Hormone therapy does not consistently reduce menopause-related anxiety, new review finds

Anxiety is a common and significant symptom of menopause and perimenopause, largely due to hormone fluctuations. Numerous studies have focused on the potential benefits of hormone therapy in reducing anxiety. A new systematic review indicates the treatment does not consistently impact anxiety symptoms in midlife women. Results of the review will be presented at the 2025 Annual Meeting of The Menopause Society in Orlando, October 21-25.

Anxiety can manifest in a number of ways, including nervousness, fear, and worry, and is sometimes accompanied by physical symptoms like hot flashes, palpitations, and insomnia. Because of its ability to seriously affect a woman's quality of life, anxiety has been the subject of multiple studies. Researchers recently undertook the task of reviewing an array of relevant studies designed to investigate the effects of hormone therapy on anxiety symptoms among perimenopausal and early postmenopausal women.

Seven studies were considered eligible, including a combination of randomized controlled trials, cohort studies, and case-control studies that evaluated estrogen-based hormone therapy administered via oral or transdermal routes. Collectively, the trials had enrolled more than 1,200 pre- or postmenopausal women and the observation studies captured roughly 175,000 individuals spanning the midlife years.

Multiple dosages and routes of administration were evaluated with varying conclusions. While the researchers determined that estrogen-based hormone therapy does not consistently reduce anxiety symptoms among midlife women, modest benefits were noted in perimenopausal or early postmenopausal women, particularly among those who were symptomatic and within a few years of their final menstrual period. The route, dose, and baseline severity of symptoms appear to have influenced treatment responses, with oral estrogen the most promising.

More detailed results will be discussed at the 2025 Annual Meeting of The Menopause Society as part of the abstract presentation entitled "The Effects of Estrogen-Based Menopause Hormone Therapy on Anxiety Symptoms in Perimenopausal and Early Postmenopausal Women: A Systematic Review.

Women are often asking if menopause hormone therapy will improve their anxiety symptoms, and we wanted to synthesize the information to counsel patients with evidence-based information."

Carys Stefanie Sosea, McMaster University

More targeted research is needed to clarify which characteristics, such as menopause stage, symptom severity, and timing of treatment, may predict which women are most likely to benefit from estrogen-based hormone therapy for anxiety symptoms.

"Anxiety symptoms are common in the menopause transition. Identifying the potential impact of estrogen-based therapy on these symptoms and whether there are differences in terms of formulation, route of administration, and dose is important so that clinicians can better individualize treatment," says Dr. Stephanie Faubion, medical director for The Menopause Society.

Both Carys Stefanie Sosea and Dr. Faubion are available for interviews prior to the Annual Meeting.