Imagine navigating the turbulent waters of menopause, where hot flashes aren't your only worry—mood swings, anxiety, and depression can feel like unwelcome companions on this life stage journey. But what if a simple hormone therapy could be the lifeline you need? Hold onto that thought, because a recent deep dive into the research reveals that estrogen therapy's impact on mental health is far from straightforward, and it's sparking debates we can't ignore.
Let's break this down together, like we're chatting over coffee about something that affects millions of women. We're talking about estrogen-based hormone therapy and its rollercoaster effects on anxiety and depression during midlife. A couple of systematic reviews, shared at The Menopause Society’s 2025 Annual Meeting in Orlando, Florida, uncovered that this treatment doesn't reliably ease these mental health hurdles for women in perimenopause or postmenopause. Perimenopause, for beginners, is that phase right before menopause when periods become irregular and symptoms start ramping up—think of it as the prelude to the final curtain on menstrual cycles.
Here's what stands out as the key takeaways from these findings:
- Estrogen therapy didn't consistently lower anxiety or depression levels in women going through perimenopause or postmenopause.
- Some women did see modest improvements, especially those who were symptomatic and within a few years of their last period, with oral forms of estrogen showing the most promise in limited cases.
- The response to treatment can differ greatly based on where a woman is in her menopause journey, how severe her symptoms are, and how she's taking the therapy—whether by mouth or through the skin—highlighting why personalized approaches are crucial.
Anxiety and depression rank high among the emotional challenges women face during the menopause transition. These issues often tie back to the ups and downs of hormones, but just how much estrogen therapy can help remains a puzzle. The two systematic reviews, one from McMaster University and the other from the University of Toronto, analyzed data from studies on midlife women, showing that the effects of estrogen-based treatments on anxiety and mood are inconsistent at best.1,2
To give you a clearer picture, let's peek behind the scenes of these studies. One review zeroed in on anxiety, pulling together seven studies that included everything from rigorous randomized controlled trials to observational studies. They looked at estrogen delivered orally or via patches on the skin, involving over 1,200 women in perimenopause or postmenopause, plus massive observational data from about 175,000 midlife participants.
The depression-focused review was even broader, sifting through 23 studies from 2001 to 2024. These ranged from small trials with just 30 to 50 women to huge population-level studies covering more than 800,000 participants. Most of the treatment-focused studies tracked women for 8 to 24 weeks, with some extending up to four years, giving a good long-term view.
And this is where it gets interesting—maybe even controversial. The results weren't black and white. Estrogen therapy's effects varied wildly depending on factors like the stage of menopause, the delivery method (oral vs. transdermal), and how intense the symptoms were at the start. For anxiety, the therapy didn't broadly cut down on symptoms among midlife women, but there were hints of benefits for those in perimenopause or early postmenopause, particularly if they were dealing with strong anxiety and hadn't had their last period too long ago. Oral estrogen seemed to edge out transdermal options in these cases, though the advantages were small.
When it came to depression, the picture was just as mixed. Out of the studies, 14 showed some uplift in mood symptoms, especially for perimenopausal women or those with a past history of depression. Yet, six found no gains—or even suggested potential downsides. Alarmingly, three big observational studies hinted that systemic estrogen therapy might actually raise the risk of depression in certain groups. For example, imagine a woman in her late 40s noticing her mood dipping as hormones fluctuate; estrogen might help some, but for others, it could make things worse without careful monitoring.
Not to mention, hot flashes and night sweats (known as vasomotor symptoms) played a role in influencing outcomes, though some research pointed to mood perks that weren't tied to easing those physical symptoms. Plus, both oral and transdermal forms had their moments of success in specific scenarios.
Clinically speaking, this all points to the need for tailored care. Carys Stefanie Sosea, the lead author of the anxiety review from McMaster University, summed it up perfectly: 'Women often ask if menopause hormone therapy will ease their anxiety, and our goal was to bring together the evidence to guide them with solid facts.' Stephanie Faubion, MD, MBA, the medical director for The Menopause Society, added that anxiety is a common hurdle during this transition, and understanding how estrogen might affect it—varying by type, route, and dosage—helps doctors customize treatments for better results.
The depression review echoed this, stressing that responses depend on personal details like menopause timing, any previous mood issues, and the exact symptoms. It also noted that stopping estrogen abruptly could sometimes bring back depression, showing how sensitive our moods can be to hormonal shifts. This is the part most people miss: hormones aren't just about physical changes; they're deeply intertwined with our mental well-being, and tweaking them requires finesse.
Looking ahead, the experts say the evidence isn't strong enough to recommend estrogen therapy as a go-to fix for anxiety or depression in menopausal women. Instead, they call for more focused research to pinpoint who might benefit most and in what situations. As the authors put it, 'Estrogen therapy for menopausal depression should be handled with care, considering each patient's unique profile ... rather than treating everyone the same way.'
But here's where it gets controversial: with some studies suggesting a possible link to increased depression risk, is estrogen therapy a double-edged sword? Could it be that what helps one woman exacerbates things for another, leaving us to question whether the benefits outweigh the potential drawbacks? And what about the role of other factors, like lifestyle changes or non-hormonal therapies—should they be the first line of defense instead?
What do you think? Do these findings change how you view hormone therapy for menopause? Have you or someone you know experienced these mental health ups and downs? Share your thoughts in the comments below—do you agree it's time for more individualized approaches, or do you see a place for broader recommendations? Let's discuss!
References
- The Menopause Society. Feeling Anxious During Menopause? Hormone Therapy May or May Not Help. Press release. October 21, 2025. Accessed October 21, 2025.
- Mejia-Gomez JC, Sosea CS, Wolfman W, Leslie B, Shprits E, Shea A. The Effects of Estrogen-Based Menopause Hormone Therapy on Depression Symptoms in Perimenopausal and Early Postmenopausal Women: A Systematic Review and Meta-Analysis. Abstract. Presented at: The Menopause Society’s 2025 Annual Meeting. October 21–25, 2025. Orlando, Florida.
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