Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women’s health, leading to decreased well-being, psychological distress, and impaired quality of life. Common menopausal symptoms include hot flashes, sleep and mood changes, fatigue, weight gain, and urogenital disturbances. Clinicians often neglect mood swings and disrupted sleep, although those can significantly limit the productivity of women and impair their cognitive function and mental health. Evidence-based management should include a personalized, holistic approach to alleviate symptoms and careful consideration of the risks vs benefits of hormone replacement therapy (HRT), with due consideration of personal preferences. A research paper in the recent issue of the World Journal of Psychiatry by Liu et al investigated the role of HRT in altering mood changes and impaired sleep quality in menopausal women, which helps us to understand the benefits of this treatment approach.