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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Chris A. on April 3, 2002, at 0:38:38
Thanks in advance. Is an oophorectomy a reasonable choice for perimenopausal bipolar women whose mood symptoms are exaccerbated by hormonal shifts? The objective would be to be on steady HRT. We have tried many other options in the hormonal/BC category, including Yasmin. SSRIs cause my bipolar to cycle markedly, so they are not an option.
The surgery is scheduled for Monday, but I'm still considering chickening out.Thanks,
Chris A.
Posted by SLS on April 3, 2002, at 12:12:21
In reply to Kramer - Bipolar, Oophorectomy and PMDD, posted by Chris A. on April 3, 2002, at 0:38:38
> Thanks in advance. Is an oophorectomy a reasonable choice for perimenopausal bipolar women whose mood symptoms are exaccerbated by hormonal shifts? The objective would be to be on steady HRT. We have tried many other options in the hormonal/BC category, including Yasmin. SSRIs cause my bipolar to cycle markedly, so they are not an option.
> The surgery is scheduled for Monday, but I'm still considering chickening out.
>
> Thanks,
>
> Chris A.
Hi Chris.I'm sorry that things have come to this for you. Is it the drop of estrogen at the end of the cycle that is responsible for the mood fluctuations or is it progesterone? What are the mechanisms involved in the mood disturbanced being disrupted by your menstrual cycle. Are you a rapid cycler? I forget.
How did you respond to Yasmin?
I probably shouldn't be doing this to you with your surgery so close, but I did have a thought.
I am guessing that DHEA (dehydroepiandrosterone) can sometimes act as a buffer to offset fluctuations in estrogen. It is best used in combination with pregnenolone. Both are available at "health" food stores and the like.
Not for any reason in particular, but is there any history of endometriosis in your family?
How confident are you and your doctor that an oophorectomy will help? Isn't there a way to shut down the ovaries pharmacologically first to see if the surgery would help? I guess you and your doctor have explored these questions already. Do you know of anyone for whom this worked? I guess it makes sense anyway since you are perimenopausal.
How will you manage your female hormones after surgery?
I'm praying for you.
- Scott
Posted by Elayne on April 3, 2002, at 20:28:44
In reply to Kramer - Bipolar, Oophorectomy and PMDD, posted by Chris A. on April 3, 2002, at 0:38:38
Chris,
I'm wondering if your doctor put you on Lupron first to induce an artificial menopause for several months? If ovarian cycling is contributing to mood instability, then shutting down function this way should make a difference and help to predict the effect of surgical menopause. (A transient placebo effect is possible,of course, so predictive value isn't perfect.) Just a thought...
Elayne
Posted by Dr. Kramer on April 4, 2002, at 6:31:05
In reply to Kramer - Bipolar, Oophorectomy and PMDD, posted by Chris A. on April 3, 2002, at 0:38:38
> Thanks in advance. Is an oophorectomy a reasonable choice for perimenopausal bipolar women whose mood symptoms are exaccerbated by hormonal shifts? The objective would be to be on steady HRT. We have tried many other options in the hormonal/BC category, including Yasmin. SSRIs cause my bipolar to cycle markedly, so they are not an option.
> The surgery is scheduled for Monday, but I'm still considering chickening out.
>
> Thanks,
>
> Chris A.I really can't pass judgement on a treatment for a particular pt in this forum. Sounds like you've tried many things, and have gotten to this point in a considered fashion. Make sure you've talked to your doc about all your concerns.
Good luck, and be well.
Posted by judy1 on April 4, 2002, at 16:00:58
In reply to Kramer - Bipolar, Oophorectomy and PMDD, posted by Chris A. on April 3, 2002, at 0:38:38
If you decide to go with this procedure I hope it brings you the stability you have worked so hard for. I agree hormones can play havoc with bipolar, although I had a wonderful second trimester that I attribute to progesterone and then of course post partum when I fell apart. You have been through so much- just know my prayers are with you- judy
Posted by Chris A. on April 5, 2002, at 0:30:43
In reply to Re: Kramer - Bipolar, Oophorectomy and PMDD » Chris A., posted by SLS on April 3, 2002, at 12:12:21
Dear Scott,Thanks for your concern. You are a master of the inductive process! No cognitive impairment there. I'll have trouble answering all of your questions. The DHEA is something that I might have tried, but think I'll go ahead with the surgery. We decided against Lupron. I know why - am just unable to articulate the reasons. To say it's more drastic than surgery sounds ludicrous (sp), but it is something to that effect. Perhaps I should have a brain transplant instead. I suppose that the estrogen spike is when the mood is the most dysphoric. What we women have to go through so that all of you guys can be born.
Thanks for your prayers. They are always appreciated. You sound better. I hope that translates into feeling better. You are so caring around here.
Blessings,
Chris A.
Posted by Chris A. on April 5, 2002, at 0:39:46
In reply to Re: Kramer - Oophorectomy and PMDD-Tried Lupron? » Chris A., posted by Elayne on April 3, 2002, at 20:28:44
We discussed the Lupron option and ruled it out. My gyn felt it would make the bipolar worse. A respected primary care doc had suggested considering it, but hadn't ever used it on any patients herself.
Thanks,
Chris A.
Posted by Chris A. on April 5, 2002, at 1:09:09
In reply to Re: Kramer - Bipolar, Oophorectomy and PMDD, posted by Dr. Kramer on April 4, 2002, at 6:31:05
Thanks for replying. I do think that more needs to be done to guide women with mood disorders through the hormonal maze. Out of the five women I know in the 'real' world with bipolar, all but one have confessed that they decompensate significantly premenstrually. It isn't something that's being addressed in med school or residencies that I know of. It's hard to find literature on the subject even though it's common knowledge that it's a problem. SSRIs can be lethal for a subset of us. My Hubby gave me the most definitive advice: Get rid of the ovaries and get on a steady dose of HRT. When asked what he knows about such his reply was "Not anything I learned in medical school." After living with me he may be convinced that it's a major public health problem.
Thanks for going out of your way this week.
Chris A.
Posted by Chris A. on April 5, 2002, at 1:19:14
In reply to Just wanted to wish you well » Chris A., posted by judy1 on April 4, 2002, at 16:00:58
Thanks Judy. How are your hormones treating you? Give your little one a good snuggling for me. In perspective I would say that my three children are well worth all the "shifts" I've endured over the years. If this works, I'll get on a soapbox recommending it to all women with bipolar or PMDD who don't tolerate SSRIs and have completed their families. If it doesn't work..... Either way, I'm not terribly comfortable with the idea of giving up body parts. I am a bit nervous about the recovery.
You sound good. You are very courageous and I appreciate your encouragement.
Blessings,
Chris A.
Posted by SLS on April 5, 2002, at 10:13:03
In reply to Re: Kramer - Oophorectomy and PMDD-Tried Lupron? » Elayne, posted by Chris A. on April 5, 2002, at 0:39:46
> We discussed the Lupron option and ruled it out. My gyn felt it would make the bipolar worse.
Hi Chris.
Thanks for the kind words in your previous post. Your gyn's conclusion regarding Lupron is absolutely justified. I know someone with bipolar disorder for whom it wreaked havoc. Lupron is well-known to produce severe depression, including psychotic depression.
Some researchers have been looking at using NATURAL progesterone as a mood-stabilizer for women. I should think that it would work. I emphasize that it be natural because all of the synthesized ones are known to be depressogenic – the important singular exception being drospirenone, which is the progestin component of Yasmin. Progesterone has been shown to exert significant anticonvulsant effects, although it might be through the its active metabolite, 3 alpha, 5 apha-THP , that it accomplishes this (GABAA-benzodiazepine receptor activation). Don’t be too impressed, I looked it up while searching for material to corraborate my not-so-reliable rembering of the mood-stabilizing stuff (which now I can’t find).
For what it’s worth, I think you’re doing the right thing. Of course, I have been know to be wrong on rare occasions. :-)
- Scott
Posted by judy1 on April 6, 2002, at 0:56:19
In reply to Re: Kramer - Oophorectomy and PMDD-Tried Lupron? » Chris A., posted by SLS on April 5, 2002, at 10:13:03
Thanks for posting the info Scott- I used Lupron during an IVF cycle once and also experienced a psychotic depression. As for progesterone, I was curious why it worked (as I mentioned earlier, I felt great in my second trimester) thanks for explaining why. I agree this should be beneficial for Chris. Hope you are doing well- judy
Posted by Elayne on April 6, 2002, at 8:07:14
In reply to Re: Kramer - Oophorectomy and PMDD-Tried Lupron? » SLS, posted by judy1 on April 6, 2002, at 0:56:19
> Thanks for posting the info Scott- I used Lupron during an IVF cycle once and also experienced a psychotic depression. As for progesterone, I was curious why it worked (as I mentioned earlier, I felt great in my second trimester) thanks for explaining why. I agree this should be beneficial for Chris. Hope you are doing well- judy
Hi Judy,
Could you clarify for me... How were you using Lupron? It sounds as if you were trying to induce ovulation, right?
Elayne
Posted by judy1 on April 6, 2002, at 14:51:02
In reply to Re: Lupron reactions » judy1, posted by Elayne on April 6, 2002, at 8:07:14
Hi,
In an IVF cycle lupron prevents premature ovulation- so fertility docs use it for a period of time to suppress estrogen and androgen production, then come in with gonadotropins to stimulate the ovaries for maximum # of eggs. It's also used in women with severe endometriosis. Hope that helps- judy
Posted by Elayne on April 7, 2002, at 13:09:51
In reply to Re: Lupron reactions » Elayne, posted by judy1 on April 6, 2002, at 14:51:02
> Hi,
> In an IVF cycle lupron prevents premature ovulation- so fertility docs use it for a period of time to suppress estrogen and androgen production, then come in with gonadotropins to stimulate the ovaries for maximum # of eggs. It's also used in women with severe endometriosis. Hope that helps- judyJudy,
I'm wondering if your depression developed after gonadotropin stimulation or in response to the Lupron itself. What I'm trying to get straight is whether Lupron itself is the bad actor.If it's used alone (as in endometriosis or to shrink fibroids, say), it basically induces menopause. It's as close as you can come to surgical oophorectomy without having surgery. You can then add back estrogen at the low levels used in hormone replacement therapy. If a woman does well, then she might do well after surgical oophorectomy. If she doesn't, she can stop the treatment. But if she has an oophorectomy and doesn't do well, or has problems tolerating exogenous estrogen, the situation is a lot trickier. Does that make sense?
Elayne
Posted by Chris A on April 7, 2002, at 19:16:16
In reply to Re: Lupron reactions/gonadotropins » judy1, posted by Elayne on April 7, 2002, at 13:09:51
Elayne and Judy,
My gyn indicated that Lupron was a bad actor and he wouldn't even consider it for someone with a mood disorder. The immediate dramatic increase of estradiol followed by the drop off is the reason. Someone without a mood disorder might be able to tolerate it.I just talked to a friend with bipolar who had an oophorectomy (along with the rest) two weeks ago and is already feeling that the hormonal fluctuations may have contributed a lot to her mixed states/rapid cycling. She is doing well. I met her on this board about 2 1/2 years ago. One of those miracle stories.
In a month to six weeks hopefully I'll have a positive result to report.Thanks for all your support. Judy you can give your little one another hug for me.
Blessings,
Chris A.
(I haven't chickened out yet, but have another 13 hours to reconsider).
Posted by Elayne on April 8, 2002, at 7:27:07
In reply to Re: Lupron reactions/gonadotropins » Elayne, posted by Chris A on April 7, 2002, at 19:16:16
Chris,
My thoughts are with you today. Things sound very promising. I wish you a safe and speedy recovery.
Elayne
Posted by judy1 on April 8, 2002, at 19:23:29
In reply to Re: Lupron reactions/gonadotropins » Elayne, posted by Chris A on April 7, 2002, at 19:16:16
I was thinking of you today and hope your procedure went well. Please post and let us know when you feel up to it. (And I did give Gabrielle some extra hugs- thank you) Take care, judy
Posted by Chris A on April 15, 2002, at 19:32:54
In reply to Hope today went well » Chris A, posted by judy1 on April 8, 2002, at 19:23:29
Dear Elayne and Judy,
I appreciated your wishes. The anticipation of the surgery was actually worse than the real thing, and recovery is going well. Emotional pain can be worse than physical pain. Morphine can zap the physical pain rather rapidly. It's too bad there isn't such a solution for the anguish so many on this board go through.
Emotionally I have felt better in the last week than in a long time. It's hard to tell if it has anything to do with hormones. It could be that it is spring, and a bit of hypomania is creeping in. It could be that there is very little stress, as the gDoc issues "couch potatoe" orders, so I have an excuse to just read and sleep.
I've been trying to figure out the best HRT regimen. For the moment the gDoc is prescribing an estradiol transdermal patch. He says we can always make adjustments. I remember getting irritable and more depressed when adding progesterone in the past. A friend is trying to tell me that progesterone is in every cell of our bodies and we need it. Some remote part of my brain is trying to tell me that there are only limited receptor sites for it. Does anyone have the facts on this at their fingertips?
More hugs for Gabrielle and some for both of you too.
Blessings,
Chris A.
Posted by Elayne on April 15, 2002, at 22:21:44
In reply to Re: Hope today went well - It did, thanks!, posted by Chris A on April 15, 2002, at 19:32:54
Dear Chris,
I've been thinking about you and am delighted to hear you're doing well. I think transdermal estradiol is an excellent choice -- serum levels tend to be much more stable than they are when oral dosing is used.
I'm not sure about progesterone receptors, but I can tell you that women rarely seem to miss this hormone after oophorectomy if they have adequate estrogen replacement.
On the other hand, women who go through menopause naturally and have an intact uterus *must* use progesterone because unopposed estrogen increases the risk of uterine cancer. It's often very tricky to find a form of progesterone that's well-tolerated; and it's not at all rare to see mood problems caused by or exacerbated by progestins.
So...enjoy being a lady of leisure for a while. Give yourself time to heal. You'll be glad you did.
Take care,
Elayne
Posted by judy1 on April 16, 2002, at 19:32:22
In reply to Re: Hope today went well - It did, thanks!, posted by Chris A on April 15, 2002, at 19:32:54
Anticipation is always worse than the actual procedure, I'm so glad it went well. Sorry I don't have any progesterone facts but I'll join you in a nice spring hypomanic phase :-) Stay well- Judy
This is the end of the thread.
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