Dr Natalie Crawford

And it actually works better than an SSRI.

So say she's on an SSRI and has done well.

She's had a long history of depression.

Suddenly, she's not controlled.

Suddenly, her symptoms are back and she's on the same medication rather than doubling or adding a second agent.

We really should be giving these women a hormonal therapy.

Now, that doesn't hold post-menopause.

So this is really a perimenopausal kind of window of opportunity.

In post-menopause, they aren't responding as well, and probably because the estrogen labels have stabilized.

So when we give a woman back—

You'll adapt.

So postmenopause, the menopause, that's why the suicide rates kind of peak in this key perimenopause area, we think.

And so in postmenopause, the hormone levels stabilize, so women tend to get better.

And so they do respond better to the SSRIs for new onset anxiety and depression in those patients.

So when we give someone menopausal dosed menopause hormone therapy in the form of estradiol, usually in a patch because you have that nice steady state, it is enough to feed back to that brain to calm down, but not enough to suppress ovulation.

So she's often giving estrogen support in very low doses.

And menopause hormone therapy is basically microdosing compared to what we do naturally.

And so we're giving enough to calm the brain down and stabilize what's happening in the brain without suppressing her natural ovulation.

Exactly.

Chaos.