A recent study has found that use of hormone replacement therapy (HRT) and testosterone are associated with significant improvements in mood in perimenopausal and menopausal women.

Fluctuating and declining hormone levels during perimenopause and menopause are often associated with mood symptoms, including low mood, anxiety and irritability. However, many doctors do not prescribe HRT or testosterone for mood symptoms related to changing or low hormones, often due to inadequate education and awareness.

In this study conducted by Newson Health Research in collaboration with Liverpool John Moores University and Monash University in Melbourne, Australia, 920 women completed the Meno-D questionnaire, which measures and rates the severity of 12 menopausal mood symptoms: energy, paranoia, irritability, self-esteem, isolation, anxiety, somatic symptoms, sleep, weight, sexual interest, memory and concentration.

All the women received body-identical oestradiol (patch, gel or spray), mainly in combination with body-identical progesterone (142 women used the Mirena coil). Within the group, 587 women (65%) received testosterone. Half the women had not used HRT before the study, and half were already using HRT but had persistent symptoms and attended to have their dose/ regimen optimised.

After treatment for three months, the women again completed the Meno-D questionnaire in a follow-up appointment. Key findings include:

• Overall symptoms decreased by 45%, and all 12 individual mood symptoms significantly improved.

• The symptoms that improved the most were reduced energy (symptom reduced by 60%), difficulty concentrating (reduced by 59%) and decreased libido (reduced by 59%)

• Women newly starting HRT improved the most (49% reduction in symptom score)

• Women already using HRT significantly improved following optimisation of their dose/ regimen and/or the addition of testosterone (35% reduction in symptom score)

Women additionally prescribed testosterone with their HRT improved more than women prescribed oestradiol with or without progesterone alone, but the difference was not statistically significant. It is possible that the benefits of testosterone were underestimated because the study duration was short (it can take up to six months to see benefit), and not all women would have achieved therapeutic blood levels in such a short time frame (testosterone dose also needs to be tailored to the individual).

The findings suggest that body identical HRT and testosterone can have beneficial effects on mood in perimenopausal and menopausal women, and is likely to be a suitable treatment option for many women presenting with new onset, unexplained mood symptoms during perimenopause and menopause. More research is needed to further investigate the long-term efficacy of body identical HRT and testosterone on all perimenopausal and menopausal symptoms, including mood, especially after individualisation of dose and formulation.

The study is available to read in The British Journal of Psychiatry and can be accessed here.

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