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This is your brain on hormones. This is your brain off hormones. This is your brain just right. Sounds like Goldilocks? There's a new treatment for postpartum depression that aims to make this better.

About one in seven women will suffer from postpartum depression. This isn't just a couple of days of feeling overwhelmed with the baby blues, something most of us felt in the weeks after a baby is born. This is overwhelming depression and inability to care for oneself and one's newborn. Neuroscientists have always been interested by the effect of sex steroids on the brain, estrogens, progestin, and testosterone. Those of us who practice reproductive endocrinology like me have a particular interest in progesterone and its metabolites, the molecules that the brain makes out of progesterone.

Progesterone and its brain metabolite allopregnanolone seem to make the brain less irritable. And falling progesterone at the end of the menstrual period may have a role in PMS in some vulnerable women. Progesterone is the most abundant hormone in pregnancy and some think that dramatic drop in progesterone after birth may have a role in postpartum depression.

For most women with postpartum depression, it seems to go away in weeks to months, but some women benefit from talk therapy or the usual antidepressants. But that can take weeks for a measurable difference. Until now, the therapies focused on postpartum depression have been based on the same principles and medication as depression that happens to men and women who haven't been recently pregnant. However, looking at the link of falling progesterone and its brain metabolite allopregnanolone, some researchers have wondered if administering allopregnanolone to women with severe postpartum depression who aren't benefiting from regular therapy might be an approach.

A pharmaceutical company has created allopregnanolone in the lab and call it Brexanolone. The research focused on women with severe postpartum depression who are randomized to a 60-hour infusion of Brexanolone or placebo. The women were within six months of giving birth and had experienced depression within a month after delivery. These women were very depressed. Starting out with an average score of 28 out of 30 on a standard depression scale, that's really depressed.

After the infusion, right after the infusion, not weeks later, women who received the Brexanolone had an average score of nine to 10. And women who received placebo had an average score 14. That meant that placebo works which we know from all studies of antidepressants but the Brexanolone worked better. Twice as many women who received the study drug had scores similar to non-depressed women than women who received placebo. The effect lasted for up to 30 days and maybe longer. And this might be enough for other therapies to take hold.

It has some drawbacks. One is that the infusion has to be done in a hospital setting as one in eight women had dizziness and several women temporarily lost consciousness, passed out. The drug itself has an average cost of $34,000 but there may be some ways that insurance or rebates from the drug company might help. And there is the cost of the infusion in the hospital-based monitoring.

The pharmaceutical company is currently studying an oral form of this hormone though they don't call it a hormone. It looks and acts like a naturally occurring hormone allopregnanolone and that's made in the brain, so I call it a hormone.

The most important aspect of those women who had this treatment is that it worked so quickly. We're all concerned that women with postpartum depression get diagnosed, get into treatment, get family support, and get the best therapy. The consequences for the new baby and for the family of a mom who's withdrawn and possibly suicidal is very significant.

So, this therapy isn't necessarily for all women with postpartum depression but for women for whom regular treatment isn't working and who are struggling to care for themselves or their baby. It's an innovative approach and it's good news for the women, their babies, and their families who are struggling at a pivotal time of their lives. So, take care of yourself and your baby. Get help if you need it. There's new stuff on the way. And thanks for joining us on The Scope.

Dr. Jones: All of us who've had menstrual periods know that we feel a little different in our bodies in the days around the start of our periods. We have what is called catamenial symptoms, symptoms around the period, but sometimes something big happens. This is Dr. Kirtly Jones from of obstetrics and gynecology at University Health Care and we're talking about catamenial catastrophes today on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women Health, with Dr. Kirtly Jones, on The Scope.

Dr. Jones: The hormonal events at the start of the period are a big deal. Estrogen and progesterone levels made by the cyst that created the egg for that month were high the week before the period. If no pregnancy happens, these hormones drop rather quickly and that signals the uterus to make prostaglandins, a chemical that causes the uterus and the blood vessels in the uterus to contract and that starts the period.

These are normal and natural events, but they may cause cramping and occasionally nausea and vomiting and diarrhea, sometimes even fainting. But for some women with other medical problems, the drop in hormones and the rise in prostaglandins can exacerbate other conditions. Asthma and seasonal allergies can get worse. Some skin conditions, including eczema and hives can get worse around the pre-menstrual time.

But I use the word catamenial catastrophe and I made up that term, for things that can really go wrong and here are a few. Catamenial migraine, now this is really pretty common. About 15% of women have migraine and many of those women have predictable migraine with their periods. Catamenial migraine may be triggered by the change in hormones, or it may be the prostaglandins. For some women, it's the only time they have migraine. Migraine is one of those headache conditions that tendsto get better after menopause. No more periods, but for migrainers, that's the name of someone with a migraine, the monthly migraine can be very disruptive.

Catamenial epilepsy, seizures that occur just before or on the first day of the period. This happens to women who usually already have a seizure disorder, but they predictively have seizures about the time of their period. There are some women whose seizures start in adolescence when their period started, and some people have all of their seizures controlled with medications, but just not the ones that happen when they have their period.

Catamenial pneumothorax, this is a biggie. A pneumothorax is when there's a hole in the surface lining of the lung that lets air out underneath the ribs. With each breath, the air is trapped, making the lung get squished smaller and smaller. We're not exactly sure why this happens, but it can be associated with endometriosis on the surface of the lung that bleeds when the period starts and makes a hole for the air to leak out. Compared to the first two catastrophes, this one is rare and it can really be a catastrophe, requiring medical intervention to get the air or blood that's compressing the lung. Rare means about one in 100,000 women per year and that's really pretty rare.

Catamenial anaphylaxis, now, anaphylaxis is an acute reaction that is usually allergic that can cause hives, itching, swollen airways and difficulty breathing, low blood pressure and fainting. Catamenial anaphylaxis is really rare and it isn't probably an allergic reaction, but it is a reaction to the prostaglandins made by the uterus, which is also made in the ordinary kind of anaphylaxis. This is so rare, it hasn't been studied much.

If you think you have a big problem associated with your periods, who should you see? Your doctor who's helping you with your migraine, seizures, pneumothorax or anaphylaxis should consult with an OBGYN, preferably a reproductive endocrinologist, omeone who specializes in women's hormones. Together, they can figure out if it's really consistently related to the periods. Often, women say, "Oh yes, it happens before my periods and during my periods and after my periods."

For women with a 28-day cycle, that means it happens all the time so that's not really period-related. In some cases, it's appropriate to stop the periods and there are several hormonal ways of doing this. The good news is that once the connection is made between the period and the catastrophe, there are a number of options available. It makes cramps and crabbiness seem not so bad, huh? It makes the menopause sound better and better every day.

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