•Psychological behavior patterns are one moderator affecting how women experience menopausal symptoms and cope with them.•Women with low ratings for hostility and stress tend to manage their menopausal symptoms without hormone therapy.•Women with high ratings for optimism and sense of coherence tend to manage their menopausal symptoms without hormone therapy. To identify subgroups of women who differ with respect to self-evaluated stress, hostility, optimism and sense of coherence, and to identify differences, if any, in whether these subgroups use or do not use hormone replacement therapy (HT). This time-trend study is based on the Finnish national HeSSup study, in which nationwide cohorts of Finnish women aged 52–56 years randomly selected in 2000 (n = 1321) and in 2010 (n = 1389) responded to postal questionnaires related to four psychological behavior patterns. Relationships between psychological behavior patterns (stress, hostility, optimism and sense of coherence) and how menopausal symptoms are experienced and how this relates to the use of HT. The proportion of HT users was higher among those with more stress and hostility and less optimism and sense of coherence than among those low in stress and hostility and high in optimism and sense of coherence. Differences in psychological behavior patterns influence the perception of menopausal symptoms and the use of HT. When the treatment of women at menopause is planned, psychological behavior patterns should be considered, as these reflect the ability to cope with menopausal symptoms.