Why more women are asking about HRT—and the mental health data behind the surge
Industry Buzz
When [menopause] symptoms are effectively managed, women often experience improvements in mood, sleep, and overall well-being.
—Katie Rowan, MD
Women’s health specialists across the United States are applauding the Food and Drug Administration (FDA) for stripping the black box warning from hormone replacement therapy (HRT) drugs.
Though a study published in 2002 suggested that HRT comes with an increased risk of breast cancer, more recent research has shown that the treatment offers several benefits, one of the most substantial being improved mental health. [][]
Related: Docs react to FDA’s removal of HRT black box warning: ‘An incredible mistake was made 25 years ago’—but not all agreeThe benefits of HRT on mental health
According to Cathleen Brown, DO, a board-certified OB/GYN and medical director of telehealth company Winona, the decline of estrogen, which occurs during menopause, can negatively impact mental health.
“Estrogen is needed in the optimal functioning and production of neurotransmitters, and we know from research studies that women who have a history of depression and anxiety have a significant risk of worsening of these conditions and worsening symptoms when estrogen levels fall,” she says.
Research shows that HRT, especially when taken in conjunction with antidepressants, can improve quality of life and low mood. [][]
“While menopausal hormone therapy isn’t FDA-approved specifically for mental health, it can have a profound impact on how women feel and function,” Katie Rowan, MD, an internal medicine physician and Menopause Society–certified practitioner, tells MDLinx.
Evidence has linked perimenopause to mood changes, diminished quality of life, and symptomatic depression. []Menopausal symptoms, including hot flashes, night sweats, and poor sleep, have been shown to impair daily functioning, productivity, and mental health.
“When these symptoms are effectively managed, women often experience improvements in mood, sleep, and overall well-being,” Dr. Rowan says.
Rapid Rounds
FDA removes black box warning from HRT, reflecting modern research showing benefits outweigh previously overstated health risks.
Strong mental-health benefits: HRT helps stabilize mood, improve sleep, and enhance quality of life—especially when estrogen decline worsens depression/anxiety.
Best candidates? Women under 60 or within 10 years of menopause, with individualized evaluation to rule out risks like estrogen-sensitive cancers or heart disease.
Ideal candidates for HRT
Seeing as physicians may soon experience an influx of patients inquiring about HRT, says Dr. Brown, now is the time to learn more about the various treatment options in order to help female patients in midlife.
To determine whether someone is a good candidate for HRT, it’s crucial to review each patient’s medical history, current medications, and underlying conditions to ensure that HRT is a safe option.
Furthermore, you’ll want to determine whether their symptoms are related to menopause or another condition, Dr. Rowan advises. She also recommends using the Menopause Rating Scale to measure each patient’s symptom burden and track them over time.
Ideal candidates for HRT are women younger than 60 years of age or women within 10 years of menopause. []HRT is not recommended for individuals with certain conditions, including estrogen-sensitive cancers and a history of heart disease. “A thorough history is so very important to ensure that we first do no harm as physicians,” Dr. Brown says.
Dr. Rowan says that HRT is a valuable tool in the toolbox of managing perimenopause and menopause symptoms; however, there are also other solutions and lifestyle habits that can alleviate symptoms and improve quality of life.
“A balanced diet, regular exercise, quality sleep, and stress management remain essential for long-term disease prevention,” she says.
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