Intervention: Estradiol
Trial phase: Phase 2
ATC code: G02BB01 | G03AA14 | G03AA17 | G03AB08 | G03CA03 | G03CA53 | G03EA01 | G03EA02 | G03EA03 | G03FA01 | G03FA02 | G03FA03 | G03FA04 | G03FA05 | G03FA06 | G03FA07 | G03FA08 | G03FA09 | G03FA10 | G03FA11 | G03FA12 | G03FA13 | G03FA14 | G03FA15 | G03FA16 | G03FA17 | G03FB01 | G03FB02 | G03FB03 | G03FB04 | G03FB05 | G03FB06 | G03FB07 | G03FB08 | G03FB09 | G03FB10 | G03FB11 | G03FB12 | G03HB01 | H01CC53 | H01CC54
SMILES: [H][C@@]12CCc3cc(O)ccc3[C@@]1([H])CC[C@]1(C)[C@@H](O)CC[C@@]21[H]
Sex: Female
Age groups: Adult | Older Adult
Healthy volunteers: Accepts Healthy Volunteers
Participants at risk: 2
Group description: Estradiol: Oral estradiol 1.0 mg/day for four weeks.
Eligibility criteria:
Inclusion Criteria:

Healthy women ≥40 years-old
Early postmenopausal, defined as:
No menstrual bleeding for 12-60 months secondary to natural menopause, according to STRAW criteria48
Hysterectomy without bilateral oophorectomy if surgery was completed after 6+ months of amenorrhea (no maximum duration of amenorrhea required)
Bilateral oophorectomy (no minimum or maximum duration of amenorrhea required)
Serum follicle-stimulating hormone (FSH) >25 IU/L and estradiol <20 pg/ml
Diagnosis of major depression on the MINI
Mild-to-moderate depressive symptoms, as indicated by MADRS score 15-31 and BDI score >15
Normal mammogram within the past 2 years
Good general health

Exclusion Criteria:

Severe depression, defined as a MADRS score >31, psychotic symptoms, or suicidal or homicidal ideation

Psychiatric illness, as defined by clinical interview and the Mini-International Neuropsychiatric Interview (MINI), as:

A lifetime history of bipolar disorder
A lifetime history of severe depression, as characterized by current or prior psychotic symptoms, inpatient psychiatric hospitalization or a suicide attempt in the previous 5 years, or
Current panic disorder or obsessive compulsive disorder
A lifetime history of psychotic symptoms
Current anorexia nervosa
An alcohol or substance-use disorder active within the past year
Current suicidal or homicidal ideation
Previous diagnosis of a sleep disorder (sleep apnea, PLMS, etc) or diagnosed on a screening PSG study
Pregnant, confirmed with serum ß-HCG at baseline (Visit 1)
Breastfeeding
Contraindication, hypersensitivity, or previous adverse reaction to E2 therapy
Current or recent (1 month) use of centrally active medications (antidepressants, anxiolytics, hypnotics, anticonvulsants, stimulants)
Current or recent (2 months) use of systemic hormone medications
History of breast cancer, premalignant breast lesions, or undiagnosed breast mass
Vaginal spotting or bleeding
History of thrombo-embolism, cardiovascular disease, congestive heart failure or other contraindication to estradiol therapy.
Liver dysfunction or disease
Renal insufficiency
Contraindications to progestin therapy
Asthma, diabetes mellitus, epilepsy, and migraine disorders that are not stable and under medical management
Other medical contraindications to estradiol and progestin therapy including porphyria, systemic lupus erythematosus, hepatic hemangiomas, deep vein thrombosis, hereditary angioedema, hypertriglyceridemia, severe Hypocalcemia.

Clinically significant abnormalities in screening blood tests including:

Thyroid-stimulating hormone <0.50 or >5.0 uU/mL)
Shift workers