Q: Wife's Episodes Coincide w/ Menstrual Cycle|
My wife (30) has been diagnosed with BPII with Psychotic episodes. We have been
married almost 8 years and I always thought her mood swings were PMS related.
She has had multiple ovarian cysts which she had to have laperoscopy surgery and
was diagnosed with endometriosis.
We had to go on clomid to give birth with two of our three kids. We concieved
our third child without help but she has had consistent abnormal menstrual
cycles. I saw your article "Does BPII cause menstrual cycle changes" She
continues to have episodes once a month (almost like cycling) but it coincides
with her period almost every time. What can be done to take the hormones out of
the picture and just deal with the BP disease? Otherwise, how is the PDOC
supposed to know what dosage she should have for her meds?
Dear Mr. B' --
1. What can be done to take hormones out of the picture? I've not seen
research on this, although I'm sure we're going to have some on this topic
soon. Meanwhile, one of my local colleagues, an OB/GYN/endocrinology
specialist, is of the opinion that "stabilizing the hormonal environment" can be
helpful, and a couple of my patients have benefited from seeing him for
consultation (that's Dr. Doug Austin in Eugene, OR; in case anybody was
wondering). His general strategies are:
a) low dose birth control pills, with no withdrawal
phase; i.e. no "placebo" pills, just steady same-dose use;
b) relatively low dose estrogen, almost always combined with progesterone in
women who've not had a hysterectomy;
c) GNRH antagonists (e.g. "Lupron") which block the signal from the
hypothalamus that maintains menstrual cycling; and if that works:
I had one patient who after the ovarectomy was
dramatically improved, and he has described several such women to me, including
one who had a diagnosis of "borderline
personality disorder" which remitted after ovarectomy.
2. Meanwhile, what's the Pdoc' to do? I generally
increase the mood stabilizers when I see symptoms, which were monthlong before,
now appearing only just prior to menses. That seems to work most of the time.
It's as though she's just a little too close to still cycling and so does, but
only when the changes in reproductive hormones are driving the cycling right at
the end of the menstrual cycle. Often women in that situation will also have
mood symptoms with other, minor, stimuli like mild sleep deprivation, or even
moderate alcohol use -- again, suggesting that she's just a little too close to
the edge of "stability".
Hope that helps.
Published October, 2002