Estrogen Variability and Irritability During the Menopause Transition

Study Overview
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Brief Summary
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Women in the menopause transition (perimenopause) experience substantial day-to-day variability in estradiol and have a 2-4-fold increase in major depression risk. About 40% of perimenopausal women are susceptible to the emergence of affective symptoms tied to changes in estradiol. Among the perimenopausal women with affective impairment, most report irritability, not depression, is their primary source of impairment and distress. The purpose of this research is to determine the neurophysiologic basis of susceptibility to estradiol fluctuations and irritability symptoms in perimenopausal women.

Detailed Description
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Using a within-subjects, cross-over design and transdermal estradiol to stabilize estradiol fluctuations (and increase levels) the investigators will test if neural dynamics (oscillatory activity in the theta and beta frequencies assessed via EEG) associated with key constructs of irritability (attentional bias to threat and frustration to non-reward) represent a biomarker target of irritability symptom response to transdermal estradiol.

Official Title
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Identifying Neurophysiological Mechanisms of Susceptibility to Estradiol Fluctuation and Irritability Symptoms in the Menopause Transition: An Experimental Approach

Conditions
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Menopause, Irritable Mood

Intervention / Treatment
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* Drug: Estradiol Patch, 0.1 mg/24 Hours Weekly Transdermal Film, Extended Release
* Drug: Placebo
* Drug: Progesterone 200 mg


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy women 45 - 59 years of age In the early menopause transition (defined by variable menstrual cycle length that is 7+ days longer or shorter than usual) Increase in irritability since the onset of menstrual cycle changes Moderate to severe irritability symptoms, as defined by IDAS ill-temper scale score >10 Have experienced 1+ very stressful life event (e.g. divorce, death of family member) within the past 6 months Negative mammogram within the past two years BMI between 18 - 45 kg/m^2 Exclusion Criteria: Use of psychotropic agents or hormonal preparations, or herbal supplements (other than multivitamins) believed to affect mood or menopausal symptoms History of psychosis, bipolar disorder, or substance dependence Active psychological symptoms severe enough to require treatment Current suicidal intent or recent history of suicide attempts (within past 10 years) Personal or family history of cancer indicative of more than average risk for breast, ovarian or endometrial cancers Personal history of any cardiovascular disease including coronary artery disease, arteriosclerosis, heart attack, stroke Personal history of thromboembolic disorders History of E2-dependent neoplasia History of gallbladder disease Recent history of migraine with aura Blood pressure classified as higher than stage 2 hypertension (≥160 mmHg systolic or ≥100 mmHg diastolic) Liver dysfunction or disease Undiagnosed abnormal genital bleeding Type I diabetes Known sensitivities to the matrix patch system in Climara® or allergy to peanut oil used in Prometrium®

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 59 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Estradiol, Then Placebo<br>Participants will first receive 0.1 mg/day of transdermal estradiol patch for 3 weeks. After a washout period of 3 weeks, participants will then receive transdermal placebo patch (matching transdermal estradiol 0.1 mg/day patch) for 3 weeks. Upon completion of the second intervention, all participants will receive 200 mg/day of progesterone for 10 days. | Drug: Estradiol Patch, 0.1 mg/24 Hours Weekly Transdermal Film, Extended Release<br>* 0.1 mg/day transdermal patch administered for 3 weeks<br>Drug: Placebo<br>* Estradiol-matched placebo patch administered for 3 weeks<br>Drug: Progesterone 200 mg<br>* 200 mg tablet administered by mouth once per day for 10 days after completion of the experimental phase of the study<br>* Other names: Prometrium;|
| Experimental: Placebo, Then Estradiol<br>Participants will first receive transdermal placebo patch (matching transdermal estradiol 0.1 mg/day patch) for 3 weeks. After a washout period of 3 weeks, participants will then receive 0.1 mg/day of transdermal estradiol patch for 3 weeks. Upon completion of the second intervention, all participants will receive 200 mg/day of progesterone for 10 days. | Drug: Estradiol Patch, 0.1 mg/24 Hours Weekly Transdermal Film, Extended Release<br>* 0.1 mg/day transdermal patch administered for 3 weeks<br>Drug: Placebo<br>* Estradiol-matched placebo patch administered for 3 weeks<br>Drug: Progesterone 200 mg<br>* 200 mg tablet administered by mouth once per day for 10 days after completion of the experimental phase of the study<br>* Other names: Prometrium;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean IDAS Ill Temper Scale Score Over Time | The 5-item ill temper scale of the Inventory of Depression and Anxiety Symptoms (IDAS) will be the primary measure of irritability symptom severity. Each symptom item is rated 1 (not at all) to 5 (extremely). The total IDAS ill temper scale score may range from 5-25. Higher scores indicate more severe irritability symptoms. The average daily irritability (IDAS) score over 1 week (7 days) will be assessed at baseline (Week 4), the last week of Condition 1 (Week 7), and the last week of Condition 2 (Week 13). | up to Week 13 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Theta Oscillatory Activity (4-8 Hz) In Response To Dot Probe Task (Indexing Threat) Over Time | Participants will complete the Dot Probe Task while EEG is recorded to examine brain responses (theta oscillations) to threat. During the task, participants will be presented with a pair of faces on each side of the screen. In anger trials, one face is angry and the other is neutral. The pair of faces is followed by an asterisk, half of the time presented on the same side as the angry face and half of the time presented on the side of the neutral face. Trials will be angry-neutral, happy-neutral, and neutral-neutral. Theta recorded at the frontal midline electrode during the different task conditions will be assessed at baseline (Week 4), Condition 1 (Week 7), and Condition 2 (Week 13). | up to Week 13 | 
| Beta Oscillatory Activity (13-30 Hz) In Response To Affective Posner Paradigm (probing Frustration) Over Time | Participants will complete the Affective Posner Paradigm while EEG is recorded to examine brain activity (beta oscillations) during frustrating task events. The Affective Posner Paradigm is a reward task designed to measure frustration to non-reward, consisting of three runs with varying degrees of reward as the participant performs the task. Beta oscillatory activity during the three task conditions will be assessed at baseline (Week 4), Condition 1 (Week 7), and Condition 2 (Week 13). | up to Week 13 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Perimenopause, Menopause transition, Estrogen, Stress, Mood, Irritability