From the Guidelines
Hormone replacement therapy (HRT) can be an effective treatment for postmenopausal mood swings and anxiety symptoms in many women. The most common HRT options include estrogen-only therapy (typically estradiol in 0.5-1mg oral doses, 0.025-0.1mg patches, or 0.5-1mg gel) for women without a uterus, or combined estrogen-progestogen therapy (adding progesterone 100-200mg daily or medroxyprogesterone acetate 2.5-5mg daily) for women with a uterus to protect against endometrial cancer. These hormonal fluctuations during menopause can significantly impact neurotransmitters like serotonin and norepinephrine that regulate mood. By restoring hormone levels, HRT can stabilize these neurotransmitter systems, potentially reducing anxiety, irritability, and mood disturbances.
Some key points to consider when using HRT for postmenopausal mood and anxiety symptoms include:
- Starting treatment at the lowest effective dose and continuing as needed for symptom relief, with regular monitoring recommended 1
- Being aware of potential side effects, including breast tenderness, bloating, or headaches 1
- Considering the potential risks and benefits of HRT, including the increased risk of breast cancer, venous thromboembolism, and coronary heart disease 1
- Combining HRT with traditional psychiatric treatments like antidepressants or therapy for optimal results in women with severe mood disorders 1
It's essential to weigh the benefits and harms of HRT and discuss individual risk factors and preferences with a clinician to determine the best course of treatment for postmenopausal mood and anxiety symptoms 1.
From the Research
Hormone Replacement Therapy (HRT) and Postmenopausal Symptoms
- HRT is an effective treatment for menopausal symptoms, including vasomotor symptoms and genitourinary syndrome of menopause 2.
- Research shows that HRT can help some postmenopausal women with selected comorbid conditions such as osteoporosis, type II diabetes, certain cardiovascular pathologies, and colorectal cancer 3.
- The benefits of HRT in improving the symptoms of menopause are well-documented, and it may also have a role in managing long-term sequelae 4.
HRT and Mood/Anxiety Symptoms
- While the provided studies do not directly address the impact of HRT on postmenopausal mood and anxiety symptoms, some studies suggest that HRT can improve quality of life and possibly longevity for selected women 3.
- Selective serotonin reuptake inhibitors (paroxetine and fluoxetine) and selective noradrenaline reuptake inhibitors (venlafaxine) have been shown to reduce vasomotor symptoms and improve depression, anxiety, and sleep in postmenopausal women 5.
- Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms, and benefits include decreased risk of osteoporotic fractures and vaginal atrophy, improved glycemic control, and decreased vasomotor symptoms 6.
Considerations for HRT Use
- The decision to start HRT should be made on an individual basis after a thorough evaluation and counseling, taking into account the potential risks and benefits 2, 6.
- The goal of therapy is to use the lowest dose for the shortest time that effectively manages symptoms, and patients and physicians should regularly assess the risks and benefits associated with HRT 6.