The relationship between estrogen and the brain is one of the most compelling — and most contested — areas in menopause science. Observational data, basic science, and the critical window hypothesis have generated serious interest in MHT as a potential tool for preserving mood, sleep quality, and long-term cognitive function, including dementia prevention. Yet the randomized trial evidence remains mixed, the timing and duration questions are unresolved, and translating promising biological mechanisms into confident clinical recommendations has proven elusive. In this HERmedicine Great Debates in Menopause session, expert panelists take on the question directly: should MHT be prescribed for brain health — including mood, sleep, and dementia prevention — or does the current evidence fall short of justifying that indication? Expect a rigorous, evidence-driven debate that engages honestly with both the promise and the limits of what we know — and equips clinicians to have more informed conversations with the patients who are already asking.