Birth control pills and bipolar symptoms
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Birth control pills and bipolar symptoms

Q: Can there be a corolation between bipolar symptoms and the birth controll pill? Can the pill induce symptoms that would not be there otherwise- or perhapsamplify an already unstable mood? Can you tell anything from a blood test- likeif hormone levels are normal?

Dear Jen --
Although there is very little written about this in the bipolar literature, I'm sure I've seen it.  The OB doc's and primary care doc's know that some women can't tolerate birth control pills because they get "too anxious".  I've always wondered if that was related to bipolar disorder as many women I've treated who clearly had bipolar disorder report that this was their experience when they took birth control pills. 

But, a) it doesn't happen to all women who have bipolar disorder, many of whom do fine, and some of whom seem to do better in terms of mood stability; and b) while having a "total hysterectomy", meaning ovaries removed too, certainly has a big hormonal impact, and seems to be the point at which some women start to have a lot of symptoms (after all, it's called "surgical menopause") -- yet there are women, I just saw one last week, who do better after such a surgery (although we had to lower her estrogen replacement patch, because until we did so, she was having her same old mood instability). 

So you can see that this area is almost a complete puzzle.  What makes some women worse makes others better -- figure that out.  Finally, nope, there's nothing you can usually tell about this from a basic lab test.  There are too many hormones to go on a goose chase looking for the "abnormal one", for one thing (prolactin, DHEAS, 17OH-progesterone,cortisol, thyroid stimulating hormone, thyroid itself, estrogen, progesterone, insulin, FSH, LH  -- all are relevant in some circumstances).  And it has been well-demonstrated that "PMS" is caused by "normal" levels of hormones interacting with something abnormal in the central nervous system -- so in general, the place to look is in the brain more than in the hormones themselves.  That said, there are some conditions where measuring one or more of the above hormones is relevant.  For more on that, at least something temporary to go on while we learn more about this, read the "Hormones and Mood" section of my website.

Dr. Phelps 

Published December, 2000

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