I know this may seem like an odd thread but following diagnosis you seem to see your life a bit clearer. I can see where I've cycled over the years and I guess that with all the med changes the one thing that has been consistent is that a few days before and upon the arrival of menstration it appears that my previous PMS diagnosis can also be seen as a cyclic phase. Severe irritability one minute/day and then deep dark depression the next. Am I the only one that sees or wonders if this is actually part of the bipolar process? We all know that hormones play a huge part in our everyday life. Does this happen to you? Tell me what you think.

I know when that special time of the month when I am allowed to be a b****, even with my medication, my Bipolar goes Haywire and I am making people laugh one minut and the next in the bathroom sobbing my eyes out cause of some PTSD flashback or just plain depression....Oh yeah Chemical embalances with the chemical hormones Is like is putting ether next to open flames...Expect an explosion!

I do hear ya, I plan on asking my doc today what we plan to do about this crazy thing. I'm tired of trying to recover every month from this.

What ever solution that can help this......PLEASE TELL MOI! LOL

sigh...I was told that birth control pills were a sure fire method of controlling the hormonal fluctuations. I don't know about you but I've never had much success with birth control pills. I do see now that they have offered a therapy where you have periods quarterly...sounds like a plan. Here's another thing that I'll have to look into and see if it works.

I hope this helps someone.

I do know one thing about B.C. I will never get that shot again cause this darn Cycle has gone Loopy and really messed me up something aweful!

PMDD

PMS has become a household word and the brunt of many jokes. According to a recent survey, many women remain unaware of its more severe form, premenstrual dysphoric disorder or PMDD. Among 500 women recently surveyed, 8 out of 10 did not know that severe premenstrual problems have been officially classified as PMDD, nor did they know that such problems can be diagnosed and treated. Even more disturbing is that the one in 4 respondents who described their premenstrual symptoms as strong or severe were among those unaware of PMDD.

“We’ve got to educate women that they do not have to tolerate debilitating premenstrual symptoms,” said Phyllis Greenberger, MSW, Executive Director of the Society for Women’s Health Research, which commissioned the Yankelovich Partners survey (sponsored by a grant from Eli Lilly, manufacturers of Prozac). “Women have a right to know if what they are experiencing month to month is actually PMDD, and how to get help.”

What is PMDD?

PMDD stands for Premenstrual Dysphoric Disorder. It is the acronym for the more severe form of PMS (Premenstrual Syndrome). Like PMS, PMDD occurs the week before the onset of menstruation and disappears a few days after. PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life, especially a woman’s relationships with her family and friends. PMDD symptoms go far beyond what are considered manageable or normal premenstrual symptoms.

PMDD is a combination of symptoms that may include irritability, depressed mood, anxiety, sleep disturbance, difficulty concentrating, angry outbursts, breast tenderness and bloating. The diagnostic criteria emphasize symptoms of depressed mood, anxiety, mood swings or irritability. The condition affects up to one in 20 American women who have regular menstrual periods.

What is the Difference Between PMS and PMDD?

The physical symptom list is identical for PMS and PMDD; while the emotional symptoms are similar, they are significantly more serious with PMDD. In PMDD, the criteria focus on the mood rather than the physical symptoms. With PMS, sadness or mild depression is not uncommon. With PMDD, however, significant depression and hopelessness may occur; in extreme cases, women may feel like killing themselves or others. Attributing suicidal or homicidal feelings to “it’s just PMS” is inappropriate; these feelings must be taken as seriously as they are in anyone else and should be promptly brought to the attention of mental health professionals.

Women who have a history of depression are at increased risk for PMDD. Similarly, women who have had PMDD are at increased risk for depression after menopause. In simplest terms, the difference between PMS and PMDD can be likened to the difference between a mild headache and a migraine.

While nearly all of the women in the survey reported experiencing premenstrual symptoms in the last 12 months, nearly half (45 percent) have never discussed PMS with their doctors. Even among women with strong or severe symptoms, more than one out of four (27 percent) had never talked with their doctors about PMS, despite the fact that most in this group reported that the symptoms interfere with their daily activities.

When asked about their reluctance to seek medical treatment even if they thought they had PMDD, nine of every 10 respondents who would not seek treatment said that they could cope with their problems on their own, and about one of every four felt their doctors would not take their complaints seriously if they did bring it up.

PMDD has recently been listed as an official psychiatric diagnosis. The fear of this stigma may contribute to women’s reluctance to discuss it with their doctors. “I frequently work with patients who have waited years to ask a doctor about premenstrual problems or have been turned away by their health care provider when they tried to discuss symptoms,” said Jean Endicott, Ph.D., Director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center. “They fear becoming the target of jokes or that seeking help is a sign of weakness. Informing women and providers about diagnosing and treating PMDD helps clear the way to effective medical care.”

Survey respondents reporting strong or severe symptoms revealed the classic PMDD features of impaired social functioning and predominant mood symptoms. Two out of three women (67 percent) with moderate, strong or severe symptoms reported interference with their daily activities. One third of these women said they find their mood changes, not their physical symptoms, to be most bothersome.

The survey also found that women with strong or severe premenstrual symptoms were five times as likely as those with moderate symptoms (26 percent vs. 5 percent) to experience these symptoms every month. A key part of the PMDD diagnosis is determining whether symptoms have occurred during most cycles of the past year and are clearly documented for at least two consecutive menstrual cycles.

When asked what they would do if they thought they had PMDD, two out of three women (66 percent) in the survey said they would most likely get information from their obstetrician or gynecologist, as opposed to consulting friends or using Internet resources. This is encouraging, according to Dr. Endicott, because the American College of Obstetricians and Gynecologists (ACOG) issued treatment guidelines for premenstrual symptoms earlier this year. It recommended the newer form of anti-depressant medications called “SSRIs” (selective serotonin reuptake inhibitors) as the preferred method for treating symptoms associated with PMDD.

Diagnosis:

How do you know if you really have PMS or PMDD? If you think you may, start keeping a PMS Symptom Diary. List the dates of your period, and which symptoms you have (and their severity) on the 10 days preceding, as well as following, your period. After tracking your symptoms for at least 2 cycles, bring this diary with you to consult your physician, along with a list of all medications you are taking (including prescriptions, over-the-counter medications, herbs, vitamins, and supplements). Your doctor will give you a complete history and physical exam to rule out other possibilities (such as hypothyroidism, hypoglycemia or depression); no specific physical findings or tests can confirm the diagnosis of PMS.

If you think you have PMS or PMDD, take Dr. Donnica’s Decisionnaire™. Check off all the points that apply to you and take this list with you when you consult your physician.

__ Do you have a stressful lifestyle?
__ Are you having relationship difficulties with your spouse, family members, or coworkers?
__ Would those who live or work with you say you have PMS?
__ Are you getting enough sleep (do you awake feeling refreshed?)?
__ Do you have regular eating habits and a balanced diet?
__ Do you get 20 minutes of aerobic exercise 3-4 times per week?
__ Do you smoke?
__ Do you drink alcoholic beverages?
__ Do you have more than two 8-ounce caffeinated beverages per day?
__ Is your diet high in red meat, salty foods or sugar?
__ Do you have food cravings in the 10 days before your period?
__ Do you have mood swings or crying jags in the 10 days before your period?
__ Do you feel bloated before your period?
__ Do you actually gain weight the few days before your period (that goes away when you’ve finished)?
__ Are you on birth control pills?

Treatment of PMDD:

For general PMS relief, your doctor may recommend birth control pills or switching to another pill if you already take one. Other prescription medical interventions will depend upon the types of symptoms that most affect you. For example, if you are affected by bloating and weight gain, your doctor may prescribe a certain type of diuretic (sprionolactone) to help your body eliminate the excess water. If severe breast tenderness is a major complaint, birth control pills are often recommended. If this is insufficient, your doctor may prescribe a medication called bromocriptine to lower your levels of prolactin (a hormone linked to breast tenderness) or an androgen called Danazol®. For dysmenorrhea (painful periods), prescription prostaglandin inhibitors such as Naprosyn® or Ponstel® can be very effective if over-the-counter non-steroidal anti-inflammatory drugs such as Motrin® or Advil® were not sufficient.

If you have severe PMS symptoms that interfere with your responsibilities or relationships, or if you tell your physician that you just feel out of control on those days, s/he may suggest that you try one of several prescription medications for PMDD symptoms. The choices are diverse and represent two major classes of anti-depressant medications: the selective serotonin reuptake inhibitors (SSRI’s) and the tricyclic antidepressants. The SSRI’s include medicines such as Prozac®, Effexor®, and Zoloft®. They are generally well tolerated, work quickly, and reduce or eliminate disturbing emotional symptoms for many women, often at doses significantly lower than those required to treat depression. A recent study showed that this type of antidepressant medication worked significantly better for the treatment of PMS than the tricyclics, although tricyclics (e.g. Pamelor®, Elavil®) have a role in treating women with severe insomnia or those with combined depression and PMS.

There are many advocates for “natural” progesterone therapy for PMS. However, to date, multiple controlled clinical trials of progesterone in several dosage forms has failed to show any benefit for the treatment of physical or emotional symptoms of PMS.

In addition to conventional therapies, many women with PMS report that they have been helped by modalities such as biofeedback, relaxation techniques, acupuncture, and massage. My general approach to these types of therapies is that if you find something that works for you -- great. For many patients, simple stress-reduction techniques such as taking long, hot baths or meditation are also helpful.

Dr. Donnica’s Top Ten Tips for PMS Management:

1. Discuss your situation with your physician. Work together to develop a comprehensive treatment plan. Follow it!
2. If you smoke, quit.
3. Practice stress management: many of the symptoms of PMS are unpredictable and emotionally draining. This can be very stressful and can exacerbate your condition.
4. Regular exercise may reduce your risk of PMS altogether; exercising once you have symptoms (even though you may not feel like it) will reduce the symptoms you experience for that cycle.
5. Take a daily, non-prescription multi-vitamin; discuss any other supplement needs with your physician.
6. Be sure to get an adequate daily intake of calcium (1,200 mg/day).
7. Eat a well balanced diet; don’t skip meals.
8. Reduce intake of caffeine, alcohol, refined sugar, and salt.
9. Enlist the support and understanding of friends and loved ones.
10. Try to get regular, sufficient sleep.

Important Questions to Ask Your Physician if You Think You Have PMS or PMDD:

1. Should I be taking any dietary supplements?
2. Are there any other illnesses that could be causing my symptoms?
3. Should I be evaluated for other conditions such as low blood sugar, under-active thyroid, or depression?
4. Could this be related to any medications I might be taking (including birth control pills)?
5. Do I have PMS or PMDD?
6. Could my symptoms be related to perimenopause?
7. Am I a candidate for prescription drug therapy for this condition?
8. What medicines should I be taking to combat PMS?

Can PMDD be Prevented?

Because doctors are not exactly sure what causes PMS or PMDD, there is currently no proven prevention. However, you may be able to alleviate some symptoms by leading a healthier lifestyle or changing other medications.

There is no cure, per se, for PMS other than menopause. As discussed above, there are many strategies for effective management, and many interventions, which may decrease the symptoms significantly. Whatever your choice of therapy, remember that you’re not committed to that choice for life! The other good news about PMS unlike other recurrent conditions is that you won’t have it for life: PMS ends with menopause if it hasn’t already disappeared after age 40 (although many of the symptoms of perimenopause are very similar to having PMS). You and your physician will monitor your progress and your comfort level with your treatment plan. If there are factors that change -- including your level of satisfaction -- discuss this with your physician.

What Men Should Know About PMS and PMDD:

The main thing that men need to know about PMS or PMDD is that jokes about PMS may be hazardous to your health! In all seriousness, PMS is serious and PMDD is very serious. Be supportive and understanding; but most of all, be thankful that you don’t have to go through these symptoms every month.

This is very interesting and informative. Thanks, I have thought about it this alot, also I am at that age that can really screw with the hormones. My dr. said dealing with an ADHD husband and son is what is causing my moods etc!! I should see a psychologist she said!!! Yup, it really is discouraging to talk to a dr!

I was diagnosed with PMDD before my Bipolar. My physchiatrist added Risperdal for me to take during the onset, at which time I became a forked tongue evil demon...who goes from being physchotic , restless, to a crying baby who sleeps 12 hours a day....geez


Now we track it and he is doing some studies on it (he is a professor at Case Western Reserve)
I have learned to track my cycles..both BP and menstrual. It appears the PMDD has a great deal to do with me hitting the roof with the BP. It's guarenteed to set me off into hypomania during the 3days prior, the normal aggitation that comes with mania....20 times worse,,,then the night before and the day of.....I am weepy and depressed...needing a minimum of 10 hours of sleep. There is an acute tie in. I am hoping more progressive studies will be done. For now, I have moved over to another mood stablizer, Neurontin for both the PMDD and insomnia from mania....it's early in the game since I just started about 2 weeks ago...and don't have a blood level yet...but we will see cause that time is coming up within the next 10 days....

Andi, I totally missed this article...thanks for bumping it up Mrs. A

I was diagnosed with PMDD before my Bipolar. My physchiatrist added Risperdal for me to take during the onset, at which time I became a forked tongue evil demon...who goes from being physchotic , restless, to a crying baby who sleeps 12 hours a day....geez


Now we track it and he is doing some studies on it (he is a professor at Case Western Reserve)
I have learned to track my cycles..both BP and menstrual. It appears the PMDD has a great deal to do with me hitting the roof with the BP. It's guarenteed to set me off into hypomania during the 3days prior, the normal aggitation that comes with mania....20 times worse,,,then the night before and the day of.....I am weepy and depressed...needing a minimum of 10 hours of sleep. There is an acute tie in. I am hoping more progressive studies will be done. For now, I have moved over to another mood stablizer, Neurontin for both the PMDD and insomnia from mania....it's early in the game since I just started about 2 weeks ago...and don't have a blood level yet...but we will see cause that time is coming up within the next 10 days....

Andi, I totally missed this article...thanks for bumping it up Mrs. AMy pleasure! I think this is important for all women to read... I am not bipolar but have been having some issues with irritability/moods etc more so now. Yes it has been since their diagnosis, but I am getting older!!!! Having trouble staying asleep which she says is because of my dealing with everything. It isn't always though.
I am going to start this journal that was mentioned. I was only dating the start but not the start of the irritability/mood changes etc.
I really feel for you to have to deal with this on top of the other stuff.
Women really have so much more on their plate.
Good luck to you all and for starting this thread.

I think that the PMS will trigger the bipolar. It does for me. I go up and down as well and it drives me CRAZY!!! I hate that time of the month. Just like you said I am happy one minute then really depressed the next. I think it is a combo of the hormones and the bipolar.

it's definitely a bipolar related issue with me but I have the symptoms that you ladies describe, hey it's a bipolar thread that I spent some time reading the posts and felt the desire to post based on my experience...

My contribution (since it may be inappropriate for me to post) is that research is in current development:

Background and Rationale for Study: Estrogen and progesterone are female hormones that regulate the menstrual cycle and likely serve an important role in the regulation of mood. Premenstrual Syndrome (PMS) which affects 75% of healthy women is a cyclic pattern of mild dysphoria and physical discomfort that begin 1-2weeks pre-menses, and resolve by 2-3 days post-onset of menses. Up to 66% of women with bipolar disorder (BD) describe premenstrual mood changes that range from mild symptoms to severe worsening that require hospitalization. Therefore, the hormonal shifts of the menstrual cycle likely influence bipolar symptoms, but confirmatory research is lacking.

Study questions: The primary aims and hypotheses are to characterize bipolar mood symptoms throughout the menstrual cycle and to determine if women with BD have: 1) a) increased severity and persistence of depression and mania symptoms in the late luteal (premenstrual) vs early follicular phase, b) larger change in mood symptoms from the late luteal (premenstrual) to the early follicular phase, compared to healthy women, 2) more relapses, in the late luteal compared to the early follicular phase. The secondary aims are to determine: 1) frequency and severity of premenstrual dysphoric disorder (PMDD) type symptoms in bipolar women; 2) association between bipolar mood variability and a) menstrual phase, b) ovulatory vs anovulatory cycles, c) antimanic drug treatment.


<TABLE cellSpacing=0 cellPadding=2 width="95%" summary="Summary of information about the study.Includes condition under study, intervention, and study phase if available." border=1><TBODY><TR><TH class=tablehead vAlign=top align=left>Condition </TH></TR><TR><TD vAlign=top align=left>Bipolar Disorder
</TD></TR></TBODY></TABLE>
MedlinePlus (http://clinicaltrials.gov/ct/visit?uid=7a3H4sIAAAAAAAAAMsoKSmw0tcvLy%2FXy8vJ1cv LzNBLzy%2FTz01NycnMSy3IKS3WBwAKdDCLIwAAAA%3D%3D%0A&warn=false) related topics: Bipolar Disorder (http://clinicaltrials.gov/ct/visit?uid=7a3H4sIAAAAAAAAAAXB2w2AMAgAwI3g3200NIWEV yjK%2Bt5xd16IMwOuBi4MOz60RSq%2BUt%2BDj2ToXSQn%0Ail YBt%2BkPqtvpmTcAAAA%3D%0A&warn=false)


Study Type: Observational
Study Design: Natural History, Longitudinal, Defined Population, Prospective Study

Official Title: Menstrual Effects On Mood Symptoms in Bipolar Disorder

Further study details as provided by University of Pittsburgh:

Total Enrollment: 45
Study start: August 2006; Expected completion: December 2007


Study Design: Women with BD (15 depressed, 15 euthymic), and 15 healthy women will enter the study. Over 3-months, subjects undergo monthly visits to assess mood and function, at the follicular and luteal phases. Ovulation is confirmed with: 1) urine dipstick tests to detect ovulation (LH surge) days8-14 from the onset of menses; 2) serum progesterone levels 7-days post-ovulation (LH surge). Subjects record their mood and physical symptoms on the daily self-report LifeChart and the Daily Rating Form.

Study Population: Women with Bipolar I or II Disorder, between ages 18-45. Primary Outcomes Measures: 1) a) mood severity – scores on the Structured Interview Guide for the Hamilton Depression Scale (SIGHADS) for depression, Mania Rating Scale (MRS) for mania/hypomania, and LifeChart mood ratings depression and mania/hypomania, for the late luteal and early follicular phases; b) persistence of symptoms - proportion of days with mild/moderate/severe depression or mania/hypomania. 2) Relapses - # bipolar episodes.


http://clinicaltrials.gov/html/images/arrow2.gif Eligibility

Ages Eligible for Study: 18 Years - 45 Years, Genders Eligible for Study: Female Accepts Healthy Volunteers


Criteria
Inclusion Criteria:

<LI style="MARGIN-TOP: 2px">Ages 18-45;
Bipolar Disorder (BD) I or II (DSM-IV criteria) must agrees to communication between PI and Psychiatrist;
Healthy Control without Past or Current Major Depression, Psychotic Disorder, premenstrual syndrome or Premenstrual Dysphoric Disorder;
25-31day menstrual cycles;
Minimum 6 menstrual cycles per year

Exclusion Criteria:

<LI style="MARGIN-TOP: 2px">Current DSM-IV Criteria Alcohol or Substance Abuse/Dependence;
Pregnancy;
Chronic Anovulation (<4 menstrual cycles/yr);
Menopause (< 1menses in 1yr);
Active thyroid disease;
Hormonal Contraception

Wow...Thanks Matt...

You can butt in anytime...with that kinda of info...I have to admit..I thought uh-oh when I saw your first line...LOL ...but this is nice...I haven't seen this one yet....perhaps I will copy it and take it to my pdoc...I know they are researching...he might have read it already....

You're a sweetie...:p

I do know that when I am premenstrual, ( not during) I am all over the place. I cycle faster and more severely, its kinda yucky. I hope it gets better for you.