Daily Archives: November 15, 2011

A Clockwork Trigger

It is said that during pregnancy and postpartum a woman with bipolar disorder is at the greatest amount of risk.

Hormones can be rough, even for the most mentally healthy woman, but what kind of role do hormones play for your everyday bipolar woman?

Estrogen‘s effect on mood is in its ability to increase serotonin and beta-endorphins which are associated with positive mood states. It helps maintain serotonin, dopamine, and nor-epinephrine levels by decreasing levels of mono amine oxidase (MAO), the enzyme responsible for inactivating them.

When estrogen levels are too low in the body, symptoms of depression, anxiety, and mood swings can occur. There have also been studies that link decreased estrogen levels to panic attacks.

Progesterone is a female hormone that prepares the lining of the uterus for a fertilized egg, but in too high of levels can cause depression, irritability, and mood swings.

PMS occurs when hormones change levels before menstruation, and the imbalanced hormones are what cause premenstrual symptoms.

I found a surprising amount of information on how to tell the difference between PMS and bipolar disorder. I had no idea that was something that people were confused about, but apparently there are women who go undiagnosed because they have continuously been told that their mood swings are linked to premenstrual disorders.

One way to tell the difference? Bipolar symptoms can happen at any time. If PMS symptoms show up anytime other than 3-5 days prior to your period, and/or if they last greater than 10 days, then it is more likely to be bipolar disorder.

Several articles said even if a woman’s bipolar disorder symptoms are well taken care of with medication, it is possible for these women to have breakthrough episodes (episodes disrupting a period of stable mood) when PMS would normally occur.

So yes. Our hormones can be a big trigger.

Even worse, there have also been studies that show that severe premenstrual symptoms in bipolar women were an early indicator when those women had more episodes of depression and worse symptoms the following year.


Considering what imbalanced hormones can do on their own, you may want to very seriously consider your choice in birth control methods.

I want to make it clear that I believe every woman has the right to pick whatever birth control method(s) she chooses, and I know several women who take hormonal birth control (but are abstinent) simply because it helps balance out their hormones.

For me, hormones have always been a trigger, but I was caught completely off guard after getting the DepoProvera birth control shot in 2004 and having my second hospitalization shortly after. And at that point, the hormones were stuck in my system, and took three months to be depleted.

Progestogens (found in many hormonal birth control methods) increase MAO concentration, thus producing depression and irritability even moreso than natural progesterone. Pure progestogen treatment without estrogen, such as DepoProvera is known to worsen depression in women who already have a tendency toward or clinical signs of depression. Of course, the doctor who administered this shot to me didn’t inform me of that, for whatever reason.

If you are speaking with your primary care provider about your options, be vigilant. I’ve had countless doctors tell me I would be fine after receiving whatever hormones I was given, and that was almost never the case. If you do your research and are firm with your doctor about what kinds of hormones you are/aren’t willing to take you are much more likely to avoid an unintentional hormonal triggering of your mood swings.