Content warning: This story includes references to suicidal ideation.

Lisa Schrenk didn’t know it yet, as she trudged down a dirt trail last August, but her life was about to change.

She’d set out late the night before with her hiking group, scrambling up Virginia’s Old Rag Mountain in darkness. They reached the peak in time to watch the sun rise over the Blue Ridge range. Afterward, the women snapped photos. In one, Schrenk gazes out over the horizon, her long dark hair pulled into a ponytail. The image is deceptively triumphant. In reality, she had been contemplating suicide. Schrenk, a longtime IT specialist for the federal government, had started setting aside belongings for friends and family, organizing her financial affairs, and clearing out her office.

Her hallelujah moment didn’t happen at the summit. It started on the way back down, when she overheard her fellow hikers talking about hormone therapy. One described how she’d suffered from intense anger, anxiety, and exhaustion until she’d started a course of hormones typically offered to people in menopause. Now, she was thriving. “I was like, oh my God,” Schrenk remembers. She was hearing some of her own symptoms listed out. Could this be the answer to her problems, too?

Schrenk had already tried to persuade her primary care physician to consider hormone therapy because she suspected that her treatment-resistant mood issues might be linked to a hormone imbalance. As someone in her early forties, she was potentially approaching or in perimenopause, when the ovaries gradually stop making reproductive hormones, with estrogen levels often fluctuating erratically along the way. (Until recently, hormone therapy was widely referred to as hormone replacement therapy, or HRT.)

But Schrenk was already taking one of the most common treatments for perimenopause symptoms—an oral contraceptive containing synthetic versions of the hormones progesterone and estrogen. Her doctor dismissed the idea of switching her to hormone therapy, which sometimes delivers “bioidentical” versions of the same hormones, often in lower dosages. Undeterred, Schrenk had then gone to two different gynecologists. “Automatic no,” she says. One had acceded to switching Schrenk&rsquo...