Can hormonal shifts fuel conversion from a potential to a florid mental disturbance, from what's calld a prodrome to a disease?  Edie's experience tells the story. 

Throughout her life Edie had been noted for her brilliant, indeed mercurial personality, but she had never experienced psychiatric problems.  A professional woman, she ran a thriving business & was highly sought after professionally.  Everything was rosy in Edie’s garden until she approached age fifty.  It all started quietly enough with the arrival of hot flashes that became severe enough to disrupt Edie’s sleep cycle.  Naturally she approached her gynecologist for some form of hormone therapy but he demurred, citing the dangers of HRT as revealed by the women’s hormone initiative study (WHIMS).  Instead he treated her with an SSRI type of antidepressant drug.  When this didn’t help he reluctantly placed her on a low-dose estradiol patch along with a compounded trans-dermal progesterone cream in what was probably an excessive dose, so that the ratio between estradiol & progesterone was quite low.  
Edie’s flushing & insomnia worsened despite continuing both the hormones & the antidepressants.  Her mercurial personality became downright volatile & she simply couldn’t slow down or sleep unless she took the sedative drug, Ativan.  Edie’s agitation & mood swings became severe, prompting her emergency admission & three week stay at the psyche ward of a local medical center, with a diagnosis of bipolar disorder.  It was notable in this regard that two of her siblings had previously been diagnosed with this serious disorder at a younger age than she, & significantly they were males, liberally supplied with male or androgenic hormones.  In contrast, Edie’s androgens had been effectively blunted by her estrogens until she approached menopause & her estrogen supply dipped & flagged, perhaps in the process unleashing the activation of her bipolar-prone brain circuits.  
Edie’s psychopharmacologists quickly got to work & she ended up on rather generous doses of Lamictal & the anti-psychotic drugs Geodon & Seroquel.  On this regimen Edie became extremely sluggish & depersonalized, yet her mania continued unabated.  She reminded me of what happens when your car is in second gear but you are driving too fast for it.  Your mind races, - slowly.  And Edie’s business also slowed way down; in fact she almost lost it.   
Finally Edie saw me, not for mental health reasons but for the purpose of clarifying whether it was okay to take hormones, given the negative publicity surrounding HRT.  I reassured her that that hormone therapy could be safe when applied expertly, avoiding oral hormones, fine-tuning the dose to fit the individual & minimizing hormonal flux.  What Edie did not anticipate however, was my suggestion that optimal hormone therapy might help her with the mood disorder that was ruining her life.

Blood tests showed that Edie’s testosterone level was well below even the female norm & her blood pressure was somewhat elevated despite treatment with an ARB type of anti-hypertensive drug.  I needed to establish an idealized estradiol dosage while minimizing the amount of hormonal flux involved because estradiol patterns, whether stable or erratic have a significant effect on Protein Kinase-C (PK-C).  I already knew that the mechanism which allowed Lithium to benefit bipolar patients was by having a stabilizing PK-C effect, so it followed that PK-C stabilization would be critical to controlling Edie's moods.  
In Edie’s case this meant using an estrogen patch dosage that was greater than the maximum one recommended, because it was clear that Edie’s body excreted estradiol faster & more efficiently than the average woman.  I also persuaded her to get a Mirena IUD because this product delivers enough progestin to the uterus so as to prevent thickening of the uterine lining while delivering the minimal amount of progestin to the rest of the body, including the brain.  Thus Edie's new regime would involve a high rather than a low ratio of estrogen to progesterone, as had previously been the case.        
Edie’s conventional gynecologist was appalled that I would prescribe such a generous dose of estrogen when the prevailing politics of menopause promoted using as little estrogen therapy as possible & for as little time as possible.  And he didn’t care for the use of Mirena either, feeling that oral or trans-dermal cream forms of progesterone would be preferable, but the good news was that now, for the first time in a year, Edie was no longer manic, and she started, in cooperation with a newer psychiatrist I had found for her, to reduce her psychoactive drug treatments.  
It took Edie about 6 months but she finally eliminated the Geodon & the Lamictal completely while reducing her Seroquel dosage to a minimal level, taken at bedtime for her insomnia.  Now Edie’s business venture is back on track, and she is alert, coherent & non-manic.  One of these days I will tweak her cortisol levels & perhaps we can eliminate her psychoactive drug therapy all together.