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I was diagnosed with bipolar disorder in 2002. I’ve had plenty of time to figure out my medications and my moods. Now, that’s not to say I don’t experience mood swings and I haven’t had episodes since my diagnosis, but I’ve worked very hard over the last 17 years to get my moods stable.
I went into early menopause. Early, like at age 42. And there’s nothing like a big hormone change to throw everything out-of-whack. And the imbalance that comes with menopause has really thrown a monkey wrench in my otherwise stable lifestyle. Even doctors agree, menopause can actually exacerbate bipolar disorder. Lovely. Isn’t it fun to be a woman sometimes? Ugh.
Estrogen levels decrease in menopause. And estrogen plays a big role in mood, and mood episodes. A recent study found the risk of severe mood episodes in people with bipolar increases with menopause. Yay. I’m not surprised, because hormones can wreak havoc on more than you’re your body.
With my hot flashes, I experience mini anxiety attacks. I have about 10 hot flashes a day (yes, I count them) and with each one, I get a burst of energy and fear that mimics a kind of panic attack. I know why it’s happening when it happens, and the hot flashes only last about 30 seconds, so I just breathe and tell myself it’s normal, it’s okay, and it will go away in a few seconds. Nevertheless, it still sucks. It’s not fun.
I’m pretty stable now, and I have been since I started menopause, but that’s most likely because of two things.
(1) I had to choose living with the effects of this abrupt hormone change over taking hormones. And by not using hormones to ease my symptoms, I have to just suck it up and live with them. I’ve been lucky so far.
(2) My psychiatrist told me that one reason I may not have had a depressive episode is because I’m on an antidepressant that works really well for me, and it has for years. I know that’s not the case with everyone. Like I said, I’ve been lucky. If your antidepressant doesn’t work as well as it should, it’s always a good idea to talk to your doctor about finding one that really does work.
My psychiatrist says I should think twice about using hormone therapy to manage my menopause symptoms, because HRT (hormone replacement therapy) medications can interact with my mood stabilizers and lower their effectiveness. Before menopause, I couldn’t use hormone-based birth control either, for the same reason. As if that wasn’t enough, the side effects of HRT can be extra dangerous for people with bipolar disorder, because taking hormones can also increase the severity of mood swings and can even trigger manic or depressive episodes. As if the side effects of menopause weren’t bad enough.
For me, at least right now, the biggest issue I’m struggling with is the anxiety that accompanies the hot flashes. I recently talked to my OB/GYN, and she suggested a non-hormone-based medication that has low side effects. It’s called Relizen. It’s over the counter, and won’t interact with my medications because it contains no hormones. I have high hopes for this drug, but if it doesn’t work, I plan to continue the conversations with both my psychiatrist and my OB/GYN to try other solutions.
One other solution I plan to try—if this new medication doesn’t work for me—is a hormone patch. The patches work by getting into your bloodstream, bypassing your brain which is the way traditional pills deliver the goods. The other thing about the patches is you can stop using them just like you can with a pill, so if I start noticing myself feeling a little off, I can just remove the patch. The half-life of both forms of medication is pretty short. So, I have options.
I want to live my best life. I don’t want to just learn to live with the constant hot flashes, night sweats, weight gain, lethargy and anxiety, on top of the increased risk of another episode. I had to do trial and error with umpteen number of antidepressants, mood stabilizers, and anticonvulsants. It was grueling. It took years. I got the t-shirt, I got the soundtrack. In the end, it was worth it. I finally found the perfect cocktail of medications.
I’m willing to do the work to get my menopausal hormones under control too. It will probably involve a lot of trial and error too, and I’ll have to go back to being hyper-vigilant like I was when I was trying to get stable the first time around. I’ll have to go back to paying extra attention to how I feel and what I’m thinking. Even little changes will need to be obvious to me, so I can avoid another episode.
But I know I can do this too. Why? Because my struggle to effectively manage my bipolar made me stronger and more resilient. And for that, I’m thankful.