In my side hustle as a functional medicine practitioner (I’m also a full time emergency room Nurse Practitioner), I work with a lot of menopausal women. Statistically, roughly 2 out of every 10 women of menopausal age will develop depression. But in my line of work, it’s more than 20%. 

Many women understand that during menopause, estrogen levels plummet. So the question becomes, in order to prevent depression during menopause, is taking supplemental estrogen or hormone replacement therapy all you need? 

Not exactly. 

Adrenal Function: The Root Cause Of Depression? 

When I work with a new client who is perimenopausal or their ovaries are fully retired, I don’t have them do hormone replacement cream or pellets. 

At least not at first. 

Instead, I have them take a functional lab test called the DUTCH hormone panel. The reason why is because the DUTCH test reveals the ability of the adrenal glands to produce cortisol, the steroid hormone that controls a number of functions. Cortisol is best known, however, as the “stress hormone.” 

Many research studies (like this one) show a strong connection between adrenal function and the production of sex hormones such as estrogen. Taking the DUTCH hormone panel confirms whether chronic stress inhibits the production of not only estrogen but also progesterone. 

Progesterone, which like estrogen is produced in the ovaries, plays a critical role in many bodily functions like sleep and blood pressure. And not only that, progesterone levels influence your mood. 

Thus, if you have progesterone deficiency, it can contribute to depression. Moreover, it can also lead to unexplained weight gain. 

This is why it’s so critical to have your adrenal function tested. If I see that your panel shows adrenal exhaustion, it’s like a huge clue. It reveals the underlying pattern that explains hormone dysfunction’s ties to depression.  

When you work with a functional medicine practitioner like yours truly, your adrenal function will be restored. That will help you feel more energetic. And from there, we’ll balance your hormones, including progesterone, which I can’t stress enough how important it is for getting good quality sleep. I may also have you take a DHEA supplement 

Obviously, if you’re not getting good sleep, you’re more likely to feel depressed. 

To emphasize the point, depression is not an isolated estrogen issue. Low estrogen isn’t the only culprit behind poor sleep, poor detoxification and inflammation. The key to overcoming all these symptoms of depression is improving your levels of circulating cortisol. 

Other Hormones Linked To Menopausal Depression

Research studies show that having low levels of other hormones such as Follicle Stimulating Hormone (FSH) during menopause can contribute to depression. That’s why when I work with clients I test their FSH levels as well as Luteinizing hormone (LH), and even Testosterone since having adequate testosterone is critical for lean muscle mass.

Estrogen Creams Vs Pellets For Menopausal Depression

First of all, let me get this out of the way. Unless you’ve had a hysterectomy (the removal of the uterus), you should never receive a stand-alone estrogen replacement theory. Having estrogen-only replacement theory in women without a hysterectomy has been associated with an increased risk of cancer, says the Cleveland Clinic.  

With that disclaimer out of the way, do I prefer creams or pellets to balance hormone levels? 

I prefer bioidentical hormone creams. Pellets may be all the rage these days. But here’s the thing about hormone pellets: Some people metabolize them poorly. Either their system metabolizes them insufficiently. Or the opposite is true: they can over metabolize them, meaning it can lead to estrogen dominance. If you have a chronic health condition, having too much estrogen and not enough progesterone to balance out the estrogen can worsen your systems. 

Another reason I prefer the bioidentical hormone creams over the pellets is that they are easier to titrate. This means you’re better able to measure and adjust the amount of hormones. 


Finally, I’d like to add one more thing about the connection between estrogen, depression and menopause. And that is that gut health is everything. You’ve heard that having a healthy gut is important for many reasons, including immune function and mood. But I bet you didn’t know that your gut also plays a big role in estrogen production. 

In fact, one research study explains that … and fair warning, it’s about to get real geeky here … “The gut microbiome impacts estrogen levels … through the secretion of β-glucuronidase, an enzyme which deconjugates estrogen, enabling it to bind to estrogen receptors and leading to its subsequent physiological downstream effects.”

The study goes on to explain that it’s only the unbound, free estrogen that is biologically active. In other words, it’s the gut that “gives birth” to usable estrogen. 

So make sure you’re eating real food, including probiotic-rich things like sauerkraut and plain yogurt. The bottom line is that estrogen does in fact play a key role in your mood during menopause. But there are other hormonal factors at play. 

A skilled functional medicine practitioner (ahem, like me!) can help you reclaim your health by restoring adrenal function and balancing your sex hormones. 

Until next time, 

Jenna Witt, NP