New study: hormone therapy may reduce mood disturbances in menopause — what Canadian patients should know

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

A study published September 9, 2026, in Menopause, the peer-reviewed journal of The Menopause Society, found that systemic hormone therapy (HT) reduced severe mood disturbances in menopausal women, with the share of patients reporting severe symptoms falling from 62.3% to 24.6% across a real-world cohort of 260 women. For Canadian patients navigating perimenopause or menopause, the finding is relevant: estradiol-based hormone therapy (sold in Canada under brand names including Estrace in oral tablet form and Estradot as a transdermal patch) is already available by prescription across the country, though coverage under provincial drug plans differs significantly depending on where you live.

Perimenopause is the multi-year transition before menopause when hormone levels fluctuate unpredictably, and menopause itself is defined as 12 consecutive months without a menstrual period. Mood disturbances during this window, including depressed mood, irritability, anxiety, and mental exhaustion, affect an estimated 45% to 68% of women, according to The Menopause Society. The new study adds to a growing body of evidence suggesting that estrogen's effects on brain chemistry, specifically its relationship to serotonin balance and cortical blood flow, may explain why some women experience significant psychological symptoms during the transition and why HT can help.

What this means in Canada

Health Canada has approved systemic estrogen therapy for the treatment of vasomotor symptoms (hot flashes, night sweats) and genitourinary symptoms of menopause. It has not issued a specific indication for mood symptoms, mirroring the US Food and Drug Administration (FDA) position. The study's authors note that mood improvements in their cohort occurred when HT was initiated for those already-approved indications, not as a standalone psychiatric treatment.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has previously acknowledged the neuropsychiatric burden of the menopause transition in its clinical guidance, but has not yet issued a position statement specifically on HT for mood symptoms in response to this study.

On the coverage side, the picture is uneven. In Ontario, estrogen products are listed on the Ontario Drug Benefit (ODB) formulary for eligible recipients, including those on social assistance or over 65. In Quebec, the Régie de l'assurance maladie du Québec (RAMQ) covers select estrogen formulations under its public drug plan. British Columbia's PharmaCare and Alberta's Alberta Health Care Insurance Plan (AHCIP) also list certain HT products, though the specific formulations covered and the co-pay structures differ. Patients with private employer benefits will generally have broader formulary access. Canadians without drug coverage who pay out of pocket can expect to spend roughly CAD $30 to $80 per month for common estrogen formulations, depending on the product and pharmacy.

For patients seeking menopause care, Canadian telehealth platforms including Cleo (a Canadian women's-health platform), Felix, and Maple can connect patients with licensed Canadian physicians who can prescribe HT. Science and Humans (scienceandhumans.com) also offers hormone-related care in Canada. US-based platforms such as Midi Health, Hone Health, and Winona do not serve Canadian patients and cannot issue Canadian prescriptions.

What changed

The study, a retrospective observational analysis conducted in a real-world clinical setting, is notable for a few reasons. First, improvement in mood was not limited to women with a prior psychiatric diagnosis. Treatment response did not differ by psychiatric history, age, menopause stage, or antidepressant use. That finding matters clinically because it suggests HT's mood benefit is not simply a proxy for treating underlying depression.

Second, the benefit was largest in women who started with the most severe symptoms. The proportion with severe mood symptoms at baseline was 62.3%; after HT, that figure dropped to 24.6%. Women with mild baseline symptoms saw smaller but still measurable gains.

Third, the study addresses a gap that has frustrated clinicians for years. Prior research on estrogen and mood has produced mixed results, partly because studies have used different outcome measures, different patient populations, and different HT formulations. This study used a standardized symptom survey in a clinical setting, which makes the results more directly applicable to everyday practice.

Dr. Monica Christmas, associate medical director for The Menopause Society, described the clinical reality plainly: patients frequently say they no longer feel like themselves, and the distress affects both personal relationships and work performance.

What Canadian patients should know

If you are experiencing mood changes during perimenopause or menopause, the first step is a conversation with your family physician, gynaecologist, or a menopause specialist. Mood symptoms during this period can overlap with clinical depression and anxiety disorders, and a proper assessment matters before any treatment decision.

HT is generally considered appropriate for women under 60 or within 10 years of menopause onset who do not have contraindications such as a history of hormone-sensitive cancers, unexplained vaginal bleeding, or active cardiovascular disease. The SOGC and The Menopause Society both support individualized risk-benefit discussions rather than blanket avoidance of HT.

If your province's drug plan does not cover your prescribed formulation, ask your pharmacist about generic alternatives. Generic estradiol tablets and patches are available in Canada and are typically less expensive than brand-name versions.

Patients in rural or remote areas with limited access to menopause specialists can use provincially regulated telehealth services. Cleo, Felix, and Maple all operate within Canadian regulatory frameworks and can provide prescriptions that are filled at Canadian pharmacies.

Limitations and open questions

The study has real constraints. With 260 participants, it is relatively small. As a retrospective observational study, it cannot establish causation, only association. The cohort's racial and ethnic composition is not detailed in the press release, which matters given documented differences in menopause symptom burden across racial groups. Black women, for instance, experience more severe and longer-lasting vasomotor symptoms on average, and it is not clear whether the mood findings apply equally across groups.

The study also does not specify which HT formulations were used, at what doses, or for how long, information that would help clinicians translate the findings into prescribing decisions. Health Canada has not updated its approved indications for HT based on this study, and the SOGC has not yet issued updated guidance. Larger, prospective, randomized trials are needed before mood improvement can be considered a standalone indication for HT in Canada.

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.