HRT may reduce antidepressant need in menopausal women

HRT may reduce antidepressant need in menopausal women | Image Credit: © TanyaJoy - © TanyaJoy - stock.adobe.com.

Hormone replacement therapy (HRT) may be an effective treatment option for negative mood symptoms associated with menopause, according to a recent study presented at the International Society for the Study of Women’s Sexual Health 2025 Annual Meeting in Atlanta, Georgia from February 27 to March 2, 2025.¹

Mood symptoms in menopausal women

Anxiety, low mood, and depression often occur in midlife women because of fluctuating and declining hormone levels associated with menopause. This has led to antidepressants and anxiolytics being recommended to prescribed to treat negative mood symptoms in approximately 1 in 3 perimenopausal women.¹

“However, current guidelines state that there is no clear evidence of benefit for antidepressants when used to treat low mood in perimenopausal women not diagnosed with clinical depression, and HRT should instead be considered,” wrote investigators.¹

Experts have recommended treatment for depressive symptom be highly individualized among postmenopausal patients.² This includes the possibility of HRT alone, which may effectively reduce symptoms in some patients. However, antidepressant utilization remains recommended in women with major depressive disorder when HRT alone is not adequate.

Patients with major depressive disorder may experience depressed mood, decreased interest, weight change, sleep disturbances, feeling of worthlessness, difficulty concentrating, psychomotor agitation, and recurrent thoughts of death.²

Robert P. Kauffman, MD, MSCP, professor at Texas Tech University Health Sciences Center School of Medicine, noted that menopause patients may experience additional stressors such as vasomotor symptoms, dyspareunia, and sleep disturbance. This highlights the increased risk of depression in this population.²

Alongside improving quality of life in perimenopausal women with psychological symptoms, HRT may reduce the need for antidepressant therapy, lowering the odds of adverse side effects linked to long-term antidepressant use.¹ Therefore, investigators conducted a study to evaluate reduced or discontinued antidepressant or anxiolytic prescription after starting HRT.

Study design and findings

The cross-sectional study included patients visiting a specialist menopause clinic in the United Kingdom from October 1, 2023, to May 31, 2024, receiving antidepressants at the time of their initial visit before starting HRT. These participants reported any changes in antidepressant and anxiolytic medication use following HRT initiation.¹

There were 1081 patients with prior antidepressant or anxiolytic use before HRT initiation included in the analysis. These individuals were aged a mean 51.7 years, and 39% reported reduced or discontinued antidepressant and anxiolytic medication use.¹

Of patients receiving standard HRT with oestrogen and progestogen, 10% reported reduced medication and 16% reported discontinuing their medication. For women receiving testosterone medications, these rates were 12% and 28%, respectively. This indicated an estimated p-value for the difference in discontinuation rates of 0.0164.¹

Conclusion and future research

At the 0.05 level, this was a statistically significant difference between groups, highlighting a significant increase in patients receiving HRT with testosterone vs standard HRT. Overall, the data showed HRT may be more beneficial for treating negative mood symptoms associated with menopause.¹

“Use of testosterone alongside standard HRT may have a superior beneficial effect on mood,” wrote investigators. “More research is needed to explore the effects of HRT +/- testosterone on mood and deprescribing of antidepressant medication in peri- and early postmenopausal women.”¹

References

1. Quaile H, O'sullivan A, Neville A, et al. Effect of HRT with and without testosterone on antidepressant deprescribing in perimenopausal and postmenopausal women with mood symptoms: A cross-sectional study. Presented at: International Society for the Study of Women’s Sexual Health 2025 Annual Meeting. Atlanta, Georgia. February 27-March 2, 2025.
2. Levine L.Does menopause really cause depression? Contemporary OB/GYN. June 6, 2024. Accessed February 28, 2025. https://www.contemporaryobgyn.net/view/does-menopause-really-cause-depression-