Using Menopausal Hormone Therapy for Mood Symptoms in Perimenopause and Menopause: A Framework for Psychiatric Clinicians

Authors

• Stephanie R. Dallocchio, University of LynchburgFollow

Specialty

Psychiatry

Abstract

Menopause and the menopausal transition are associated with significant neuroendocrine changes that increase vulnerability to mood symptoms in midlife women. Fluctuations and eventual decline in estradiol and progesterone influence serotonergic and gamma-aminobutyric acid (GABA)-ergic pathways, contributing to anxiety, irritability, anhedonia, and depressive symptoms. GABA is the major inhibitory neurotransmitter in the central nervous system; activation of GABAergic pathways decreases neuronal excitability and helps regulate anxiety, mood stability, sleep, and stress responses. Emerging evidence supports menopausal hormone therapy (MHT) for select patients; however, psychiatric clinicians frequently rely solely on psychotropic medications and may not evaluate hormonal contributions to mood disturbance. This clinical review synthesizes contemporary research examining neuroendocrine influences on mood and evaluates the evidence for MHT during perimenopause and early menopause. Randomized controlled trials, cohort studies, and recent consensus guidelines were reviewed to assess efficacy, safety, and clinical applicability. Evidence suggests that transdermal estradiol, particularly when combined with micronized progesterone when indicated, may improve mood symptoms in appropriately selected women during perimenopause and menopause. Updated recommendations from major menopause societies provide clearer guidance on treatment timing and individualized risk assessment. This manuscript proposes a practical framework to assist psychiatric clinicians in identifying MHT candidates, conducting baseline evaluations, and integrating hormone therapy with standard psychiatric treatment.

Recommended Citation

Dallocchio SR. Using Menopausal Hormone Therapy for Mood Symptoms in Perimenopause and Menopause: A Framework for Psychiatric Clinicians. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).