Estrogen and Fear in PTSD

Inclusion Criteria:

1. Female, 18-45 years of age

2. Chronic (at least one month post-trauma) DSM-5 FULL PTSD diagnosis OR subPTSDdiagnosis (subPTSD defined as: meeting criterion A, F, G, H, and clusters B, C, andat least 1 of the clusters D or E.)

3. CAPS-5 Past Month score ≥ 20

4. Criterion A traumatic event

5. Stable medications for 3 or more months by the time of study entrance (with theexception of benzodiazepines)

6. Women on oral contraceptives, specifically those using monophasic or biphasic offirst, second, third or fourth generation with up to 35mcg of ethinyl estradiol; ORusing etonogestrel / ethinyl estradiol 0.120mg/0.015mg per day vaginal ring birthcontrol; OR using the norelgestromin / ethinyl estradiol 0.150mg/0.035mg per daytransdermal patch birth control.

7. Willing and able to provide informed consent

Exclusion Criteria:

1. Diagnosis of bipolar I disorder with a past year manic episode

2. Diagnosis of a psychotic disorder or psychotic symptoms that would interfere withthe ability to focus on posttraumatic stress disorder (PTSD) in clinic, asdetermined by clinical judgment.

3. Diagnosis of moderate or severe substance use disorder that would interfere with theability to focus on posttraumatic stress disorder (PTSD) in clinic, as determined byclinical judgment.

4. Cognitive impairment that would interfere with the ability to focus on posttraumaticstress disorder (PTSD) in clinic, as determined by clinical judgment.

5. History of neurological disease (that involves the brain), seizure, or significanthead trauma (i.e., extended loss of consciousness, neurological sequelae, or knownstructural brain lesion).

6. Suicidal ideation with imminent risk that warrants a higher level of care.

7. Concurrent trauma focused psychotherapy

8. Pregnancy (to be ruled out by urine ß-HCG).

9. Metallic implants or devices contraindicating magnetic resonance imaging byinterfering with patient safety or fMRI data collection. Cases will be cleared bythe Principal Investigator and/or Baylor College of Medicine (Imaging).

10. History of breast cancer or hormone-responsive cancer.

11. Use of benzodiazepines

12. Self-injurious behavior that involves suicidal intent, requires medical attention,or occurs daily.

13. High risk of adverse emotional or behavioral reaction, and/or an inability tounderstand study procedures or the informed consent process, based oninvestigator/clinician clinical evaluation (e.g., evidence of serious personalitydisorder, antisocial behavior, serious current stressors, lack of meaningful socialsupport)