Role of Hormone Replacement Therapy in Managing Menopausal Mental Health

A bstract Hormonal changes during menopause can cause several troubling psychological effects in women both during and after this phase. The effects of hormone replacement therapy (HRT) on psychological health after menopause are still debated. This updated narrative review summarizes the available evidence on the topic and its clinical implications. Estrogen has neuroprotective properties, and its abrupt decline during menopause contributes to various mental health issues, including cognitive deficits, memory decline, and mood disorders. Although HRT was initially believed to benefit cognitive problems, the Women’s Health Initiative and other landmark trials indicated it could cause more harm than good. However, subsequent data have yielded mixed results regarding the impact of estrogen with or without progesterone on cognition, memory, sleep, depression, or anxiety. Benefits are primarily observed in peri-menopausal women, shortly after menopause, and in younger women who have surgical menopause. Adding progesterone, particularly medroxyprogesterone acetate, may ameliorate the benefits of estrogen on mood and cognition but may enhance its effect on sleep quality. The risks tend to outweigh the benefits if initiated in the elderly and after several years of menopause. Mental health is not a recommended indication for HRT in menopausal women. However, HRT may benefit younger menopausal women when administered in appropriate doses and formulations, along with careful monitoring for possible adverse effects.