10/07/2026
Perimenopause isn’t just hot flashes.
For many women, changes in mood and sleep can be some of the most disruptive symptoms of the menopause transition.
And there is randomized clinical trial data worth knowing about.
In a 12-month randomized, placebo-controlled trial of 172 initially non-depressed perimenopausal and early postmenopausal women, clinically significant depressive symptoms developed in 32.3% of those receiving placebo compared with 17.3% of those receiving transdermal estradiol plus intermittent micronized progesterone.
Importantly, the mood benefit remained significant even after accounting for changes in vasomotor symptoms, suggesting the effect wasn’t simply because women were having fewer hot flashes.
A subsequent analysis of the same trial found improvements in self-reported sleep with transdermal estradiol plus intermittent progesterone, even after accounting for changes in vasomotor symptoms and depressive symptoms.
The nuance matters: these findings do not mean hormone therapy is appropriate for every woman, nor that there is one universal regimen for perimenopause. Individual symptoms, reproductive stage, medical history, contraception needs, risks, and treatment goals all matter.
But they do reinforce something important: mood and sleep symptoms during the menopause transition deserve to be taken seriously, and hormone therapy is an evidence-based conversation worth having when clinically appropriate.
REFERENCES:
Gordon JL, Rubinow DR, Eisenlohr-Moul TA, et al. Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(2):149-157. doi:10.1001/jamapsychiatry.2017.3998
Geiger PJ, Eisenlohr-Moul T, Gordon JL, Rubinow DR, Girdler SS. Effects of perimenopausal transdermal estradiol on self-reported sleep, independent of its effect on vasomotor symptom bother and depressive symptoms. Menopause. 2019;26(11):1318-1323. doi:10.1097/GME.0000000000001398
