Author: Melissa Howard
I was fourteen when an ovarian tumour was discovered on my left ovary. I had been menstruating for just over a year when the diagnosis was made. The large tumor was removed along with the majority of the small organ. A minimal amount of unaffected ovarian tissue was left behind, with the hope that it could function as a normal ovary once it had healed. I was placed on an oral contraceptive(OC) to regulate my period and to control polycystic ovary syndrome (POS) I had been diagnosed with. Coincidently, just after my surgery, I experienced a dissociative and depressive episode. This began my struggles with hormone imbalances throughout my life.
I was part of the 15-27% of bipolar women who lived with a condition called premenstrual dysphoric disorder (PMDD). It
it similar to PMS but the symptoms are more severe and often debilitating.
I had not yet been formally diagnosed with BD 1 at the age of fourteen, however, I had already experienced several bouts of depression and periods of dissociation in my young life.
Prior to my surgery, my periods brought on a tidal wave of emotions. I was either lethargic, unmotivated, sad or furious. I became electrically charged by any negative encounters I had and wasn’t capable of self regulating my less than appealing feelings.
My mood was unpredictable on most days, however, the week before my period I became nothing less than a monster and often questioned my own inability to control my disruptive mood fluctuations. They were confusing and only worsened with age.
I lived with unexplainable anger and sadness, over and above the symptoms of bipolar disorder. Every time my cycle approached its time of the month my family nor I could predict what type of mood disturbance I would display. There was some comfort in knowing exactly when it would be making its appearance, the oc’s I was taking provided that regularity but they also contributed to my depressive episodes.
I received my formal BD 1 diagnosis at 19. I was informed by my psychiatrist that the disorder could be negatively affected by hormonal fluctuations such as my monthly cycle. Given the fact that I had only one properly functioning ovary, my body lacked adequate estrogen which was linked to causing depression. That combined with the use of an oc, left me vulnerable to an increased amount of mood variations
As I learned to manage my mood with medication and therapy, I was able to recognize how unbalanced my hormones were as my period approached.
I became pregnant not long after my BD 1 diagnosis. My psychiatrist had weened me from the medications that posed a risk to my fetus, however, I remained on an antidepressant. I managed well throughout my pregnancy with the help of my obstetric team and psychiatrist. I was at a heightened risk for developing postpartum depression (PPD), therefore, after my daughter’s birth I resumed the medications that were safe to consume while breastfeeding. I was able to maintain stability without experiencing a mood episode. I decided to discontinue the use of my oc following my daughter’s birth and felt significantly better. I continued to take my medications to manage my bipolar disorder and experienced many years of stability.
Six years passed when I became pregnant for a second time. With the help of my psychiatrist, I decided to ween off all of my medications for the duration of my pregnancy. I was followed closely by my psychiatrist, therapist and obstetric team. This was the first time I had been off bipolar medication since being diagnosed. I adapted well and my mood remained stable up until I reached 3 weeks postpartum where I crashed and burned.
My psychiatrist medicated me immediately, however, as I waited for the medications to take their effects, my condition became acute. Safety measures were put into place in order for me to recover as well as care for my family. I was lucky enough to be able to stay with my parents for the extra support I needed while my husband was at work. During the night he was tasked with our son’s night time feedings in order for me to regain a consistent sleep schedule which my bipolar disorder required. My mood stabilized within 8 weeks and I avoided psychosis. Flying solo without medication after the hormonal surge that ran through my body after childbirth was too intense and triggered a postpartum depressive episode.
Two and a half years later I underwent surgery to treat endometriosis and an ectopic pregnancy. Hormones once again contributed to my second manic/ psychosis in thirteen years. That episode was grave and it took many months for me to regain stability.
I was put into surgical menopause at the age of thirty-nine, after having a hysterectomy. During and after my recovery I experienced hot flashes a few times a night which prevented me from getting the sufficient amount of sleep I was accustomed to. My mood began to shift into a depressive state. The ultimate concern was if my sleep cycle became altered by insufficient estrogen levels, it would create a waterfall effect triggering a mood episode.
My inability to sleep through the night because of the menopausal symptoms I was experiencing required immediate attention. I was referred by my psychiatrist, to a hormonal specialist who prescribed a low dose of estrogen to allow me to maintain hormonal balance. I wasn’t thrilled about going onto hormone replacement therapy (HRT) given the adverse effects I could experience, however, the benefits of HRT outweighed its risks for me. My sleep pattern was regulated within two weeks of using an estrogen patch and my mood returned to a neutral state. Though I still experience sporadic hot flashes, they do not impact my mood stability as they once did.
looking back at my evolving stages of life, I have no doubt that my hormones played a significant role in the intensity of my mood episodes.
The advice I took under the care of my psychiatrist and other treating practitioners was done under close supervision. The decisions made were based on how bipolar 1 affected my life. In saying this, everyone experiences their disorder differently. What worked for me may not work for another. Please consult your health care provider if you or a loved one is experiencing mood disturbances thought to be triggered by hormonal fluctuations.
