I’ve taken birth control pills for much of my adult life. Sometimes the contraceptive benefit was useful, but much of the time, it was more about keeping estrogen fluctuations associated with PMS at bay. I’ve recently decided to stop taking the pill because there is some indication that oral contraceptives may promote inflammation. The connection isn’t particularly clear, but I want to at least try since my body isn’t very happy currently.
The last time I took an extended break from birth control was a little over three years ago. I was going away on a month-long trip, and by the time I realized I didn’t have refills left on my prescription, it was just too rushed to fit in a trip to the doctor. When I got home from the trip, I figured that I might as well try staying off of it. Maybe I’d feel fine without it.
The first thing that I noticed was that PMS made an appearance again, and the awful cramps during my period that I used to have as a teenager were back. Then several months later I had a relapse of my depression, and all hell broke loose. I was getting lengthy periods ultra-frequently, and my mood was a disaster. It took me a while to realize that I should go back on birth control, but when I did my, body definitely thanked me.
The role of estrogen
So why all of this hormonal craziness? The cycling of estrogen levels causes fluctuations in levels of various neurotransmitters in the brain. Depression rates among women are highest during the childbearing years, when estrogen levels are high and cycling.
During postpartum and peri-menopausal stages, there is a sharp drop-off in estrogen levels, and these times are particularly high risk. In menstruating women, there’s a natural drop-off in estrogen starting after ovulation and lasting until menstruation begins; however, it’s nowhere near as extreme as what happens postpartum or peri-menopausally.
PMS and PMDD
Mood fluctuations are not uncommon with premenstrual syndrome (PMS). Dr. Wikipedia tells us that up to 80% of women experience symptoms of premenstrual syndrome, with 20-30% meeting the full criteria for PMS. Dysmenorrhea (painful periods) affects 20-90% of women.
Premenstrual dysphoric disorder (PMDD) occurs in 3-8% of women, and it’s a mental illness that kicks PMS mood disruption up several notches. It was introduced in the DSM-5, the newest edition of the Diagnostic and Statistical Manual of Mental Disorders. In PMDD, mood symptoms occur in the time between ovulation and the onset of bleeding. Symptoms typically last for around a week, but they may last up to 2 weeks.
Managing the madness
SSRIs are the most common type of medication used for PMDD, and fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro/Cipralex) have been approved by the U.S. Food and Drug Administration (FDA) specifically for use in PMDD. Unlike in depression and bipolar, response to SSRIs is rapid in women with PMDD, occurring within a day or two. Because of this, the SSRI only needs to be taken in the last 2 weeks of the menstrual cycle or during the time when symptoms are occurring.
Another option is birth control pills containing the progestin drospirenone, which is found in Yasmin, among others. Cognitive behavioural therapy (CBT) may be useful in reducing overall impairment by changing behaviour patterns.
I haven’t been off the birth control long enough to really see yet how it’s going to affect me. If my mind and body start to rebel, I plan to restart it. Maybe I’ll end up taking birth control until I hit menopause and then switching over to hormone replacement. In theory, it would be nice not to throw hormones into my body, but that can be pretty easily outweighed if my own hormones are getting into a war with my depression. So we shall see. But how has evolution not made all of this a well-oiled machine?
For my female readers, have you noticed a relationship between your hormonal cycles and your mental health?