Case:  A 15-year old girl has suffered from progressive premenstrual emotional disturbances ever since her periods began 3 years ago.  Approximately one week prior to each menses her anxiety levels would rise and she would become more irritable and labile.  This would interrupt her ability to fall asleep.  As her period approached her moods would decline up until the first day of her menses when extreme relief would come and she was back to her normal self, fearing the next go around 28 days later.  During her freshman year at high school several events conspired to distress her more and more and began to socially isolate her.  Events in turn began to involve her parents, and misunderstandings arose between them.  Doctors tended to minimize her problems, telling her this was normal in teenage girls.  This progressive burden of stress added to the suffering that the PMS would cause her so much so that she eventually jumped off a bridge in a suicide attempt one day a week and a half before her next period, because she saw no way to stop the impending suffering that had grown too much to bear.  After this she was put on progressively higher doses of an SSRI, which caused her depression and suicidality and wildness to evolve into a continuous pattern from the PMS pattern.  She begged to be taken off the SSRI and eventually this happened in a hospital, and after a week or so of detoxification and the onset of her next menses, she appeared in my office with her parents on day 3 of her cycle, feeling quite like her normal self and refusing to ever take medications again.
A Neuroendocrine consultation led to the hypothesis that a family history of both mood disorders and significant PMS and post partum depressions in her female ancestors rendered her brain sensitive to the emotional modulating effects of her reproductive hormones – estrogen and progesterone.   Like many before her in related situations, she was prescribed natural progesterone, with doses every 8 hours from day 14 through day 28 of each menstrual cycle, and with a taper into each new cycle. 

In her first menstrual cycle on the progesterone, up to 300mg 3 times per day, she experienced a dramatic resolution of her anxiety and her sleep improved greatly.  She made it through her menses without severe depression and decided to try progesterone, 200mg, 4 times per day in the next cycle with a positive attitude for the first time in years relating to her menses