From the Guidelines
Hormone replacement therapy (HRT) can effectively help with postmenopausal mood swings and anxiety symptoms. For many women, estrogen therapy helps stabilize mood by addressing the hormonal fluctuations that contribute to emotional symptoms during menopause. Common HRT options include oral estradiol (typically 0.5-1mg daily), estradiol patches (0.025-0.1mg, changed twice weekly), or estradiol gel (0.5-1.5mg daily). Women with an intact uterus must also take progesterone (such as micronized progesterone 100-200mg daily or cyclically) to protect the uterine lining. Treatment duration should be individualized, but starting with a 3-6 month trial period is reasonable to assess benefits. HRT works by restoring declining hormone levels, particularly estrogen, which affects neurotransmitters like serotonin that regulate mood. The brain has numerous estrogen receptors, and when estrogen levels drop during menopause, these mood-regulating systems can become disrupted. While HRT can significantly improve quality of life for many women, it's not suitable for everyone, particularly those with certain types of cancer, liver disease, or history of blood clots. A healthcare provider should evaluate individual risk factors before starting treatment, as noted in the USPSTF recommendations 1.
Some key points to consider when evaluating the use of HRT for postmenopausal mood and anxiety symptoms include:
- The benefits and harms of HRT vary depending on the specific hormone regimen and individual patient factors 1.
- Estrogen therapy has been shown to increase bone density and reduce the risk of fractures, but it also increases the risk of breast cancer, venous thromboembolism, and coronary heart disease 1.
- The use of HRT for relieving active symptoms of menopause, such as hot flashes, urogenital symptoms, and mood and sleep disturbances, is outside the scope of the USPSTF recommendations, and literature on this topic was not reviewed 1.
- The USPSTF recommends against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women, citing fair to good evidence of both benefits and harms 1.
Overall, while HRT can be an effective treatment for postmenopausal mood and anxiety symptoms, it is essential to carefully evaluate individual patient factors and weigh the potential benefits and harms before initiating treatment.
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 potential role in managing long-term sequelae 4.
HRT and Mood/Anxiety Symptoms
- One study evaluated the effects of HRT alone and in combination with a selective serotonin reuptake inhibitor on mood, cognition, and neuroendocrine parameters in peri- and postmenopausal women, finding that HRT did not enhance the effect of antidepressant alone on mood ratings 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, which may indirectly improve mood and anxiety 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 patient's age, time since menopause, and comorbidity status 2, 6.
- The goal of therapy is to use the lowest dose for the shortest time that effectively manages symptoms, and the patient and physician should regularly assess the risks and benefits associated with HRT 6.