Some Women Are Prescribed Antidepressants, But What They Really Need Is This Treatment

Hormone replacement therapy (HRT) is making a significant comeback as research continues to support its safety and effectiveness in treating perimenopausal and menopausal symptoms. But despite the growing evidence, many women are still being misdiagnosed with depression and prescribed antidepressants—when their underlying issue may be a hormonal imbalance.

Misdiagnosis and Missed Opportunities

Perimenopause, the transitional phase leading up to menopause, can begin as early as a woman’s late 30s or early 40s. This stage is marked by fluctuating estrogen levels that cause symptoms like fatigue, brain fog, mood swings, anxiety, and insomnia. These symptoms can closely resemble depression, and for years, clinicians have responded by prescribing selective serotonin reuptake inhibitors (SSRIs) or other antidepressants instead of addressing hormonal causes.

As quoted in the WSJ, Stephanie Faubion, medical director of the North American Menopause Society said, “A lot of women, unfortunately, who are going to their doctors because of hot flashes and night sweats are getting slapped on antidepressants.”

Recent studies suggest that an increasing number of women in midlife who report mood issues during perimenopause are prescribed antidepressants—even when they do not meet diagnostic criteria for major depressive disorder. While SSRIs can help with hot flashes and certain emotional symptoms, they don’t address the root hormonal shifts that may be driving the change.

What Hormone Therapy Actually Does

Estrogen therapy is widely considered the most effective treatment for managing symptoms such as hot flashes, night sweats, vaginal dryness, disrupted sleep, and mood instability. When administered early—ideally within 10 years of a woman’s last period and before age 60—HRT has also been shown to reduce the risk of osteoporosis, heart disease, and even cognitive decline.

Some evidence now shows estrogen can have antidepressant effects, especially when used in combination with SSRIs or SNRIs. In fact, recent research presented at women’s health conferences in 2024 and 2025 suggests that HRT could actually reduce or eliminate the need for antidepressants in many menopausal women.

Despite this, many physicians remain hesitant to prescribe estrogen therapy, due in part to lingering concerns from earlier interpretations of a Women’s Health Initiative (WHI) study. That large-scale study linked HRT to an increased risk of breast cancer and stroke. However, follow-up analysis now shows that the risks were overstated, especially for women who begin treatment early and use non-oral methods like skin patches or gels.

Estrogen: Not Just About Hot Flashes

The benefits of estrogen go beyond comfort. Transdermal estrogen helps maintain bone density, improves skin elasticity, supports cognitive function, and may lower the risk of Type 2 diabetes. When combined with progesterone in women who still have a uterus, the risk of endometrial cancer is reduced to near baseline.

As for breast cancer, the most up-to-date estimates show that the increase in risk from combined estrogen-progestogen therapy is modest—about one additional case per 1,000 women per year. For women using estrogen-only therapy (typically those without a uterus), breast cancer risk may actually decrease.

Additionally, concerns about Alzheimer’s disease have evolved. Recent findings suggest that starting HRT after age 65 may accelerate tau protein accumulation in the brain, which is linked to dementia. However, when therapy is initiated earlier, studies show a neutral or potentially protective effect on cognitive health.

Time and Delivery Matter

Experts widely agree that the timing and delivery method of hormone therapy are crucial. Women under 60 who begin treatment within 10 years of menopause typically see the greatest benefits with the fewest risks. Transdermal and vaginal estrogen—applied through patches, gels, or creams—carry lower risk of blood clots and stroke compared to pills.

Professional organizations like The Menopause Society, the American College of Obstetricians and Gynecologists, and the North American Menopause Society now recommend individualized treatment plans that factor in personal health history, age, and risk tolerance.

A Shift in Practice

Momentum is building to change how doctors approach midlife women’s care. In 2025, a panel of physicians formally petitioned the FDA to remove the “black box” warning on low-dose vaginal estrogen products, arguing that it unfairly discourages women and clinicians from using safe, effective treatment for symptoms like vaginal dryness and painful intercourse.

Meanwhile, some menopause specialists have begun advocating for testosterone therapy—albeit off-label—to address low libido, fatigue, and muscle loss in menopausal women. Although no testosterone product is FDA-approved for female use in the U.S., low-dose regimens are gaining popularity under the care of trained clinicians.

Looking Ahead: Informed, Empowered Care

The stigma surrounding menopause is slowly fading, replaced by a more science-backed and patient-centered approach. Apps like MenoPro and virtual clinics are empowering women to track their symptoms, evaluate treatment options, and consult with menopause-literate providers.

But challenges remain. Too many women are still dismissed, misdiagnosed, or steered toward ineffective treatments when hormone therapy might be the more appropriate option.

This shift in awareness, driven by updated science, advocacy, and platforms connecting women to evidence-based care, marks a turning point in how society and medicine understand menopause. Hormone therapy, once feared, is now reemerging as a powerful tool when used at the right time and in the right way.