The Mood Changes Of Menopause May Have A Deeper Root Than You Think
Irritability, anxiety, mental exhaustion, and feeling unlike yourself can appear during perimenopause and menopause, alongside hot flashes, night sweats, and disrupted sleep.
Mood changes like these affect up to 68% of women during the menopause transition. Hormone therapy is FDA-approved for hot flashes, night sweats, and genitourinary symptoms, but its role in easing mood symptoms is less well understood.
A recent study examined whether hormone therapy might help.
About the study
Researchers reviewed the records of 260 women who had never used hormone therapy and were seen at an urban, academic menopause center between 2023 and 2025.
Before starting systemic hormone therapy, each woman completed a questionnaire called the Menopause Rating Scale, which measures depressed mood, irritability, anxiety, and mental exhaustion.
They completed the questionnaire again about four and a half months later.
Nearly all participants used an estrogen patch, and the average age was 52. About half had a history of anxiety or depression, and roughly one-quarter were taking antidepressants when they started treatment.
Because the study reflected real-world clinical care rather than a controlled trial, it included women with varied health histories and women at different stages of menopause.
Severe mood symptoms became less common
Before starting hormone therapy, 62.3% of participants scored in the severe range for mood symptoms. After roughly four and a half months of treatment, 24.6% did, a drop from about 6 in 10 women to fewer than 1 in 4.
Scores on the psychological portion of the questionnaire fell across the group.
The biggest improvements occurred among the women who had the most severe symptoms at the start.
Response did not differ by psychiatric history, age, menopause stage, or antidepressant use, meaning mood scores improved in women with and without a previous diagnosis, and in those taking antidepressants as well as those who were not.
These results suggest that hormonal changes during menopause may contribute to significant mood symptoms for some women.
However, because the study did not include an untreated comparison group, it cannot show that hormone therapy alone caused the improvements.
Hormone therapy isn't a depression treatment
The study does not establish hormone therapy as a treatment for depression or anxiety disorders. Researchers didn't compare it with antidepressants, therapy, or a placebo, and there was no untreated comparison group.
The authors framed their findings as a reason for further investigation, not as evidence that hormone therapy should be prescribed for mood.
Still, the results align with evidence that menopause-related hormonal shifts can affect mood, sleep, and cognition. For some women, those changes may help explain why they suddenly feel different.
What to do if your mood changes
Tell your doctor about new or worsening mood symptoms, especially if they affect your relationships, work, sleep, or daily life.
Treatment may include therapy, medication, lifestyle changes, hormone therapy, or a combination, depending on your symptoms and health history.
Be specific about what has changed, such as increased anxiety, persistent low mood, unusual irritability, or trouble concentrating. Noting when the shift started and how long it has lasted gives your doctor more to work with.
The takeaway
Mood symptoms can be part of menopause. This study suggests they may improve when hormonal changes are addressed, but it doesn't prove hormone therapy treats depression or anxiety.
If your mood has changed in a way that's affecting your daily life, bring it up at your next appointment and ask about the full range of options available to you.
