Purpose <p>Perimenopause represents a period of increased vulnerability to new-onset and recurrence of pre-existing psychiatric conditions, in part due to hormone fluctuations which disrupt neurotransmitter signaling. Due to its ability to stabilize hormone levels, menopause hormone therapy (MHT) has gained interest for its potential role in treating psychiatric conditions. This review examines the evidence of MHT’s effects on depressive, anxiety, cognitive, bipolar, and psychotic symptoms and disorders during perimenopause and postmenopause.</p> Recent Findings <p>Estrogen monotherapy appears effective for treating depressive symptoms and major depression in perimenopause, though is not effective for postmenopausal women. The efficacy of combination MHT for perimenopausal depression remains understudied. Studies of MHT’s effect on anxiety symptoms, cognitive symptoms, and bipolar affective disorder are mixed. Emerging evidence suggests MHT may help to prevent depression and recurrence of primary psychotic disorders in midlife women, though additional research is needed.</p> Summary <p>Existing research on MHT’s psychiatric effects is limited by methodologic inconsistencies. Though some studies suggest potential psychiatric benefits, further studies are needed to clarify how menopause stage, MHT formulation, dose, and psychiatric symptom severity influence mental health outcomes in perimenopausal and postmenopausal women.</p>