From the Guidelines
Hormone replacement therapy (HRT) is not recommended for patients experiencing mood symptoms during perimenopause with normal hormone levels, due to the potential risks outweighing the benefits, as indicated by the US Preventive Services Task Force recommendations 1. When considering treatment for perimenopausal women with mood symptoms, it is essential to weigh the potential benefits against the risks. The most recent and highest quality study, published in 2017, suggests that menopausal hormone therapy (MHT) can be used in female cancer survivors, but alternatives should be tried first, and patients should be referred to a specialist for dosing and management 1. Some key points to consider when evaluating the use of HRT for mood symptoms in perimenopausal women include:
- The therapeutic effect of estrogen on mood regulation, as it modulates serotonin, dopamine, and norepinephrine systems in the brain
- The potential risks associated with HRT, including increased risk of stroke, pulmonary embolism, and invasive breast cancer
- The importance of individualizing treatment duration and using the lowest dose possible to control symptoms
- The need to evaluate contraindications, such as history of breast cancer, coronary heart disease, or previous venous thromboembolism, before initiating HRT
- The consideration of alternative treatments, such as lifestyle modifications, stress management, and selective serotonin reuptake inhibitors (SSRIs) for more severe symptoms. In general, the decision to use HRT for mood symptoms in perimenopausal women should be made on a case-by-case basis, taking into account the individual patient's risks and benefits, and using the most recent and highest quality evidence available 1.
From the Research
Hormone Replacement Therapy for Perimenopausal Mood Symptoms
- Hormone replacement therapy (HRT) may be effective in alleviating menopause-related depressive symptoms, particularly in perimenopausal women 2.
- Estrogen therapy has been consistently reported to improve mood in perimenopausal women, although its efficacy for overt depression or during postmenopause is more questionable 2.
- The progestogenic component in combined hormone therapy may counteract the beneficial influence of estrogens on mood and even induce negative mood symptoms 2.
Considerations for HRT in Perimenopausal Women
- HRT may be considered for perimenopausal women experiencing mood symptoms, despite having normal hormone levels, as it may contribute to alleviating menopause-related depressive symptoms 2, 3.
- The administration of HRT should be individualized and followed across time, taking into account the woman's medical history and risk-benefit balance 4.
- In cases of more severe depressive conditions, a combination of antidepressant and hormone therapy may be effective 2, 5.