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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by chiron on June 30, 2007, at 0:33:00
I was just reading how women with bipolar II react negatively to birth control pills, as do most with mental health issues that are already sensitive to hormone fluctuations.
I know when I tried Trivora-28 and Ortho-Cyclen years ago I had horrible constant pms.
My dr. is suggesting I try Yaz to see if I can ease some of the horrible pms and hormone stuff. I have talked to friends that have found some pills to be helpful, and they say that it is a trial-and-error thing.
Has anyone found that a certain birth control pill helped with pms, or even during the month? If so, what is your diagnoses and what pill is it?
Posted by revaaron on July 4, 2007, at 0:45:49
In reply to Mood Disorders and the Pill, posted by chiron on June 30, 2007, at 0:33:00
Full disclosure: I'm not a woman, but I've had a fair bit of experience with women and birth control and my knowledge comes largely from my wife's experiences, but also from another four women with whom I've lived with at the time they went on some started some form of hormonal BC, usually the pill.
I don't know if this happens to all women, each one of the 5 women I've known pretty intimately (one gf then wife, the rest were very good friends with whom I lived with) had pretty severe emotional problems going on hormonal BC, and also coming off of it again.
The general trend that I've seen repeated in my wife over and over again and also with the women I've lived with who have been on more than one form of BC seems to be that the less hormone you get, the better off you are. The amount of hormone you're taking in to get the effects of BC isn't relevant in its effectiveness at preventing birth (unlike most medications), but it does affect how you feel when you're on it.
My wife has been on these over the years in this order: Norplant (implant), NuvaRing and most recently an IUD. The IUD has been by far the best as far as side effects are concerned. She just had it removed 3 months ago- we're going to try for a kid!
First, she tried the Norplant, which is a set of 5 small glass tubes containing a hormone that is slowly leeched out into your bloodstream. With the Norplant there were some pretty extreme changes to her personality. She's an INTP, and much less emotional than most folks in a lot of ways, but when she was on the Norplant she was way more emotional, more prone to worry, more prone to emotional over-reaction, more anxiety, and generally meaner. She went from being a non-cryer to someone who cried much more. I noticed this as she started it, but I chalked it up to some other issues which were going on at the time, and I imagine there was some synergy there. But when she had the Norplant taken out there was another change in her personality and mood. It was rough for a spell, less so than when she first got the NorPlant but still signifigant. By this time we had both done some research and knew that these kind of reactions are possible, though the way the doctors talk and the literature reads these are rare side effects. Maybe they are, but I've seen the same kind of changes in every woman I've lived with in their day to day demeanor. My wife figured this out, and in addition to the personality effects I describe she talked a lot about how when she was on Norplant she was a lot more stressed out and had a strong overall 'brain fog' that she had a hard time dealing with sometimes. This seemed to disappear when she got rid of the Norplant. She was on the Norplant for 5 years, which is the normal amount of time.
She then started NuvaRing, which she described as being better than the Norplant, but still far from good. She was on Nuvaring for a few years. During the Norplant and NuvaRing there were also sexual side effects- decreased desire, she'd often get more anxious and stressed in bed than she was before, she'd often want to stop in the middle of making love, sometimes ending up crying. It wasn't me hurting her, but she didn't have anything concrete to pin it on either. The sadly ironic thing is that during these years (most of our relationship) we had sex pretty rarely between these issues and others (my lower libido, our poor sexual communication), yet it was the reason she was on these nasty medications.
She has always had a really strong monthly flow. I can't remember that far back all that well as far as her periods are concerned, but during the Norplant years she still had her period, her flow was not as bad as it was before Norplant, but it still could be pretty bad at times. Her cramps weren't as bad, but she still had cramps.
During the NuvaRing period (no pun intended) she probably had the lightest flow and the least painful cramps out of the three BC methods she has been on. I'm not 100%, but I think toward the end of the NuvaRing period, she would often not have a monthly menstration, though there would usually be other stuff going on during her period.
The best setup so far for both of us has been the IUD they sometimes call the Intra-Uterine System, which is a IUD made of plastic (I think) that contains a progestogen called levonorgestrel. One of the big reasons she decided to try the IUD was that the amount of progestogen it delivers is an order of magnitude (10x!) less than with oral contraceptives, and less than half of NorPlant, Depo, and NuvaRing. We determined this by researching the increases in the serum levels of hormone with the available options. The hormonal IUD was really promising because it is basically a local contraceptive- it works by getting the progestogen hormone to where it needs to be rather than flooding the entire body.
Since she started on the IUD there have been many, many improvements, some pretty dramatic. She's begun to enjoy sex again, it no longer seems to hurt physically and mentally like it did sometimes before. Her desire is up. As an external observer I can tell you she is happier, less anxious and stressed, a lot more sociable and is enjoying life more than she did during the Norplant and NuvaRing periods. She has never been on any sort of medication (SSRI or other antidepressant, anti-anxiety) to treat the side effects of the contraceptives.
She has cramps again sometimes, but in severity and frequency, a ton less than she did with the Norplant and with no BC. She has her period more often, but the flow isn't like it was in the pre-BC or Norplant days. Sometimes she still doesn't, I think. She had some acne with the Norplant and NuvaRing, but it pretty much disappeared with the IUD, which made her quite happy.
We were incredibly happy with how well the IUD worked and the low amount of side effects. One drawback to the IUD is that it took some doing for her to get her doctor to agree to one. She had done an incredible amount of research, and I had done some helping too, but when she went in the doctor said "no" at first, but after a lot of convincing and sharing of documentation the doctor agreed to it. The doctor said that some women were freaked out by the IUD insertion procedure- up in stirrups, someone's hand inside you putting this little thing into your cervix, cold metal etc etc. But for women having serious emotional or other side effects form hormonal BC I would seriously look into it. My wife said they ask if you want some sort of benzo before the procedure, because a lot of women tweak out, though she being the b*dass she is declined. I love that woman. Anyway, she had it inserted and more recently removed, both quickly and easily with no complications.
As far as PMS was concerned... with the IUD she pretty much doesn't have PMS. When she was on the Norplant and NuvaRing I always knew when it was that time of the month, even when there was menstration involved.
One note- like I said, she most recently was using an IUD that was plastic and had very light hormone doses- this is not the traditional IUD, which is based on around copper or silver and contains no hormone. She was really interested in the copper IUD because of the lack of mind-fogging hormone but decided against it because copper IUDs usually increase flow, and she's always had a really heavy flow as it is.
Also, from an outside perspective, there were no personality/emotonal changes when she had the IUD removed. There was before she started it, but she had to get off the NuvaRing for a time (month? weeks?) before they inserted the IUD. Norplant and NuvaRing definately had some funky adjustment periods when starting and stopping them.
The NuvaRing wasn't too bad, better than the Pill, but my wife says a lot of women are really weirded out by inserting something like the NuvaRing themselves, though you do it with your hands, not some mechanical instrument. Though she also tells me a lot of women are freaked out by tampons, so I guess it shouldn't surprise me. Don't get me started on menstral cups, I'm way too much of an advocate for some people's comfort. :)
If you want me to try and dig up the blood level numbers, I can ask my wife or redo some of the research, but the differences were pretty startling. Some it is referenced on Wikipedia. I'm no expert, but I can ask my wife who is definately a lay expert, if you have any questions that she might be able to answer better than I can.
After seeing these kind of side effects in every woman I've lived with who started birth control while I lived with them I can't help but wonder how rare these side effects are. I can't help but wonder how many women don't make the connection (we didn't for a long time!) and start treatment for these symptoms with SSRI or benzos. None of these women had any preexisting conditions for which they were being treated (anxiety, depression, bipolar, etc). I can't imagine having BPD and adding these sort of reactions on top of it. I think you'd have to be a strong woman not to flip out with both of these things going at once.
Maybe one day men will be able to get one of those injected polyeurethane plugs that are reversible with another injection. Cheap, easy, reversible and best of all- non-hormonal. *sigh*
good luck!
revaaron
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