![[dr. bob]](/dr-bob-sm.gif)
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 November 4, 2001, at 15:05:25
Does anyone know if bipolar exacerbated with PMDD is considered a good enough reason in the US to have a bilateral oophorectomy (removal of ovaries)? I can't take the usual SSRIs for PMDD because they cause cycling of the bipolar. The hormonal shifts throw my HPA axis off enough that I get suicidal. I would like to better informed when I go see a gyn this week. My logic says that eliminating the
shifts in hormones and taking continual HRT would level the roller coaster a bit. Any feedback would be appreciated.Thanks,
Chris A.
Posted by jazzdog on November 4, 2001, at 16:34:35
In reply to Surgery for PMDD?, posted by Chris A. on November 4, 2001, at 15:05:25
Alas, continuous hrt does not necessarily mean no mood swings. Some women spend many years trying to find a dosage and balance of estrogen and progesterone that doesn't cause worse mood swings than when they had ovaries. Sorry, I know how awful PMS combined with bipolar can be - but I'd think very hard before having major surgery.
Posted by Chloe on November 4, 2001, at 17:47:43
In reply to Surgery for PMDD?, posted by Chris A. on November 4, 2001, at 15:05:25
Chris,
I too have horrible PMS and a mood disorder. I was just tried on the first BC pill that I can tolerate. It's very new, and has a new form of progestin that has no androgenic effects. I am really liking it so far. I am actually feeling LESS anxious on this pill. And I plan to take it without breaks and only have periods a couple times a year. The hormonal withdrawal of the placebo week makes me very depressed and suicidal.So, when you go to the gyn, ask about YASMIN 28. I don't know what your age is. But I am 35, and my gyn thought it was fine for me to take on this continual basis. I do hope you don't have to resort to surgery. That seems very radical...Especially since there are so many ways to shut off the ovaries. The depo shot is also another option, that one gets every three months. It's a progestin shot, and can cause depression, but it's very effective in shutting down the system. I never had a period while on that.
So...There is so much to learn about before you consider surgery. Let us know what you decide to do.
Chloe
Posted by Beliala on November 4, 2001, at 22:57:55
In reply to Surgery for PMDD?, posted by Chris A. on November 4, 2001, at 15:05:25
Have you tried the birth control pill continuously? I think they recommend you take the placebo week once every 3 months (to have a period) but that isn’t so bad. Actually I’ve read of some women who get estrogen-withdrawal headaches taking the bcp normally and then adding an estradiol patch during the placebo week, which might be an option if you have an open-minded doc (let me know if you find one of those; I’m still looking myself). The bcp suppresses your ovaries so you don’t get the hormonal ups and downs. The one that’s most recommended for depression is Ovcon-35, which has a very low progestin potency. The progestin is what usually causes the depressive side effects in women who react badly to hormonal treatment. Estrogen tends to elevate mood and is a mild MAO-inhibitor....unfortunately I don’t know if it could possibly trigger manic episodes.
Posted by Beliala on November 4, 2001, at 23:12:37
In reply to Re: Surgery for PMDD? » Chris A., posted by Chloe on November 4, 2001, at 17:47:43
Your experience with Yasmin is encouraging. I’m thinking of asking my doc for that one because I’ve had SO many unpleasant mental and physical symptoms since discontinuing the birth control pill in August 2000. This acne, hair loss and excess facial/body hair growth aren’t exactly doing wonders for my mood and I’ve read merely correcting the hormone imbalance generally isn’t enough to reverse the effects on hair follicles - hence my desire for an anti-androgen. Unfortunately my doc is of the mindset that this is all due to "stress." Well, yes, having ones hormones out of whack is stressful. The bcp worsened my fatigue when I was on it before but the way I feel now is MUCH MUCH worse.
Posted by Chris A. on November 5, 2001, at 0:16:51
In reply to Re: Surgery for PMDD? » Chris A., posted by Chloe on November 4, 2001, at 17:47:43
Thanks for the input. I'll have to check out the Yasmin 28 - haven't heard of it before. We've tried a number of BC and HRT strategies on a contiuous basis. Guess I'm getting a bit desperate. Progestin does cause severe depression and irritability for me. Yes, surgery is a bit radical and I don't want to make the wrong decision. The whole idea is to get better, not worse :-) Is there such a specialty as gynecological psychiatry? I'm having trouble locating any medical literature that has any serious answers for this dilemna.
Blessings,
Chris A.
Posted by Chloe on November 5, 2001, at 11:29:48
In reply to Re: Surgery for PMDD? Chloe, posted by Beliala on November 4, 2001, at 23:12:37
Beliala,
I have found that Yasmin does make me tired. But I would much rather have that than anxiety and panic! I was on Loestrin for 2 days, and nearly lost it, I got so anxious and suicidal. I stopped it immediately, and was scared to try Yasmin, because I thought it was the estrogen that was causing the anxiety. But that is not seeming to be the case. I tolerate the estrogen fine in this combo of drospironone and ethinyl estrogen.Yasmin is really unique, in that I think the progestin has some diuretic effect. So I have no breast pain or swelling and I am not bloated at all. I have had to increase my Lithium however. I think I was not only peeing out extra fluid, I was also peeing out all my lithium!
So, Yasmin is not like any bcp I have ever tried. But I am starting to look at it more as a psych med that a hormone. It really has some antianxiety qualities for me, as well as shuting down my cycles, which really can make me crazy (ie, irritable, depressed, suicidal, heavy bleeding, cramping)!
I do hope your gyn will consider a trial of Yasmin. I am sorry you have had all the awful side effects of the androgenic bcps.
Hang in there
Chloe> Your experience with Yasmin is encouraging. I’m thinking of asking my doc for that one because I’ve had SO many unpleasant mental and physical symptoms since discontinuing the birth control pill in August 2000. This acne, hair loss and excess facial/body hair growth aren’t exactly doing wonders for my mood and I’ve read merely correcting the hormone imbalance generally isn’t enough to reverse the effects on hair follicles - hence my desire for an anti-androgen. Unfortunately my doc is of the mindset that this is all due to "stress." Well, yes, having ones hormones out of whack is stressful. The bcp worsened my fatigue when I was on it before but the way I feel now is MUCH MUCH worse.
Posted by judy1 on November 5, 2001, at 13:11:48
In reply to Re: Surgery for PMDD? Thanks all, posted by Chris A. on November 5, 2001, at 0:16:51
Hi Chris,
Have you seen an endocrinologist yet? (Closest to an OB psychiatrist- my IVF doc who has written textbooks in endocrinology). I DO understand the desperation of resorting to surgical intervention but I hope you don't resort to that. Just last week I had to see a neurosurgeon for herniated discs and half kiddingly asked if he did lobotomies. You have my prayers- Judy
Posted by susan C on November 5, 2001, at 15:12:54
In reply to Surgery for PMDD?, posted by Chris A. on November 4, 2001, at 15:05:25
hi,
If you are up to it, do a search here on progesterone and progestin...There are numerous posts on the connection between mood, hormones and bipolar and PMS...briefly, I have tried progestin...to bad effect, and tried progesterone, to good effect. Also www.womensinternational.com is a good source of information. I also agree with everyone else who as posted...you are not alone, the truth is out there and get LOTS of opinions before even considering surgery...MHO
mouse 50 and counting
susan C
Posted by Chris A. on November 8, 2001, at 17:29:04
In reply to Re: PMDD/Yasmin » Beliala, posted by Chloe on November 5, 2001, at 11:29:48
Dear Chloe and Beliala,
Is Yasmin new? I couldn't find it in the PDR or latest supplement to it. Do you know what potential it has to shut down the ovaries in comparison to OrthoPrefest or some of the other bcs that a have come out in the last couple of years? The anti-anxiety prospect sounds good, but more fatigue is something I don't need.
Here's to balance,Chris A.
> Yasmin is really unique, in that I think the progestin has some diuretic effect. So I have no breast pain or swelling and I am not bloated at all. I have had to increase my Lithium however. I think I was not only peeing out extra fluid, I was also peeing out all my lithium!
Posted by Chris A. on November 8, 2001, at 17:59:49
In reply to Re: Surgery for PMDD? Thanks all » Chris A., posted by judy1 on November 5, 2001, at 13:11:48
Dear Judy,
Back problems while expecting? That doesn't sound like fun. When is your EDC? I saw your question about ADs. APs might be safer. I won't mention ECT. We'll just pray that the depression doesn't get that bad.
At least complete hysterectomies can be done laporascopically. Not sure about lobotomies -:)
We have one endocrinologist here. Next closest is 250 miles away, so no, I haven't checked with one. Yesterday my pDoc suggested a doc that has some interest and apparent expertise with PMDD and perimenopause. My appointment isn't until Dec. My gyn appointment is now rescheduled since they made it with the wrong doc - my old one that I have trouble communicating with! More time for research and reflection.
One comment on Health A toZ was that women who've had total hyterectomies have twice as much depression as other women. They didn't mention what HRT they were or weren't taking. I need to sort some info out before I make any radical decisions. Thanks for helping me put on the brakes. I don't want to do something permanent that might make this worse.Blessings,
Chris A.
P.S. Please take good care of yourself and that precious little one> Hi Chris,
> Have you seen an endocrinologist yet? (Closest to an OB psychiatrist- my IVF doc who has written textbooks in endocrinology). I DO understand the desperation of resorting to surgical intervention but I hope you don't resort to that. Just last week I had to see a neurosurgeon for herniated discs and half kiddingly asked if he did lobotomies. You have my prayers- Judy
Posted by Chloe on November 8, 2001, at 18:37:45
In reply to Re: PMDD/Yasmin » Chloe, posted by Chris A. on November 8, 2001, at 17:29:04
>
> Is Yasmin new? I couldn't find it in the PDR or latest supplement to it. Do you know what potential it has to shut down the ovaries in comparison to OrthoPrefest or some of the other bcs that a have come out in the last couple of years? The anti-anxiety prospect sounds good, but more fatigue is something I don't need.
> Here's to balance,Chris,
Yes, Yasmin is new. It came out in July of 2001. There seems to be very little info on Yasmin, itself. Alot of the data is just the usually bcp literature with a tiny paragragh about Yasmin tacked on. I can't remember the exaxt website, but I do have the link to monogragh. My thoughts are a mess tonight, and I can't seem to sting to gether a decent sentence...But I have been on Yasmin for two weeks, and the fatigue is going away. I feel almost back to normal, which is a disappointment to me. I really liked feeling like I could nap! It beats feeling so anxious that I have to be doing something all the time. Oh well, it was fun while it lasted.
For your situation, all I would say is, give it a try. It's not like the shot or IUD where it is somewhat "permanent" after you chose to try it. With Yasmin, if you take a pill and don't like how you feel, you can always quit it, and keep on with your search. Just know Yasmin is being marketed to treat pms, and they are shooting for the label to say Yasmin treats pmdd. So it's definitely worth a shot. Have you gone to google.com and down a search on "Yasmin and depression"? You must do the two together, or you will get alot of hits about a women in the middle east named Yasmin.
Anyway! Go to http://www.yasmin-us.com/PI/YasminPI.htm first, and see what you think.
take care
Chloe
Posted by SLS on November 9, 2001, at 10:21:10
In reply to Re: Surgery for PMDD? » judy1, posted by Chris A. on November 8, 2001, at 17:59:49
> At least complete hysterectomies can be done laporascopically. Not sure about lobotomies -:)
There's another endoscopic procedure now being investigated for depression. It's called a rectal-opthalmotomy. They go through your butt and sever the optic nerve to get rid of that shitty outlook on life.
- Scott
Posted by judy1 on November 9, 2001, at 21:01:58
In reply to Re: Surgery for PMDD?, posted by SLS on November 9, 2001, at 10:21:10
Oh Scott that was funny; I'm glad you still have that great sense of humor no matter how bad things get- actually maybe that's why you have it. Take care, judy
Posted by judy1 on November 9, 2001, at 21:09:25
In reply to Re: Surgery for PMDD? » judy1, posted by Chris A. on November 8, 2001, at 17:59:49
Hi Chris,
I'm glad you're seeing an expert in PMDD; hopefully he'll help you sort things out. I also read about depression being worse in women with total hysterectomies- it's good to see you're doing your homework. I think we've decided on APs if things get too bad (last trimester here) but the EDC changed, I was ireegular and I'll post when things get closer. I think children are the gift that keeps me going here. Take care- judy
Posted by Kaysey on November 9, 2001, at 23:19:04
In reply to Re: PMDD/Yasmin » Chris A., posted by Chloe on November 8, 2001, at 18:37:45
>
>
> >
> > Is Yasmin new? I couldn't find it in the PDR or latest supplement to it. Do you know what potential it has to shut down the ovaries in comparison to OrthoPrefest or some of the other bcs that a have come out in the last couple of years? The anti-anxiety prospect sounds good, but more fatigue is something I don't need.
> > Here's to balance,
>
> Chris,
> Yes, Yasmin is new. It came out in July of 2001. There seems to be very little info on Yasmin, itself. Alot of the data is just the usually bcp literature with a tiny paragragh about Yasmin tacked on. I can't remember the exaxt website, but I do have the link to monogragh. My thoughts are a mess tonight, and I can't seem to sting to gether a decent sentence...
>
> But I have been on Yasmin for two weeks, and the fatigue is going away. I feel almost back to normal, which is a disappointment to me. I really liked feeling like I could nap! It beats feeling so anxious that I have to be doing something all the time. Oh well, it was fun while it lasted.
>
> For your situation, all I would say is, give it a try. It's not like the shot or IUD where it is somewhat "permanent" after you chose to try it. With Yasmin, if you take a pill and don't like how you feel, you can always quit it, and keep on with your search. Just know Yasmin is being marketed to treat pms, and they are shooting for the label to say Yasmin treats pmdd. So it's definitely worth a shot. Have you gone to google.com and down a search on "Yasmin and depression"? You must do the two together, or you will get alot of hits about a women in the middle east named Yasmin.
>
> Anyway! Go to http://www.yasmin-us.com/PI/YasminPI.htm first, and see what you think.
> take care
> Chloe
Hi Chloe:
I posted last month about an interest in Yasmin, when AnneL first mentioned it. I looked it up on the Berlex website and liked what I read--plus WebMD had some positive articles about Yasmin and PMDD. I have been on Ortho-Cyclen (the last of many!), and this past month, I just went off the pill completely (for the very first time in 11 years).
It wasn't really time for me to refill my bcp prescription, but I contacted my gyn, and told him that I wanted a script phoned in for Yasmin, and he has done so. I plan to start it as soon as (if?) I have another menstrual period--off the pill my periods are to say the least, irregular--but I was sick of the Ortho-cyclen--I still had PMS--not as bad as some experiences with PMDD--but still enough raging feelings/negative thoughts.
I was glad to hear that you have had positive experiences with it, other than fatigue. Before ortho-cyclen and ortho-tricyclen I also used Loestrin 1/20--you may remember that I also posted that it made me VERY depressed. I never really made the association (I just had associated it with a particularly bad time in my life)until I started hearing others talk about the severe depression. Thank God for some very close friends, who were very understanding about my behavior and who made a pact to 'watch over me, for fear that I would 'succeed' with a suicide attempt. Yes, that stuff (Lo-estrin) did me in like nothing I have ever experienced.Other than fatigue, have you experienced any of the other potential negatives of ocps? --acne, hirsutism, alopecia (isn't that wild--I would lose hair on my head, yet grow blonde 'fuzz' on my face)--all the androgen effects.
OCPs have always caused a great deal of fluid retention for me too--I was very interested in not having to deal with that.Let me know of any other note-worthy experiences that you have had. I am anxious to see how this works.
Thanks.
Kaysey
Posted by Chloe on November 10, 2001, at 10:34:45
In reply to Re: PMDD/Yasmin » Chloe, posted by Kaysey on November 9, 2001, at 23:19:04
> Other than fatigue, have you experienced any of the other potential negatives of ocps? --acne, hirsutism, alopecia (isn't that wild--I would lose hair on my head, yet grow blonde 'fuzz' on my face)--all the androgen effects.
> OCPs have always caused a great deal of fluid retention for me too--I was very interested in not having to deal with that.
>
> Let me know of any other note-worthy experiences that you have had. I am anxious to see how this works.
Kaysey,
I am so glad you decided to try Yasmin. It sounds like the ortho-cyclen wasn't helping all that much and causing you some unpleasant side effects.Yasmin's progestin is an "anti-androgen". So the hirsutism, acne, hair loss are not typical side effects. I have not experienced any of that. I do have two red blotches on my face from the healing zits that I got from my short stint on Loestrin, though! I am in agreement with you on that one. It's awful!
In terms of the fluid retention, I think you will find that it will not be an issue. The progestin drospirenone has powerful diurectic properties. I found I lost weight initially on Yasmin. I also have not experienced breast tenderness which is so wonderful. I really do not feel like I am taking a birth control pill. I am very pleased with it.
At times I wonder if I am feeling "hormonal", because I have been a little teary. But it is impossible to tease out if it's my depression or something else. I have a very complicated depression/rapid cycling kinda thing. And I have only been taking Yasmin for 2.5 weeks, so things will probably even out. But I have not found this teariness unpleasant. I just feel a little emotional at times, and I like that!
Let me know what you think of Yasmin. I'd be so interested to hear your reaction.
Best wishes
chloe
Posted by Chris A. on November 10, 2001, at 13:55:43
In reply to Re: PMDD/Yasmin » Chris A., posted by Chloe on November 8, 2001, at 18:37:45
Dear Chloe,
Thanks for the link. I am definitely going to ask my gyn about it. I don't need the bc, but definitely need some help with the PMDD and bone density. It would be nice to get off of the Klonopin, too. Keep me posted on how it is working for you.
Blessings,
Chris A.
> Chris,
> Yes, Yasmin is new. It came out in July of 2001. There seems to be very little info on Yasmin, itself. Alot of the data is just the usually bcp literature with a tiny paragragh about Yasmin tacked on. I can't remember the exaxt website, but I do have the link to monogragh. My thoughts are a mess tonight, and I can't seem to sting to gether a decent sentence...
>
> But I have been on Yasmin for two weeks, and the fatigue is going away. I feel almost back to normal, which is a disappointment to me. I really liked feeling like I could nap! It beats feeling so anxious that I have to be doing something all the time. Oh well, it was fun while it lasted.
>
> For your situation, all I would say is, give it a try. It's not like the shot or IUD where it is somewhat "permanent" after you chose to try it. With Yasmin, if you take a pill and don't like how you feel, you can always quit it, and keep on with your search. Just know Yasmin is being marketed to treat pms, and they are shooting for the label to say Yasmin treats pmdd. So it's definitely worth a shot. Have you gone to google.com and down a search on "Yasmin and depression"? You must do the two together, or you will get alot of hits about a women in the middle east named Yasmin.
>
> Anyway! Go to http://www.yasmin-us.com/PI/YasminPI.htm first, and see what you think.
> take care
> Chloe
Posted by Chris A. on November 29, 2001, at 16:13:34
In reply to Re: PMDD/Yasmin » Kaysey, posted by Chloe on November 10, 2001, at 10:34:45
Dear Chloe and all,
After some research and finally getting into see a new gyn I'll be starting Yasmin in a few days. If it doesn't work we can still consider extracting the ovaries. The new gyn spent 45 minutes talking with us. He went over in detail how the drastic variations of hormones affect perimenopause and PMDD. I was impressed. My former gyn, in the same office, seemed to have a five minute limit on office visits and I never felt heard. All of you out there who need a good gyn who listens and takes seriously your concerns, keep looking. They do exist.
Are you still pleased with Yasmin? Thanks for bringing m attention to it.
Blessings,
Chris A.
Posted by Kaysey on November 29, 2001, at 21:11:48
In reply to Re: PMDD/Yasmin » Chloe, posted by Chris A. on November 29, 2001, at 16:13:34
> Dear Chloe and all,
>
> After some research and finally getting into see a new gyn I'll be starting Yasmin in a few days. If it doesn't work we can still consider extracting the ovaries. The new gyn spent 45 minutes talking with us. He went over in detail how the drastic variations of hormones affect perimenopause and PMDD. I was impressed. My former gyn, in the same office, seemed to have a five minute limit on office visits and I never felt heard. All of you out there who need a good gyn who listens and takes seriously your concerns, keep looking. They do exist.
>
> Are you still pleased with Yasmin? Thanks for bringing m attention to it.
>
> Blessings,
>
> Chris A.Hi everyone,
Coincidentally I am scheduled to start Yasmin this Sunday. Things had gotten so bad that I stopped taking the Ortho-Cyclen, just to see after all these years, how I would do without ocps, altogether. After six weeks of oily hair/oily skin followed by dry hair/dry skin, bleeding and pain during ovulation--at 43 I was somewhat surprised--, unprecipitated sadness and PMS (which lasted 3 weeks by itself-- and included development of shingles, and the worst hair loss ever-- during this I asked my gyn call in a script for Yasmin,), I am almost looking forward to any positive change!
Let's be sure to compare notes.
Thanks
Kaysey
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.