It has come to this: I'm asking about my wife's ladybits on the internet
March 5, 2013 6:58 AM   Subscribe

My wife has been having the heaviest period of her life, complete with cartoonishly exaggerated mood swings, for almost two weeks now. This began very suddenly, three days after her last normal period. Tests and biopsies all came back normal; doctor is recommending the pill or a progesterone IUD to get the bleeding under control. But there is a difficulty: she doesn't react well to progesterone at all (details inside). Two-part question: Can anyone think of possible causes for this which wouldn't have shown up on the tests she's already had (detailed inside again)? And B, have any of you who react similarly to progesterone had success combining the pill with antidepressants?

The tests so far have included a pelvic exam, blood work, ultrasound, and a uterine biopsy; all came back normal. She had laparoscopic surgery for endometriosis several months ago, but based on the test results her doctor doesn't think this new problem is related. They say they've ruled out all the scary possible causes, which is, well, it's very nice that she doesn't have cancer, but it would also be nice to find out what she does have rather than just treating the symptoms, which is where they seem to be focused now -- if any of this sounds familiar, or you can think of possibilities we can ask about, we'd love to hear it.

Second part, assuming we do have to just throw hormones at the problem: the last time she was on the pill (years ago), she had significant issues with depression (clinically depressed one week out of every four, just generally not-that-happy the rest of the time). FWIW, she was also depressed throughout her pregnancy -- so we're pretty sure the problem is progesterone. Anyone out there who reacts similarly who had success using antidepressants to smooth that out? Opinions about the interaction between them and the pill?

My wife is, of course, aware that I am asking this. "I am ook's wife and I approve this message"
posted by ook to Health & Fitness (28 answers total) 1 user marked this as a favorite
How old is she? Could this be the beginning of menopause?
posted by crazycanuck at 7:06 AM on March 5, 2013

How old is she? Women going into peri-menopause can have heavy and oddly timed periods.
posted by chiababe at 7:06 AM on March 5, 2013

How old is your wife? Also, has she seen an endocrinologist lately? Also-also: are you guys done having kids?

Re: progesterone-containing IUDs. The amount of hormones that these release into the bloodstream is pretty miniscule compared to the amount released even by the fancy-schmancy, low-hormone "mini-pills".
posted by julthumbscrew at 7:07 AM on March 5, 2013

Yikes, I should have included that -- she is 38, so menopause is possible but it'd be pretty early...

We are done having kids. She hasn't seen an endocrinologist specifically but based on the tests so far her doctor says her thyroid function is normal.
posted by ook at 7:11 AM on March 5, 2013 [1 favorite]

I'd probably see an endo, to be honest (assuming her OB/GYN has ruled out all of the glaringly-obvious scary stuff). You also might wanna ask about endometrial ablation, if she is indeed done childbearing (I've heard of some people having this after they were done having kids to help with uber-heavy periods).
posted by julthumbscrew at 7:18 AM on March 5, 2013 [1 favorite]

Stupid question probably, but I'm assuming the bloodwork included a pregnancy test? Sounds like it could be a miscarriage based on my experience. Wouldn't necessarily show up on the at-home ones, but there may be traces of hormones that show up there.
posted by two lights above the sea at 7:18 AM on March 5, 2013

I'm sorry that you're both dealing with this. I can't speak to much of your question but I have been on antidepressants for the last several years and getting an IUD did not really affect me, mood-wise. I had been on the ring before and I was done with that after a month - too many hormones, I put on weight and was bloated, I was cranky, etc. But the IUD has not made me hormonal and it has made my periods much less of an ordeal. Previously, the first day or two of my period would be crazy and then it would taper off and now it's barely noticeable. YMMV.
posted by kat518 at 7:20 AM on March 5, 2013

I can tell you that you do not get the same hormonal effects from an IUD as you do from the pill. I love my IUD: no hormonal effects at all.
posted by Eicats at 7:22 AM on March 5, 2013

This recently happened to me (although I already had an IUD).

Did they rule out fibroids? I understand they are difficult to find, as my doctor said that from its size, the one they found at my last appointment would have been there in my last ultrasound.
posted by hrj at 7:32 AM on March 5, 2013 [4 favorites]

I'm on Celexa and have the Mirena IUD and have had no issues with either. FWIW, I was on the pill for a couple of years and it turned me into an irrational and frequently weepy crazy lady.
posted by futureisunwritten at 7:38 AM on March 5, 2013

Did she have a transvaginal ultrasound? This would identify cysts, fibroids, etc.
posted by Riverine at 7:48 AM on March 5, 2013 [1 favorite]

I too love my Mirena, and it has no affect on my mood, even though I am prone to depression. And no more periods!
posted by catatethebird at 7:48 AM on March 5, 2013 [2 favorites]

The pill and Depo Provera both made me depressed, but the progesterone IUD has been pretty ok for me. I'm told that most of the hormones it releases stay in the local area of the uterus and ovaries, so you don't get as much systemic effect. That said, I'm now on several meds that can cause depression, so I eventually started Wellbutrin and have been feeling totally normal since then. So hopefully the IUC wouldn't cause a depression problem for her, but if it did there are definitely other meds she could try to combat it.
posted by vytae at 7:50 AM on March 5, 2013

I have endo and fibroids; I'm 34. It sounds like endo complications? IMNAD. I have really heavy periods, mood swings, and pain. They vary month to month.

I don't tolerate progesterone either, but there are different types of progesterone. I really didn't tolerate Norethindrone at all, but I did semi-ok on the Depo Provera pill (medroxyprogesterone). She should talk to her doc about the different types of progesterone, just to make sure she hasn't tried them all yet. It's definitely a thing to not tolerate progesterone.

That being said, I had to stop taking hormones altogether, because they make my bipolar go wacky.

I'm not actively treating my endometriosis, other than treating the symptoms. I had a lap last year and that helped, but I'm really just waiting for an excuse to have a hysterectomy. There isn't really much left after hormones...there's Danazol and Depo Lupron, and I've read that the side effects are terrible. Endometriosis is so hard to treat.

I take Seroquel for my bipolar, and it made my hormonal moods swings less pronounced. I'd recommend trying an antidepressant etc. for the mood swings.

I've heard about people controlling endometriosis and fibroids through diet. I've heard good things about this book. I've read a lot about people alleviating symptoms with a gluten free diet. I don't want to undercut the severity of this illness (believe me, I know how much is SUCKS) might be condescending to suggest a diet, but it's worth a try when you're running out of options. I'm looking into diet changes myself.
posted by hotelechozulu at 7:59 AM on March 5, 2013 [2 favorites]

I'm actually in the middle of undergoing something very similar but I've got 10 years on your wife.

Here's what I wholeheartedly recommend: find another gynecologist.

I only say that because I had a similar issue and my regular gyn wanted to also try me on _____ and see how it went.

Instead, I found a great doctor who said, "Sure, we can treat these symptoms, but let's find out WHY this is happening," so while it completely sucks because I'm currently not getting any better, I am undergoing tests with an endocrinologist and I'm scheduled for another biopsy so she can figure out the why and not just treat the (really unpleasant and yes-I-know-I-suck-to-be-around-please-bear-with-me) symptoms.

**Also as a sidenote, I have Celiac and have been gluten free for years. So for me, gluten hasn't made a difference. YMMV.
posted by kinetic at 8:03 AM on March 5, 2013 [1 favorite]

As an older woman going through this, I'm nthing menopause. I've had heavy periods lasting 41 days,followed by nothing for months at a time.Not optimal,but within normal range.
I can't speak for the other issues, but I wish you luck.
posted by pentagoet at 8:04 AM on March 5, 2013

Never thought I'd be writing about this on the Internet, but here we go...I'm 39 and entered perimenopause four years ago. My early symptoms very much mirror your wife's. So yes, it's early for this stage of life for her, but it does happen. Encourage her to have this conversation with her doctor (and get a second opinion, particularly from a doctor who takes her history of depressive symptoms seriously). Best wishes to you both!
posted by heathergirl at 8:09 AM on March 5, 2013

Also an endo sufferer and this could be part of being peri-menopausal. [Early menopause is common with endo.] I had this happen to me several times in the last few years. For over a month at one point - sorry for that news. Can you get a FSH blood test to check her levels?
posted by honey-barbara at 8:19 AM on March 5, 2013 [1 favorite]

Nthing everything everyone else has said, but also...she might consider having her prolactin levels checked (simple blood test). Prolactinomas, even tiny ones, can result in very heavy bleeding. They're usually very easily treated, though.
posted by skye.dancer at 8:21 AM on March 5, 2013

Happened to me as a senior in college - I had my period for three weeks straight.
Being a dumbass college kid, I figured it would go away and one day it did.
Turns out I was having a prolonged miscarriage.
posted by jen14221 at 8:56 AM on March 5, 2013

All of the women in my maternal family hit perimenopause somewhere between 35-40 and it manifests as almost continuous and heavy bleeding on and off for years with no medical reason ever being found. My mom was hospitalized due to low iron and blood palate count from losing so much blood when I was a teen. Could be that.
posted by tenaciousmoon at 9:00 AM on March 5, 2013

I have had ridiculously rollercoastery moods while on the pill -- multiple kinds) and also take medication for depression and ADD. In my experience with Mirena, I had absolutely no problems. The hormones were only noticeable because of my noticeably better skin (and the noticeably crappier skin I had when I no longer had the IUD). I was very, very pleased with my experience.

As anecdata, I know multiple other women (probably more than 10) who have had the same experience: history of mood disorders, strongly disliked the pill, had a great experience with Mirena. Not one had a negative experience. To me, it was pretty much the perfect birth control method.

Although it is intended as a long-term method, it is easily removed. Mine expelled twice, which is VERY rare, but both times it was painless. My understanding is that unlike the pill, the hormones do not stick around in your system. COMPLETELY NONSCIENTIFIC ANECDOTE: I know two people who got pregnant within a week or two after removal.
posted by Madamina at 9:47 AM on March 5, 2013 [1 favorite]

A lot of people like the Mirena, but some women do experience mood swings on it. I did (for seven irrationally weepy months). My doctor kept saying it was impossible and in my imagination, but then I found this Mirena side effect forum on the Curezone forums and had the IUD taken out and the weepy, irrational moods stopped immediately.

My take was that I'm very sensitive to artificial hormones (or maybe just to levonorgestrel) and while most people find the small localized hormones of the Mirena tolerable, even unnoticeable, it isn't that way for everyone.

Nthing that it'd be good to consult an endocrinologist. I hope your wife finds a remedy that works great for her.
posted by feets at 9:56 AM on March 5, 2013 [2 favorites]

Definitely try a different doctor for her ladybits. It took me a couple before they figured out I'd experienced premature ovarian failure (early menopause) at 19. Apparently blood testing needs to performed a number of different times in order to make this sort of diagnosis. I do not tolerate the Pill for reasons similar to your wife and so elected to just put up with the associated symptoms.
posted by xyzzy at 10:15 AM on March 5, 2013

I've had horrible mood swings on some pills and no mood changes at all on others. For what it's worth, my doctor doesn't recommend Mirena or a progesterone-only pill for me because she says the combination progesterone and estrogen pills are easier to tolerate.

I've been on 4 combo-pills in the past two years. Two of them gave me terrible mood-related side effects, the other two, nothing. I would guess its entirely possible for your wife to find a pill that would not cause these side effects, but I would definitely get a second opinion.
posted by inertia at 11:15 AM on March 5, 2013 [1 favorite]

This happened to my grandmother as part of perimenopause, she was in her 50s, it was the 1980's, had a hysterectomy.

Birth control makes me clinically depressed too...weepy and 'crazy'. Anti depressants might have helped with the depression, but they don't make you 'normal' either. It's like taking medication that makes you drowsy and then drinking a big cup of are awake, but still shouldn't operate heavy machinery. It makes you tweaky.

I vote for find another doctor, endocrinologist.

Good luck!
posted by jrobin276 at 11:57 AM on March 5, 2013 [1 favorite]

Wow. that is a lot of blood loss. Has her doctor put her on a preseciption iron supplement? Because I think she needs iron, STAT.

Anemia will cause mood swings, heart palpitations, and especially feelings of generalized anxiety, fatigue, and obviously, depression.

Since she has/had endometriosis, she might have the symptoms of anemia which tend to go along with endo (at least, persistent anemia was a big feature for me with the endo. IANAD, and YMMV) Since anemia causes fatigue, anxiety and mood swings... *sigh* I was also checked and re-checked for thyroid problems that were probably down to persistant anemia.

At any rate, your wife is losing a lot of blood, so really, she needs iron.

Ferrous Fumarate is the easiest, most bioavailble form of iron. GNC makes a great women's formula of this with B vits and C. It's important to take any iron along with B's and C.

I will say that the most effective iron supplements I ever took, that actually made a difference were (a) a prescription for Ferrous Sulfate 325 mg tablets prescribed by my doctor after my son was born (looking at the bottle right now) AND (b) the Ferrous Fumarate GNC Women's formula I mentioned.

I've also done liquid iron (Floradit) and didn't not experience the near-instantly physical and emotional improvements that I did with those two other formulations I've taken.

Just in case your wife already thinks she has this covered... I started taking regular OTC iron supplements after the ferrous sulfate prescription ran out last year.... And I ended up getting treated again for anemia just recently, even though I took the regular supplements every damn day and have an awesome diet.

Sorry for going on so long. Simple things like this often get overlooked and it has infuriated me over the years to have spent months sick and getting tests, when really, a large portion of my physical discomfort was down something insanely simple to detect and cure.

(I won't go on about the 5 years I suffered with totally obvious endo symptoms that 7 doctors missed....)

Her doctor might not tell her, but at this point while she considers other options, your wife is pretty depleted and needs quality (iron+) supplementation to keep up with all of the blood loss.

Good luck.
posted by jbenben at 12:33 PM on March 5, 2013 [1 favorite]

Thanks, everyone, for all the information. We're not settled yet on what the next steps will be but this has been really helpful.
posted by ook at 7:49 AM on March 6, 2013

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