Hormone driven mood disorders when the ovaries are ostensibly "normal."

In some cases like Janet's, our female patients suffer mentally because of ovarian diseases such as PCOS, where their hormonal disturbances are florid enough to warrant a diagnostic label, but what if diseases like that are simply not present, & the ovaries are technically normal?  Can supposedly normal ovaries, as they shift to a different level  during a woman's thirties, chemically drive the mood disorders?  Sally, after years of mental suffering, had decided to take matters into her own hands.  She  had heard that hormone therapy might benefit people like her, women suffering from severe mood disorders. Over the years she had tried a variety of psychiatric drugs, mostly antidepressants and particularly SSRIs, with little or no benefit & to boot they made her feel empty, drugged out and emotionless. The right hormones she heard, might do the opposite, lifting women out of lives of dogged survival into those of joyous celebration.
Her problems had begun in Sally’s early teens, triggered by the trauma of a brutal sexual molestation. She fell into a deep, long-lasting depression characterized by suicidal feelings, chronic insomnia, mood swings & depression. Suicide was attempted on several occasions. Quickly diagnosed with major depressive disorder, a “psychiatric” condition, she was even considered by some to be bipolar after treatment with one of the antidepressants & this prompted the use of mood stabilizers as well, to little or no benefit. As she matured however, she decided to fight back against her demons, and took up middle distance running. This activity more than anything else, helped her to reduce her “mental” problems to manageable proportions. Life wasn’t great, but it was tolerable and she functioned well at work, although her social life remained drab and limited, lacking greatly in emotions.
Living life in the small like this, Sally found she could keep a cap on things, using her mind to override her darkest feelings, and this is where she stayed until several years ago, when depression and suicidal feelings became large once again, despite continuing her exercise program and a healthy lifestyle. Now, thoughts emanating from the deep recesses of her mind came bubbling to the surface and nothing she thought of consciously could keep them down. Clinical psychologists tell me this is a common pattern for childhood victims, to decompensate emotionally when in their mid-30s although they have no theories as to the mechanisms involved. My suspicion however is that the explanation is a hormonal one, as most women’s patterns of ovarian hormones shift significantly in their mid-30s, leading to a greater degree of hormonal flux.
Finally in her mid-30s, Sally visited us on the recommendation of a friend and to cut a long story short, lab testing suggested a relative deficiency of estradiol and a greater than usual degree of estradiol flux. I treated Sally with a generous dose of estradiol using dot-matrix patches and gradually established an appropriate dose, adjusted to the level of her individual estrogen excretion-rate & thus tailored to her individual needs. Vaginal progesterone was used to protect her from irregular bleeding and uterine over-stimulation. After a year her major depression, which had been as high as an 8 on a 10 scale, was now completely absent and her suicidal ideations had utterly disappeared.  Sally now started dating for the first time in years & her personality, far from being blunted by psychiatric drugs as it used to be, had become far more colorful and vibrant.
Sally’s internist disapproved of my hormonal approach, stating that “psychiatric” problems should be treated only with psychiatric drugs. And she couldn’t understand how a pre-menopausal woman could be given estradiol supplements, particularly at a time when so many physicians were so biased against hormone therapy for the menopause thanks to the women’s health initiative study. She spoke about “standards of care” as if hormone therapy for women could be standardized according to a one-size-fits-all approach, and as if all pre-menopausal women possessed perfectly normal, absolutely identical degrees of ovarian function, an unrealistic, dualistic approach that could belong only in a black or white world of fantasy.
Modern medicine would say that Sally was the victim of a psychiatric disorder and that she required diagnosis and treatment only at the hands of a psychiatrist, on a psychiatric basis, implying it was all in her head.  In contrast, members of the alternative medicine community might foolishly insist that she was suffering from chronic fatigue, fibromyalgia, hidden hypothyroidism or adrenal exhaustion.
The reality in my opinion is that Sally experienced a mood disorder by virtue of the fact she had inherited depressive-prone brain circuits or that they had been activated by her youthful molestation.  Subsequently the interplay between age-related, subtle hormonal changes including a greater than usual degree of hormonal flux, operating directly on brain circuits or influencing them indirectly through the stress machinery of the hypothalamus, amplified these problems once the patient had reached her 30s. Clearly to my mind since hormones contributed to their activation, it seemed that altering her hormones, specifically increasing her estrogen/progesterone ratio, might  effectively put them back under wraps, thus naturally controlling her mood problems, and that’s exactly what they did, not just marginally but dramatically.  Now if hormonal shifts in a woman's thirties have the power to provably drive emotional disturbances, how about the more dramatic shifts of menopause?