Symptoms

HRT, anxiety and low mood

Menopausal low mood and anxiety often overlap with lost sleep and hot flushes. NICE says to consider HRT and menopause-specific CBT when depressive symptoms do not meet the criteria for depression. Diagnosed depression is managed under the menopause and adult depression guidelines, and the NHS may offer antidepressants when perimenopause or menopause is the cause.

By Ines Kovac. Published 19 October 2026. 7 minute read.

Summarize with:

An open lined notebook on a weathered wooden table, with a blue and silver pen lying on the left page.

Anxiety and low mood in menopause

The NHS symptom list names mood swings, low mood and depression, and it says a hot flush can include anxiety, palpitations or dizziness (NHS: menopause symptoms). Anxiety during a flush comes with the heat. Low mood that lasts for days is a separate problem.

Hot flushes and night sweats may improve over time and be replaced by low mood and anxiety. The guide on how long menopause symptoms can last follows that span from the first signs through the years after periods stop.

Broken nights occur in these same years for many people. The sleep topic covers night sweats and waking. If you are unsure which stage you are in, the stage checker uses your age and your last period. The symptoms hub covers a wider range of changes.

Hormone replacement therapy and depression

NICE separates depressive symptoms that do not meet the criteria for a diagnosis of depression from depression that is suspected or already diagnosed (NICE menopause guideline: recommendations). The first group covers low mood that has not been diagnosed as depression. A clinician decides which description fits.

When that low mood starts around the same time as other menopause symptoms, the guideline says clinicians should consider HRT. When those depressive symptoms come with hot flushes or night sweats, it says to consider menopause-specific cognitive behavioural therapy as well, or on its own if other treatments are ruled out or the person would rather not try them.

Depression in the menopause years, once it is suspected or diagnosed, is handled differently. Care follows NICE's menopause guideline alongside its guideline on depression in adults.

A further line in that guideline says not to offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine routinely as the first treatment for hot flushes and night sweats alone. The CBT option above can be added to HRT for those flushes, or used when HRT is unsuitable or declined. This line is about those flushes on their own. Antidepressants remain something the NHS may offer for low mood, depression or anxiety brought on by the menopause transition (NHS: menopause treatment).

If the low mood arrived with the other menopause symptoms, I would start the GP conversation with HRT and with CBT aimed at menopause.

Can HRT cause depression?

Hormone replacement therapy can cause depression. The NHS lists mood changes, including low mood or depression, for both the oestrogen and the progestogen in HRT (NHS: HRT side effects).

Many of these effects settle after a few weeks. Mood changes on oestrogen may last through the first few months (NHS: oestrogen tablets, patches, gel and spray). If they are severe, they carry on, or they are hard to cope with, the advice is to speak to a doctor, who may change the dose or the type.

The same effects can look like menopause symptoms. The NHS notes that HRT might not be behind the mood change, so a clinician has to tell the two apart. Changing or stopping the prescription is a decision for the person who prescribed it.

Some people on combined HRT describe a mood shift after a change in the progestogen dose or the type of progestogen. That pattern is worth raising at a review appointment. Ask the prescriber before you change the dose.

How HRT may help anxiety and low mood

HRT can also help with anxiety and low mood when they are menopause symptoms (NHS: about HRT). The benefits page names anxiety and low mood caused by menopause, and it says many symptom types often improve within days or weeks of starting (NHS: benefits and risks of HRT). For some people, improvement takes longer.

Our page on what hormone replacement therapy is and the forms it comes in explains tablets, patches, gel and spray, and who is usually offered each. Extra cases of breast cancer, clots and stroke per 1,000 women are explained in HRT risks in plain numbers. The hormone therapy topic hub gathers the hormone guides, and every published piece is listed on all guides.

CBT and what else can help

NICE Clinical Knowledge Summaries say low mood and anxiety resulting from menopause can be helped by psychological therapies such as CBT (NICE CKS: managing menopause). That is the same therapy named above for flushes and for depressive symptoms that come with them.

Mood swings, low mood and anxiety are common around perimenopause and menopause, and CBT can help low mood and feelings of anxiety. The NHS self-help page also points to rest, staying active and time for relaxing activities (NHS: things you can do). For weight, bones and heart, read diet and menopause.

Where HRT is unsuitable, the treatment page says CBT may be offered for flushes, and clonidine or an antidepressant if that CBT does not help the flushes. That sequence is about the flushes. Antidepressants for menopause-related low mood are a separate option, as the treatment paragraph above sets out.

When to see a GP, and when to seek urgent help

See a GP if low mood has lasted more than two weeks, if self-help is not helping, or if you want a referral for more support (NHS: low mood, sadness and depression). Also see a GP if mood changes on HRT are severe, lasting or hard to cope with, which the side-effect paragraphs above describe.

The menopause symptom checklist to take to your GP lets you note mood along with the other symptoms, including how often each one happens and how much it bothers you.

If you need help sooner, use 111 online or call 111 and choose the mental health option, or ask for an urgent GP appointment (NHS: where to get urgent help for mental health). Call 999 or go to A&E now if your life is at risk, or if you cannot keep yourself or others safe.

What I would do next

I would note whether the low mood follows the cycle or the flushes, and I would take the checklist to the appointment. If the mood worsened after a progestogen was started, I would ask the prescriber to review the dose or the type.

Sources

Comments

No comments yet. Questions and your own experience are welcome.

Thank you. Your comment will appear once it has been reviewed.