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.

9 responses to “A Clockwork Trigger

  1. I’m glad to hear there’s an actual science behind the fact that hormonal birth control pills always make me feel like crap. Some years ago, I took Yasmin birth control pills to balance my hormones, and they made my feel great, but I later found out they were estrogen-only pills, and it’s not safe for women of childbearing age to take them, I’m not sure why. The last time I had to have birth control pills prescribed, I got a different brand, one with progesterone. Apparently doctors will no longer prescribe estrogen-only birth control pills for women of childbearing age, because it’s unhealthy for us somehow.

    • Don’t quote me on this but I believe they wont prescribe estrogen only pills because it puts you at higher risk of getting blood clots and having a stroke. That’s also why they won’t give anyone birth control that contains estrogen if you smoke or if you have migraines (which was a bummer for me when I found out about the migraine one), at least that’s what one doctor told me.

  2. I’m going to say this, and I might get some backlash for this. Doctors are blinded by their specialty. OB/Gyn’s will tell you it’s hormones. Psychiatric professionals will tell you it’s a disorder. Rheumatologists will tell you it’s a pain disorder. And Internal Medicine docs will shrug and give you a referral to a doctor that best fits your most significant symptom. That’s why two heads are better than one. In this case, it might be four or five.

    Birth control is a major issue for women with BP. Especially, since many mood stabilizers interact with hormonal contraceptives. When I started Lamictal, I was warned that they didn’t play nice and it was impossible to tell which way would it go. Would the Lamictal lower hormone levels or vice versa?

    I found it was the other way around. In my case, hormonal bc reduced the Lamictal levels in my system. So, when I got to the placebo week, my Lamictal levels would surge when my hormone levels dropped, creating a serious inbalance. I noticed this, brought it to my OB/Gyn’s attention, and she asked what I wanted to do. I wanted to continuous cycle, because I already did my homework.

    I have never heard anything positive about the shot. Ever. Personally, I know two girls that were sterilized by it. I knew three others that profusely bled for three or more months. And yet, health care practioners practically force it on women. For any reason. I was enthusiastically encouraged to get it after my son was born. When doctors unearthed bipolar disorder, it was thrust upon me as “the only reliable method of bc when on Lamictal”. Psh.

    Oh, and another quick note before I wrap up, my sister and I seem to have a unique physiology that stabilizes us when we’re pregnant. Apparently, we require high levels of hormones for peace of mind. *shrug*

    I agree 5000%! Women, especially women with BP, know your body, know yourself! And then know that doctors aren’t Gods or databases. Do the homework and take control of your treatment. Remember, you pay those doctors to work for you!

    • could you lower your lemectal dose during the placebo period? Maybe that would help?

      • It was just easier to go to continuous cycle rather than finding the exact dose by either fiddling with it and finding results or taking a blood every month. No thanks. I’d rather just suffer one bad week every three months.

  3. Once I got the bipolar more stabilized, serious PMS/PMDD breakthrough symptoms started showing up more clearly. We’ve attacked it with an add-on antidepressant and bc, which is actually a multi-purpose strategy despite not needing birth control.

    I am not thrilled with being on birth control for a bunch of reasons, but it’s a lot better with a monophasic estrogen pill than it was with a triphasic, which made me so completely insane that I refused to try bc again for over 15 years! So that’s another detail that matters – monophasic versus triphasic (and whatever else there is) – can make a big difference because of which hormones it pumps into your system at what point in the cycle.

    I’m hoping that we can look at a different pill at my next GYN appointment but the length of the experimentation cycle (3-4 months per drug for enough time to “settle in”) is a huge irritation for me.

  4. Fabulous resource. You are a font of useful information! Thank you.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s