top of page
Search

You Started HRT. So Why Don't You Feel Better?

Writer: Edwige Theokas
Edwige Theokas
2 days ago
13 min read

Updated: 4 minutes ago


You fought for that prescription. Maybe it took months of asking, a stack of articles you printed yourself, and a speech you rehearsed in the car.


And for a few weeks it felt like a small miracle. The night sweats eased. You slept until five. The fog lifted enough that you stopped finding your keys in the fridge.


But three months in, something is still gnawing away at you.


You're sitting in the pickup line, or in the parking garage before a big meeting, and there it is again: a low, hollow hum. Dread, sad, anxious, and unfulfilled, like you're running a life that looks right on paper but feels like it belongs to someone else.


You're not imagining this, and I wanted to offer perspective around what else may be going on.


HRT was designed for what changing hormones do to the body: the hot flashes, the night sweats, the 3 a.m. wake-ups, and for some women in perimenopause, low mood too. It was never designed for grief, burnout, the fight-or-flight that runs your day-to-day, old stress your body is still carrying, or a life you've outgrown.


So if HRT helped your body and left this hum where it was, the treatment may be doing its job. What's left over is the part therapy can help with, and the two work side by side.


I'm writing this from inside midlife myself. I'm 48, a mom of two young kids, and in the middle of perimenopause.



What HRT Can Do, and Where It Stops


HRT, also called menopausal hormone therapy (MHT), is real medicine, and I'm glad more women can finally get it. For hot flashes, night sweats, and sleep, the evidence is strong. For mood, the picture is more mixed. (I wrote more about why hormones matter in healing here.)


The Study of Women's Health Across the Nation (SWAN) followed women through the transition for years and found they were more likely to have major depression during and just after it than before it.



It isn't approved as a depression treatment, and the evidence doesn't support it for depression after menopause.


One finding stays with me. In a 2018 randomized trial of 172 women ages 45 to 60, women on placebo were nearly twice as likely as women on transdermal estradiol plus micronized progesterone to develop clinically significant depressive symptoms over a year (about 32% vs 17%).


The benefit showed up mainly in the early transition and in women with more recent stressful life events. Hormones and life stress were tangled together in that study, the same way they're tangled together in your kitchen at 10 p.m.


Think of your life as a house. Perimenopause can cause a crack in the floor. Sleep goes, your fuse gets shorter, and the reserve you used to run on wears thin.


HRT can repair a lot of that floor, and for many women that repair is the difference between standing and falling through. A floor holds up everything else in the house: the rooms, the people, the boxes you've been meaning to sort for years. Fixing it doesn't decide what goes on top.



How HRT and Therapy Work Together


HRT works from the body up. It steadies the hormonal swings that drive the heat, the 3 a.m. wake-ups and, for some women, the low moods. Therapy works on the layers sitting on top of that: your nervous system, the stress it has been carrying for years, the grief, the roles you've outgrown, and the decisions you keep putting off. Different layers, same house.


They also make each other easier. When HRT gives you back some sleep, you have more room to do deeper work. You can stay with a hard memory or an honest conversation without being flattened for the rest of the week. And when therapy helps your nervous system settle, it gets easier to tell what's hormonal and what's stress, which makes every conversation with your prescriber more useful.


You don't have to finish one before you start the other. You don't need every dose question answered, every lab back, or a perfect month on HRT before you've earned a seat in my office. If something you describe sounds medical, I'll say so, and you can bring it to your next regular appointment. Meanwhile, we get to work on the rest.


Your medical provider treats the hormones. I work on what they stirred up.


Why Perimenopause Opens a Door


For most of your adult life, you had a buffer you didn't know about. Steadier hormones, sleep that reset you overnight, and enough reserve to push past whatever you didn't have time to feel. That buffer is what let you be the strong one at work and at home for twenty years.


Perimenopause thins it. The coping skills that always worked, like staying busy, staying pleasant and powering through, start to stop working as well. Things you had tucked away move closer to the surface: an old hurt, a loss you never had time to grieve, resentment you swallowed so the house would keep running. (I wrote about why perimenopause brings old trauma back up here.)


That can feel like falling apart. From where I sit as a therapist, it also looks like an opening. In therapy, we can only work with what shows up in the room, and in midlife far more of it shows up. The material is closer, your patience for pretending is shorter, and your reasons for doing the work are clearer than they've ever been.


You also bring something now that you didn't have at 30: judgment, perspective, and a sharp sense of what matters and what doesn't. The life you built in your thirties was designed by a woman with far less information than you have today. Perimenopause is often when that old design starts to feel outdated.



When You're Also Someone's Mom


All of this lands differently when you're raising kids.


For a lot of mothers, stopping to feel something registers as taking something from the family. Mom guilt is quick to tell you that an evening spent on yourself is an evening your kids didn't get. Mom guilt would have you believe that the time away from your kids is going to negatively impact them.


Then the invisible labor of being a mom fills every gap: the permission slip that is due in 3 days, the dentist reminder, the birthday gift for a classmate, noticing the sneakers are too small again. And layered over the work calendar, the family calendar, and a body in perimenopause is the good-mother script from school, family, and social media, the one almost no real Tuesday lives up to.


Then there's the mother you had. Midlife has a way of bringing her into the room. Maybe you're caring for her now. Maybe you're grieving her. Maybe you hear her voice come out of your mouth at bedtime and feel something you can't name. Some people call this the mother wound, a name for the ache with no blame attached, and it's one of the places old stress likes to settle.


The anthropologist Dana Raphael gave the identity shift of becoming a mother a name: matrescence. Midlife can arrive as a second shift stacked on the first, before the first one has finished. And if you had your children later, the two can overlap almost completely.


You can love your kids fiercely AND feel grief, anger, and exhaustion on the same day. Both are true, and neither makes you a bad mother.



The Fix Carousel


If you've solved every problem in your life by researching harder, planning better, and pushing through, you'll try to solve this one the same way. You're the strong one everyone counts on. Of course you will.


So the carousel around how to solve the problem starts spinning.


  • A new eating plan, because maybe it's inflammation.

  • A new planner, because maybe you're just disorganized.

  • A new job, because maybe it's the job.

  • A weekend of decluttering, because maybe it's the house.

  • A supplement stack, a morning routine, an app that tracks your cycle and your sleep and your steps.

  • And somewhere in the back of your mind, the quiet fantasy of leaving, because maybe it's the marriage.


None of these are wrong, and some of them might be exactly right. The trouble is the order. We reach for an answer before we've asked the right question.


HRT doesn't belong on that list. It treats real symptoms, and it may be exactly what your body needed. The carousel is everything we keep reaching for after the hot flashes ease and the hum stays. It's worth noticing what you might hear if you paused.



Why Sitting Still Feels So Risky


Usually the hardest part of a feeling is what it might ask of us.


If I admit how lonely I feel in my marriage, then what? If I admit I've outgrown the career I spent twenty years building, do I have to walk away from it? If I let myself feel how much I miss my mother, how do I get through the workday? If I admit I resent carrying the mental load for everyone, do I have to blow up the whole house to fix it?


Feeling it means seeing it, and once you've seen something, it's hard to look away. So seeing starts to feel like signing a contract to start your life over, now, with kids, a mortgage, and people counting on you.


Your nervous system reads that kind of truth as a threat, and it does what it was built to do with threats. It looks for a way out. Staying busy is a very effective way out. Every new plan, protocol, and project buys a little more time before you have to sit still, and from the inside it feels responsible, even admirable.


The feeling stays put, though, and in midlife, when your margin for pushing through has shrunk, it tends to get louder.


Noticing, understanding, and choosing are three separate steps, and you're allowed to take them at three very different speeds. You can know you're lonely in your marriage without calling a divorce lawyer on Tuesday. You can admit the job no longer fits without resigning in the morning. You can name your resentment about the mental load without reorganizing the whole house this weekend.


The fear, when women say it out loud, usually sounds like this: it feels like I'd have to rebuild my whole life from scratch. I understand why it feels that way.


But the reality is that you may be in the middle of a transition, and you need to stop long enough to see where you are before having to decide which way you're going.

The way I work with this is adapted from William Bridges' transition model. Bridges described a stretch between an ending and a new beginning that he called the neutral zone. The old way no longer fits, and the new one isn't clear yet. He saw that in-between as a seedbed for whatever comes next.


In my experience, the change a truth asks for is almost always smaller than the change you feared. It might be:


  • One honest conversation.

  • A boundary around your evenings.

  • Saying no to the committee.

  • Handing off the family calendar, or half of it.

  • Asking for help you've been too proud to ask for.


Sometimes it's bigger, and when it is, the aim is to make that choice from a steadier place than panic.


Avoiding the truth leaves the decisions to someone else: to exhaustion, to resentment, or to a body that finally refuses to keep going.



How Therapy Can Help


Therapy gives the part HRT can't reach a place to go. With me, it's a place to stop running, slow your body down enough to feel safe, and ask the question you've been avoiding: how are things going, really?


Here's what that work tends to look like.


We start with your body. My work centers on trauma and nervous system regulation, so before we open anything heavy, we build your capacity to feel hard things without being flooded by them. That steadiness is what makes the rest possible.


We untangle what's there. Some of the confusion is hormonal. Some is burnout and the mental load. Some is grief, and some is a truth asking for your attention. Sorting those threads with someone is a lot lighter than trying to sort them alone at midnight.


We grieve what needs grieving. Your parent, if you've lost them or are losing them. The version of motherhood you pictured. The self you were before everyone needed you at once. Grief that has been waiting for years usually needs more than a spare ten minutes.


We reach what insight can't. EMDR earns its place when a reaction is bigger than the moment, like when one comment at a family dinner can still undo a whole week. That usually points to older material your body is holding, and understanding it alone tends not to reach it. (Here's more on how EMDR differs from talk therapy.)


We sort what changes now from what can wait. Seeing something doesn't have to mean blowing up your life. We go at a pace your body can handle.


Why I offer longer sessions


If you've spent years holding it together, you'll likely spend the first part of any appointment doing the same for me. You give a tidy update and check that I'm following. In a 50-minute hour, by the time you've landed, it's nearly time to leave for pickup. Two hours gives us room to settle in, do real work, take a break, go deeper, and land before you walk out the door. (Here's what happens in a two-hour session.)


A good place to start is a Midlife Transition Session: one two-hour session, $495. If you want a steadier container, the Midlife Transition Series is four two-hour sessions over eight weeks, $1,850, moving through four steps: Name It, Grieve It, Untangle It, Build It. I also offer weekly 50-minute sessions.


I see clients in person in Bordentown City, a short drive from Hamilton, Robbinsville, Chesterfield, and Princeton, and online anywhere in New Jersey.



A Ten-Minute Experiment


Give yourself ten minutes this week. Phone in another room, nothing to produce. Just these three questions:


  1. If I'm completely honest, what am I tired of pretending about?

  2. When I think about that, where do I feel it in my body? Chest, throat, stomach, jaw?

  3. A year from now, how do I want to feel? (Answer with a feeling, even if your mind jumps to a to-do list.)


One rule: no action items for seven days. You're not allowed to fix anything you notice. The point is to practice letting a truth be in the room without running from it or rushing to solve it.


If that feels unbearable, that's useful information too. It usually means the feeling has been waiting a long time, and it may need more support than ten minutes alone can give.



Is This You? Four Direct Questions


  • Did HRT help your sleep or your hot flashes while the flat, hollow feeling stayed right where it was?

  • Do you keep starting new plans (a diet, a planner, a job search) and feel the same a few weeks later?

  • Do you feel guilty spending an evening on yourself, even when you can see you're running on empty?

  • Has your mother, or your grief for her, been on your mind more than you expected this year?


If two or more of those landed, you're not broken, and you're not ungrateful for the help you already have. Your body may have gotten some relief, and the rest of you may need care too.



A Life With Room for What You Now Know


If you're navigating perimenopause with HRT, you already did one hard thing. You researched and asked for help with your body, and you kept asking until someone listened. That took more persistence than most people will ever know about.


The foundation may have been shaky, but it's steadier now. What goes on top of it doesn't have to be the old life patched up, and it doesn't have to be a stranger's life either. It can be a life with room for what you now know: about your limits, your marriage, your work, your mother, and the kind of mother you want to be.


When you're ready, the first step is a conversation.



Not sure yet?





Frequently Asked Questions


Why do I still feel depressed on HRT?


HRT treats symptoms driven by changing hormones, and for some women in perimenopause it lifts mood too. It can't resolve grief, burnout, old trauma, or a life that no longer fits. Therapy can work on those alongside HRT, while your prescriber checks whether your dose and type are right for you.


Can HRT treat depression in perimenopause?


It may help. US guidelines from 2018 and a 2020 European position statement say estrogen can ease depressive symptoms in perimenopause, especially alongside hot flashes. It isn't approved as a depression treatment, and the evidence doesn't support it for depression after menopause. Depression usually needs its own care: therapy, medication, or both.


How long does HRT take to help?


The NHS says HRT can take up to 3 months to work fully, and finding the right type and dose can take time. If you don't feel better after 3 months, talk to your prescriber. If your mood is getting worse, or you have thoughts of harming yourself, don't wait: call or text 988.


What should I ask my prescriber if HRT isn't helping my mood?


Bring a few questions to your next regular appointment.


  • Have I been on this dose long enough to judge?

  • Is my dose or delivery method right for me?

  • Could my progestogen be affecting my mood?

  • Should we check thyroid, iron or sleep apnea?

  • Could this be depression that needs its own treatment?


Therapy can start alongside these questions.


Can the progesterone in HRT affect my mood?


For some women, yes. Some notice low mood, irritability, or anxiety with certain progestogens, the progesterone part of combined HRT. Changing the type, dose or delivery is a medical decision, so tell your prescriber what you're noticing and when in your regimen it shows up.


Should I see a therapist if I'm already on HRT?


If the physical symptoms have eased and the flatness hasn't, it's worth it, and you don't need to sort out every medical question first. Your OB-GYN or perimenopausal provider treats the hormones, and a therapist works on what they stirred up: grief, burnout, old stress, relationships, and decisions. The two work best side by side.


Is there a perimenopause therapist near Bordentown or Princeton, NJ?


Yes. I'm Edwige Theokas, a Licensed Professional Counselor and EMDRIA Certified EMDR therapist. I see women in person in Bordentown City, a short drive from Hamilton, Robbinsville, Chesterfield, and Princeton, and online anywhere in New Jersey. You can start with a two-hour Midlife Transition Session or a free 15-minute call.



About me


I'm Edwige (Eddie) Theokas, M.Ed, LPC, a Licensed Professional Counselor in New Jersey and an EMDRIA Certified EMDR therapist. I run Planting Seeds Counseling in Bordentown, where I work with women in perimenopause and midlife, navigating stress, anxiety and trauma.


Last reviewed: October 19, 2026. This post is general information, not medical advice. Decisions about HRT belong with your prescriber. I work with clients who live in New Jersey. If you're in crisis, call or text 988 or call 911.


Sources


 
 
 

Comments

bottom of page