Mi-12-011 87.89

Menopause International 2012; 18: 87–89. DOI: 10.1258/mi.2012.012011 Menstruation and mental health:what’s the chance of talking about that? When asked to write this piece my first thought was normal and it would settle, so agreed to another injec- where will I begin? I feel its best to start from where I am tion. The bleeding did not stop and the depression today and work backwards. Today I am a happy, confident became much more apparent. I also remember becoming 32-year-old woman who is happily married with two fairly anxious at this time and I recall that I suffered from beautiful children. I have a part-time job that I enjoy and I insomnia – so much so that my fiance´ and I ended up also run my own successful business working as a keynote sleeping in separate beds as I disturbed him so much speaker and trainer. I have no major health issues and I during the night with my constant tossing and turning.
manage my surgical menopause very effectively using So back to the general practitioner (GP) I trot. This time I estrogen and testosterone hormone replacement therapy asked for a referral to a gynaecologist and explained that I (HRT) in the form of patches, gels and a vaginal estrogen was sure that my symptoms had something to do with cream. I am so grateful to finally be able to enjoy my life hormones. The doctor felt that this was not required, that every week of the month and as far as I am concerned I we should just stop the injections and return to using a owe my life to the gynaecologist who correctly diagnosed contraceptive pill. It was documented that I had become me and continues to support me in managing my chal- very depressed on the injections – and I recall being offered some advice on how to reduce stress as she felt The reason that I am in surgical menopause is because that stress/depression could also affect menstrual bleed- in 2009 I made the decision to have a hysterectomy and ing. (This I agree with to a certain extent but come on – 24 removal of my ovaries to rid myself of a hormonal con- weeks of almost constant bleeding after a hormone dition that had plagued my life for 10 years. I suffered injection kind of screams out adverse reaction of some from a severe form of premenstrual syndrome, recognized sort!) I should probably point out at this point that I had by some as premenstrual dysphoric disorder (PMDD).
no history of any mental health issues – and thankfully Interestingly, this is where the first stumbling block is for after correct treatment for my condition I have no conti- sufferers like me – no-one can agree on what to call this nuing issues in this area. I will also point out that I fully condition. I read with interest lately that this issue will understand how my condition could go unrecognized for hopefully be resolved with the International Society for such a long time as the many symptoms of PMDD can Premenstrual Disorders looking to implement a new easily be misdiagnosed as symptoms of other conditions. I classification, which will hopefully lead to better diag- was equally confused at times by the often very puzzling nosis for women such as myself. I am hopeful that with a symptoms that I presented with – it was only when the clear set of diagnostic criteria women will no longer have penny dropped that there was such a definite link to to be shunted from pillar to post as myself and so many hormones – that by reflecting upon my medical history a I presented with mild symptoms in my teens. My So anyway – I struggled on for another year trying a medical notes document ‘issues appear to be cyclical’. But spell of time hormone contraceptive free before returning being a bashful teenager – I put up and shut up when I to the pill to control bleeding for my wedding. I returned was informed that periods are just part of a woman’s life, to my GP. I recall this very vividly as I was only married a learn to live with it basically. So I did – talking about few months and my moods and bleeding were under- periods, etc. was SO embarrassing at that age. So I standably interfering with married life. It was noted that muddled through trying various different contraceptive I was still bleeding irregularly when off the pill. Bleeding pills, which all gave me a different selection of side– was occurring approximately two weeks of the month.
effects, but for me it was a case of which was the lesser I was referred to see a gynaecologist. In November 2003, evil. I agreed to try the contraceptive injection (age 22).
I attended my long-awaited appointment. I took my After the first injection I bled almost continuously for 12 husband along with me for moral support. Both expressed weeks and became depressed. I was advised this was quite concern that my issues were related to my hormones.
Menopause International Vol. 18 No. 2 June 2012 D Barrowman Menstruation and mental health I explained the strains that my situation was causing the gynaecologist stating that as I had been in hospital as within our relationship, my moods, the constant bleed- a result of my suicide attempt, and they had found no ing, painful intercourse, etc. Various unpleasant internal physical cause for the bleeding I was being discharged examinations took place (which later came back clear).
from any further investigations at his clinic. His docu- My first appointment ended with me leaving in tears as mented reason was that he was now certain my problems my husband and I had basically been told again that my were stress related. Can you imagine how very frustrating symptoms were related to stress – but this time there and upsetting this was, when I knew deep within myself appeared to be some ammunition for this claim. His that something that was completely out of my control theory was that our relationship was being tested as we were newly weds, so I was suffering from stress and that So thankfully being the strong person that I am I was impacting upon my menstrual cycle. Explanation decided that this was not going to beat me. I got back to that these issues had been going on since my teens work, and returned to taking the contraceptive pill that appeared to fall on deaf ears. I tried to explain that it was had given me the least problems. The Efexor, after a few the bleeding, moods and other physical symptoms that increases in dosage, kept me ticking along. I am were causing me stress but he appeared convinced it was delighted to say that the following year I fell pregnant with my first beautiful son. Efexor was stopped and So I gave up – returned home and came to the con- pregnancy was a joy as I had no vicious cycle; however, clusion that this was just the way life was going to be.
after birth things went downhill fairly quickly. The Learning to work around my bad weeks, I would try and anxiety and insomnia came back along with a few new avoid certain situations and only socialize if I had to. This symptoms including intense paranoia, confusion and had a huge impact upon my quality of life, I had also sweats. By this time the monthly pattern was screaming started my own business – something I was more than out to me. I had a spell back on antidepressants as I was capable of doing and I had always wanted to do. But sadly diagnosed with postnatal depression but they made no the symptoms were becoming a lot worse – the insomnia difference this time. Back on the pill until I could take it and anxiety occurring every third week was debilitating as no more and asked for another gynaecologist referral.
was the continued heavy irregular bleeding. I would But once again I fell pregnant with my second beautiful become so upset as I felt so out of control of what was son. So out the window went any further investigations happening to my body and mind every month. But then until after childbirth. I will admit that I was scared of the cloud would lift and I would be enjoying life again bringing another child into the world as I was just and functioning well until the next cycle. At this point functioning at this point two weeks out of every month.
my husband had really started to notice how intense Blair arrived and the symptoms returned with a ven- things were becoming and supported me in every practi- geance. This is the point that I decided I could no longer cal and emotional way he could – but he could not live with this as I was beginning to get scarily low and remove or understand the horrid pattern of symptoms did not want a repeat of what happened a few years that would come and then go. It must have been incred- previous. Some may argue that it was the dealing with ibly frustrating for him as half the month he had happy, two children that made things worse – but when I reflect confident, sensible Donna and the other half he had back the only reason I could cope before I had the chil- irritable, anxious, exhausted and paranoid Donna. Things dren was because I could literally lie down to this con- came to a head in June 2004 when I was totally over- dition. That however was not an option with two whelmed with anxiety – completely irrational and children to care for, and on my two good weeks I was a exhausted. I went to my GP who was shocked and could fantastic mother, nothing phased me and life was good.
not understand what had happened, and how it hap- My new GP was wonderful and recognized that my pened so quickly. She had never seen me at this point in problems were hormone related and supported me to my cycle before as I was ashamed to admit that I was follow the guidelines published by the National having mental health issues. She immediately did what Association for Premenstrual Syndrome (NAPS). We tried would have been the sensible thing at the time and a few newer pills, then the Mirena coil but every time I started me on Prozac. Sadly three or four days later – as had something with any amount of progesterone I things peaked I tried to take my own life. To this day I would feel awful. Through charting my symptoms have no idea when I crossed the line between sanity and during a normal cycle it was obvious that they related to suicide. I can just remember thinking that I was such a the days when progesterone was at its highest. We tried a burden on everyone, I was a failure as a wife and that my combination of numerous things but with no success.
life was always going to be controlled by this horrendous The moment my life changed was when I found a pattern. I remember being in hospital and not believing specialist gynaecologist who I believe saved my life. We what I had done, I was so ashamed of myself. Notes show decided to go ahead and try the gonadotropin releasing that within a few days I was once again lucid, and hopeful hormone analogue monthly injections to force my body for the future. I must have appeared very bizarre when the into menopause and remove my cycle. After two months I only reason I could give as an explanation to the psy- was literally a new woman. I could not actually believe chiatrist was that my periods were causing me to have the difference in myself – and my husband was such severe symptoms. Again they put it down to stress astounded. I no longer hated myself, I felt in control and sent me home with different antidepressants – Efexor.
rather than out of control. The bleeding stopped, the These did help me, mostly with the anxiety but did not anxiety and paranoia disappeared and I was functioning remove the physical problem of the heavy irregular like a normal human being. The relief was immense. A bleeding. Sadly a few weeks later I received a letter from few menopausal symptoms crept in but they were solved Menopause International Vol. 18 No. 2 June 2012 D Barrowman Menstruation and mental health by using low-dose estrogen HRT. I used this regimen for symptoms. I eventually decided that something else must six months. This relief, however, came at a cost. It was not be wrong with me – and ordered some blood tests to advisable to stay on these injections long term; however, a check for infection, etc. They came back clear. At the same hysterectomy and removal of my ovaries would give a time I contacted my consultant again who explained to permanent solution. At age 29 this was a huge decision me that a woman of my age would normally have a lot of but if I wanted to have any quality of life with my family estrogen in her body – and that the HRT was simply it was the only option for me. Yes I had my children and replacing what I would normally have. She suggested probably did not plan to have any more but I hated increasing the dose of patches and adding in some local having that choice taken a way from me by this con- estrogen direct to my vagina. If I am 100% honest – I was dition. Anyway, I proceeded with the surgery and today I not convinced but I went ahead anyway. I am pleased to say that I have never looked back. I have taken a great So here I am 2.5 years postsurgery. Hormones still amount of time to educate myself about HRT, and it is challenge me as I am now in surgical menopause.
very interesting and eye opening to read how flawed the Menopause – believe it or not came as a complete sur- study was that led to all the scaremongering around HRT. I prise to me. I do not know if I just did not allow myself to was also amazed to read the amount of evidence that think about it – but boy did I know when it arrived. I supports estrogen therapy in women – especially young assume that because I entered menopause via surgery – it women like myself. But sadly many doctors are still arrived like a tornado. The first thing that really disturbed reluctant to recognize this. Thankfully I have a very good me was the dryness and soreness of my vaginal area – and medical team now – they trust me and I trust them. I feel being a typical woman I put up with it – not wanting to as is I have finally taken control of my hormones – rather bother the doctor with something as unimportant as my than my hormones controlling me. I now speak at vagina!! Then I started to feel like I had just gone 10 women’s health conferences – helping to educate the rounds with a boxer – I ached, I was exhausted. At this medical profession about the very real effect hormones point I was using 1 Â 25 mg patch of estrogen every three have on women – and I am pleased to say that they are days – when I look back know I laugh my head off at how starting to listen. Menopause does not need to be naive I was. Understandably my GP advised me to stay on as low a patch as possible of HRT – and to be fair I kept alot of my symptoms to myself – especially the vaginal Menopause International Vol. 18 No. 2 June 2012

Source: http://www.peersupportnetwork.co.uk/MI-12-011.pdf