Can I Start HRT for Mood Alone?

I’d like to start HRT. At 49 I am still having periods, albeit less regularly. My main concern is emotional well-being that is clearly a part of my cycle, as the other menopausal symptoms aren’t nearly as frustrating for me. Is my emotional health a compelling enough reason for my medical practitioner to prescribe HRT?
—Not hot, but bothered

Many women experience changes in their mood that are associated with the rises and falls of their hormones during their menstrual cycle. This can occur throughout our reproductive lives, but many women note that their symptoms get worse during the late-reproductive and perimenopause stages. This makes sense, because our hormone shifts are more extreme in the lead-up to menopause. More dramatic hormonal changes will cause more symptoms.

Regardless of where you are in your reproductive life span, if your mood changes are impacting your functioning, you may have severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Severe PMS is defined as having any symptoms that are associated with the days prior to your menstrual cycle and that impact functioning. PMDD is defined as having one of several changes in mood — mood swings, sudden sadness, irritability, or anxiety — in the days leading up to your period that significantly impacts your functioning or causes distress.

Suppressing the hormones from the pituitary gland that drive our menstrual cycle with birth control pills has been shown to be an effective way to treat severe PMS and PMDD. The estrogen and progesterone in the doses typically found in hormone replacement therapy does not always effectively suppress ovulation and thus may not effectively treat your symptoms. However, a low-dose birth control pill taken continuously would be a safe and reasonable option until menopause.

Yes, mood changes that are associated with your cycle and are disrupting your life are a valid reason to seek treatment, and taking hormones, particularly as birth control pills, is an evidence-based treatment for your symptoms.