within a few months. Whether the improvement holds over a year or longer is still an open question, because follow-up was short. Keeping a simple record of mood alongside other symptoms during the first several months can make a follow-up visit more useful.
Does age or menopause stage change how hormone therapy affects mood?
Not in this study. The response did not differ by age or by menopause stage, and the women averaged 52.1 years old. That suggests the mood benefit was not limited to one narrow window, such as the years just before the final period. Age and timing still matter for other parts of the hormone therapy decision, including its risks, and those deserve a separate conversation with your doctor.
Bottom Line
In 260 women starting hormone therapy at a New York menopause center, severe mood symptoms fell from about 62 in 100 women to about 25 in 100 after an average of four and a half months. The benefit was the same regardless of psychiatric history, antidepressant use, age, or menopause stage. Without an untreated comparison group, this cannot prove the hormones caused the change, but it is a solid reason to take mood seriously in menopause care and to test hormone therapy for mood in a randomized trial.
