Hormone Therapy Adjustments for Depression

Introduction to Hormone Therapy

Continuous progesterone administration may contribute to depressive symptoms in some women, and studies have shown that progesterone can affect mood regulation, particularly when administered continuously, according to the American College of Obstetricians and Gynecologists 1
Low estrogen levels are associated with increased risk of depression, as reported by the North American Menopause Society 2

Administering 200mg of oral or vaginal micronized progesterone for 12-14 days every 28 days, a cyclical approach, has been associated with lower risk of mood disturbances compared to continuous administration, as recommended by the American College of Obstetricians and Gynecologists 1
Avoid progestins with anti-androgenic effects as they could worsen mood symptoms, according to the Endocrine Society 1

Transdermal administration is appropriate and recommended as the first-line approach for estrogen therapy, as stated by the American College of Obstetricians and Gynecologists 1
Estrogen therapy has been consistently reported to improve mood in perimenopausal women, although the optimal dose is unclear, with some studies suggesting a dose of 0.5-1mg daily, as reported by the North American Menopause Society

Testosterone can help with libido and energy, but monitor for any adverse effects, as recommended by the American College of Obstetricians and Gynecologists 1
Systematic analyses have shown that testosterone can help with diminished libido and sexual function, according to the Endocrine Society 1

Assess mood symptoms after 4-6 weeks of hormone therapy adjustments, and monitor for any side effects of increased estrogen, such as breast tenderness or breakthrough bleeding, as recommended by the American College of Obstetricians and Gynecologists
If depression persists despite hormonal adjustments, consider adding an antidepressant, as suggested by the American Psychiatric Association

Transdermal estrogen administration avoids first-pass hepatic metabolism and may have a better safety profile, according to the American College of Obstetricians and Gynecologists 1
If the patient is approaching menopause, be aware that systemic hormone therapy initiated during the menopausal transition has been associated with higher risk of depression in some studies, particularly in the first year after initiation, as reported by the North American Menopause Society