What's wrong with my friend?

August 9, 2006 7:10 PM

Is my bipolar friend pregnant, or is it just her meds?

This is going to be long and dysfunctional, so please bear with me and keep the judgments to a minimum.

My best friend is bipolar and an abuse survivor. She was put on combination birth control pills several years ago in order to deal with intense bleeding from cysts. She has, up until recently, not relied on birth control as birth control, but only to combat this problem. Therefore, she is not really in the habit of taking it at the same time every day. There are quite a few longer-than-12-hour gaps between pills. In my understanding, this can make her ovulate, and pretty much makes them ineffective birth control. She doesn't really mind this, as she wouldn't really mind being pregnant. However, she is on several medications that she would need to immediately stop taking were she to become pregnant, so this is something she would need to know as soon as possible.

Here's a schedule of events that have us concerned:

Around July 10, she began taking a combination of Celexa and Trazadone for her bipolar. There were some side effects, mostly mental slowness, from the medications.

She had unprotected sex a few times on the weekend of July 23.

She had a normal period from July 25-28.

She had more unprotected sex the weekend of July 29-30.

She began lowering the doses of her meds [following the orders of her doctor] the first week of August.

More unprotected sex the weekend of August 5-6.

She began taking Remeron, and ceased to take the other medications, yesterday.

For the past two weeks or so, she has begun to have every symptom I have ever heard of women getting in the earliest stages of pregnancy. These include intense nausea, frequent/strong urination, discharge, headaches, slight cramping when she shouldn't be cramping, extreme fatigue, strong food aversions, and mood swings.

Obviously, several of these could also be side effects of medication.

My main question is, if a woman has a history of intense bleeding during and between menstrual periods, and these are only stopped while she is taking the birth control pills, would said woman be more likely to bleed when on the placebo week, even if she is pregnant?

Also, assuming she may have become pregnant the weekend after her period, would you assume it was the meds, or fear pregnancy?

Basically, I need to know if I should be talking her into getting a blood test so that she can get off the Remeron and birth control, because it looks like she might be pregnant, or calmly telling her it's just side effects and she needs to calm down herself.

Because she is bipolar, she tends to let little things really get to her, and I need to make sure I am not ignoring or belittling a potential health issue with my efforts to calm her fears.

I should be able to answer any questions you have for her, and I appreciate all the help you can give. She has already agreed to see a doctor at the first available moment, but at this point I am not even sure a doctor would do anything, as it might be too early for pregnancy to show on a test.

posted by starbaby to health & fitness (17 comments total)

She needs to go to the doctor. Even if she is pregnant, it's dangerous to just stop taking those drugs on her own.
posted by IndigoRain at 7:11 PM on August 9, 2006

Go to the nearest store and buy a pregnancy test. They are less than $10 and will work as soon as the first couple of days after the day that should have been the beginning of her first missed period.
posted by fshgrl at 7:24 PM on August 9, 2006

She wouldn't go off anything without a doctor's supervision. Blood test = doctor = help coming off.

As for the pregnancy test, if she messed up her pills and ovulated, would the first day of her "missed period" move to two weeks after ovulation, or would it still be in line with the cycle her pills put her on? She hasn't missed a period yet, unless the bleeding she had was from an internal problem instead of menstruation, which I am still not clear is a possibility or not.

Thank you.
posted by starbaby at 7:53 PM on August 9, 2006

Experts tell us that there is only a 25% chance of conceiving, even under the best conditions.

However, if she has a typical menstrual cycle (28 days, ovulating ten days after the first day of the previous period) the August sex occured during a time of increased fertility. Unfortunately, pregnancy tests won't be very effective for another two weeks (again assuming typical menstruation).

So, take her to a doctor. That is the only safe and responsible thing you can do, it is the best thing you can do.
posted by oddman at 8:02 PM on August 9, 2006

I have taken celexa, trazadone, and remeron, and I think it's quite possible that some of what she is experiencing could have something to do with the meds. For instance, celexa actually can cause disruptions in the menstral cycle, and it can be difficult to discontinue. Remeron screws with appetite and can make you really tired. Changing psych meds tends to bring about things like mood swings and fatigue in general.

If your friend is pregnant, though-- there is always a chance-- I don't think it's as big a deal as you describe. When I took remeron (just a few months ago) I was never giving any sort of warning about pregancy, and looking it up now, I see that while there hasn't been adequate testing done yet, there is no evidence that remeron causes significant harm to unborn fetuses. If she were to carry a baby to term, she would certainly want to discuss with her doctor the safety of continuing w/ remeron the whole time, but if she is only a week or two pregnant, there is no reason why immediate termination would be needed.

I'm guessing that the mood swings inherent to med changes are making your friend far more worried about this than she needs to be, causing symptoms that might normally go unremarked on to swell into seemingly great dangers. Tell her to get a drug store pregnancy test as soon as the first day of her missed period. Until then, she doesn't need to worry about discontinuing the meds.

But the most important thing is for her to call her doctor and discuss her concerns. Answering questions about what is normal and what she can expect to experience is the perscribing doctor's job. The physical and psychological effects of these sort of meds can be pretty extreme, and the doc shoudl be available to help your friend negotiate that.
posted by bookish at 8:20 PM on August 9, 2006

As for the pregnancy test, if she messed up her pills and ovulated, would the first day of her "missed period" move to two weeks after ovulation

No. Pills aren't quite that awesomely powerful, unfortunately.

You guys are spinning your wheels here and I doubt it's helping your friends state of mind at all. Either she's pregnant or she's not and endlessly obsessing over it will not help. Taking a pregnancy test (at home or at the doctors they give you the same pee test at the doctors btw) will put an end to this. Take one now, if it's negative take another one in 2 or 3 weeks. Repeat as needed.
posted by fshgrl at 8:22 PM on August 9, 2006

A pregnancy test is, like, five bucks. And remarkably accurate for something so cheap, ubiquitously available and totally reliant on said accuracy.
posted by frogan at 8:56 PM on August 9, 2006

listen to fshgirl: there's not much point in speculation. It doesn't matter how likely or unlikely pregnancy is, it just matter whether she is or isn't. Get some piss sticks.

I don't know about all the other meds she's taking, but she shouldn't freak about needing to stop birth control RIGHT NOW on the off chance that she's pregnant. Taking the pill if you're already preggers isn't a big deal; studies have found "no greater risk for birth defects" in women who unknowingly continued taking the pill after getting pregnant.

And remeron "has not been studied in pregnant women." So they don't really know how bad it is, but according to the PI sheet they gave pregnant rats & rabbits 20 & 17 times the max recommended human dose, and they didn't develop birth defects (no teratogenic effects). Some rats showed fetal death when given 20 x max human dose (but not when given 3 x max dose). And no studies of human effects. Hence the official party line of caution in prescribing to pregnant woman. So, again, she should talk to her doc, but there's no reason to freak out about stopping asap (and she should definitely not quit without doctor supervision).

So yeah, she should talk to her doc, and don't stress too much about discontinuing meds right this instant--she can wait until she finds out for sure whether she's pregnant or not.
posted by neda at 8:59 PM on August 9, 2006

She was put on combination birth control pills several years ago in order to deal with intense bleeding from cysts.[...] There are quite a few longer-than-12-hour gaps between pills. In my understanding, this can make her ovulate, and pretty much makes them ineffective birth control.

Missing a pill, while not advised, isn't so bad on combination (estrogen and progesterone) pills. It's mini-pills (progesterone only) where you really need to take them at the same time every day.
posted by Violet Hour at 11:06 PM on August 9, 2006

Okay, I will repeat: a urine test is useless as she has not missed a period yet.

And about missing pills, the information packet inside every combination pill I have ever taken warns you to take it the same time every day. I realise it's not as rigid as will POPs, which have a three hour window, period, but taking one pill at 6AM and the next one at 8PM the next day, repeatedly, doesn't really seem like it would be much help. This doesn't seem like it falls into missing "a" pill, but missing several.

And I also already mentioned that she will be seeing a doctor as soon as she can.

Thanks.
posted by starbaby at 5:29 AM on August 10, 2006

She had a normal period July 25. Today is August 10. She isn't pregnant. Or rather, she might be conceiving right now, and implantation might be occurring any day now, which would cause symptoms of pregnancy to occur *soon*, like in another week or two. There is absolutely no way that symptoms which occurred two weeks ago are pregnancy-related.

She isn't pregnant. She's fucked up because she's taking an assload of powerful drugs, and she's in withdrawal from other powerful drugs.
posted by jellicle at 6:32 AM on August 10, 2006

Urine tests aren't "useless" if she hasn't missed a period; supposedly newer tests (look for names like Early Response) will tell you about a week after you become pregnant. What's useless is trying to determine via the internet whether or not this girl is pregnant.

" If a woman is pregnant, the amount of hCG in her system should be around 25 mIU at 10 dpo (days past ovulation), 50 mIU at 12 dpo, 100 mIU at around two weeks dpo. Blood tests can determine pregnancy as low as between 5 to 10 mIU/hCG"
posted by shownomercy at 6:36 AM on August 10, 2006

starbaby: in your initial post, you wondered if her "normal period" may have been just "irregular bleeding". If it was "irregular bleeding", then she may be pregnant, and a piss test would show it. In that case, the urine test would not be useless. Take the test.

ok, suppose the test comes back negative. Then her "normal period" was indeed a normal period. Also suppose that her birth control pills are not working, and that she has a 28-day cycle. Women typically ovulate mid-cycle, which would put her ovulation date at/around Aug 7. That means that only her most recent burst of sexual activity would possibly risk in pregnancy, and more importantly, the pregnancy would not yet have implanted (takes 6-8 days) and she would not be symptomatic yet for that reason. In any case she should retest for pregnancy later in August (around August 22).

Also keep in mind that many conceptions do not stick. A chemical pregnancy early on is very common. If her piss test was negative, and then she went to the doctor and had a blood test done (doing her quants), then she would have to come back in a couple of days to see if they keep doubling. I would think that would cause undue stress to your friend, not to mention being costly. If the piss test comes back negative, just wait. Like the other posters said, she doesn't have to stop her meds immediately. The benefit of her current regimen probably outweighs the risks of birth defects in a hypothetical pregnancy which may or may not exist.

I think your best course of action would be to buy your friend home pregnancy tests and prenatal vitamins and have her take them. If she won't take the prenatal vitamins, have her take at least 800 mcg of folic acid daily.
posted by crazycanuck at 6:40 AM on August 10, 2006

Thank you for your answers. You have all really calmed me down. Now I just hope I can help her to calm down.
posted by starbaby at 7:01 AM on August 10, 2006

oddman writes "Experts tell us that there is only a 25% chance of conceiving, even under the best conditions."

In other words take a look around, one in four of the people around you were conceived the first month their parents were trying.
posted by Mitheral at 7:34 AM on August 10, 2006

Therefore, she is not really in the habit of taking it at the same time every day. There are quite a few longer-than-12-hour gaps between pills. In my understanding, this can make her ovulate, and pretty much makes them ineffective birth control.

Maybe not ineffective, but unreliable. And I assume you meant 24 hour gaps?

Being pregnant, giving birth, and starting to parent is a emotionallly (& sometimes spiritually) trying time. I would suggest that during the turbulence of changing meds is not the best time to become pregnant. Perhaps you could encourage her to wait until her meds are more stable before trying/letting herself become pregnant. Don't push it, because the woman will do what she wants. But I know from personal experience and that of people close to me that both changing phsycological meds and becoming a mom are difficult times, and personally I wouldn't want to try and deal with the cumulative effect of both for the sake of my own sanity and for my own interest in being emotionally available for my future kid. YMMV.
posted by raedyn at 7:54 AM on August 10, 2006

Yes, I did mean 24 hours gaps. There are sometimes over 12-hour gaps between when she is supposed to take a pill and when she does.

She went several years after the diagnosis without medication, and is convinced she *can* do without it during pregnancy/breastfeeding if necessary. She knows it's not the best time, but is of the opinion that it won't hurt anything for it happen, so long as she knows about it and can react accordingly, whether that means switching medications or going off of them altogether [under a doctor's supervision]. I have tried to talk her into using her birth control correctly, as it's not that difficult, but she has still repeatedly disregarded this. I would much prefer she waited until many things in her life are more stable, but given her history of instability in her work, financial, and romantic situations, I doubt she has any hope of her life falling into place and being presented with the perfect timing for a child. She is currently in a healthy, monogamous relationship with a wonderful guy, she just landed a great new job, and her finances are working themselves out, so she doesn't see any reason to *really* try to keep this from happening.
posted by starbaby at 8:28 AM on August 10, 2006