Oral Contraceptives and Mood?

[heybeesly]

Okay.  Hi.

 

I take oral contraceptives for multiple reasons - primarily, because I have a relatively mild case of endometriosis, and my periods are severely painful when left to their own devices.  Hormonal birth control helps them to be tolerable, and some months even nonexistant.  Secondarily, I take them to prevent pregnancy, as I am sexually active in a monogamous heterosexual relationship.

 

I also have Bipolar Disorder, type II, and am currently being treated for it.

 

In college, I tried taking Yaz, and as a result became severely depressed.  I believe that this contraceptive may have been a major influence in my mental state that led to my first suicide attempt.  Soon after being hospitalized, I stopped taking Yaz, and felt more like myself within a week or so.

 

Understandably, I was cautious to take hormonal birth control again.  However, several years later, I found I could not deal with my crippling periods any longer.  I sought help from my OBGYN, and after a lengthy consultation, I was prescriped Lo Loestrin FE.

 

I have taken this medication for the last few years with no problems whatsoever.  My periods were light and barely painful, and I didn't experience any mood disturbances that could be directly related to my period or hormones.

 

However, due to financial difficulties, I had to seek help from a different "lady parts" doctor last month.  The new doctor informed me that, since I have a history of migraines, the Lo Loestrin FE significantly raised my risk of having a stroke at a young age, and recommended a progestin-based oral contraceptive.

 

I have been taking Micronor for three weeks now, and already notice a difference in my moods.  I am more reactive, cry easily, and am beginning to have suicidal ideation for the first time in many years.  The only medication I have changed recently is my oral contraceptive.

 

How do I approach my Planned Parenthood doctor and convince her to put me back on my old birth control pills, even though it puts me at a higher risk of a stroke?  I felt better mood-wise on those pills; is it stupid to want to go back on them?  Shouldn't I want to feel good emotionally?  Is it a bad idea to put my emotions before my physical health?  I am at a serious loss right now.  All I know is I feel like crap.

Edited February 10, 2014 by heybeesly

[WinterRosie]

Some say "not indicated for depression" - mine has a warning against taking it if you've ever been diagnosed with depression. And for this reason.

So, you ask by saying "I'm prone to depression and I've noticed that this pill makes it worse." 

If you are already at a higher risk of stroke (over 35, smoker, very inactive, higher blood pressure... I can't remember the others) then they may decide that the risk is too high. If you're risk of stroke is otherwise very low than it should be okay. But if you're in America they may still decide that it's not okay. Care providers there seem pretty scared of being sued for malpractice, from what I understand. And you getting a stroke would likely be in the realm of "not an okay risk."

 

Ultimately it's between you and your doctor to find a trade-off between your mental stability and physical health. 

[malachite]

I have the exact same problem as you. Doctors will not prescribe me estrogen-based pills due to migraines. I highly recommend heeding their concern. In fact,  the first migraine I ever had was due to taking the Pill. It really can increase risk of stroke. I tried a progesterone only pill (PIP) and not only did I find that my moods were less stable,but it caused my period to stop which can increase risk of endometrial cancer. I am going to see a new gyno tomorrow. They want me to get an IUD, but that freaks me out and I'm not doing it. I have been using condoms with my male partner. That's what I'll continue to do, because I can't risk my physical or mental health. Would be nice if most of family planning weren't on the woman's shoulders. Where's the male Pill? I wish you luck.

[climber47]

I don't think it's stupid at all to put your emotions above your "physical" health, if you can even draw a line like that... to me they're very connected, but I see your point. Doesn't stress raise your risk of just about any scary medical disaster? I suppose a doctor doesn't have to prescribe something just because you ask for it, but it's worth telling them you understand the risk but the benefits outweigh it.

 

Is it possible it's a money thing with the clinic? It's been a long time but I feel like Planned Parenthood pushed certain brands or something. I know the estrogen/stroke thing is a real issue, though...

 

Estrogen wreaks some havoc for me with some chronic pain issues, as well as increasing my cancer risk, but I had to get back on hormonal birth control in order to stabilize my emotions, too. My doc said Nuvaring was the lowest level of hormone so I'm trying that myself. But then there's no generic for that is there so maybe not a good option!

 

Anyway, I think it's definitely a valid concern and worth asking about.

[lavender fairy]

I have had similar problems with my moods being all over the place from hormonal birth control.  I finally stopped taking it, and my gyno pushed me to take a progesterone-only pill to regulate my cycles.  BIG MISTAKE!  I was suicidal.  I self-harmed for the only time in my adult life.  I was a complete mess.  Once I connected my emotional outbursts to the start of the progesterone, I stopped taking it, and I felt much better.  I told my doc that it made me moody and I didn't like it.  I coped with the irregular cycles. 

 

I have had docs try to convince me to take oral contraceptives since, but I have always refused because I am too scared of the consequences.  Most recently, my doc tried to convince me to use the Nuvaring.  She said it lowered the risk of mood side effects.  I was concerned about taking it for other reasons, and refused.  She also encouraged me to get an IUD, which I was afraid of also.  The doc had scheduled a follow-up appointment to talk about it, and I simply cancelled it. 

[tamagotchi]

Many women can't tolerate progestin only birth control.  You will not be the first one to come back to the obgyn with that problem.  You would explain that your moods have taken a turn for the worse and that you want to be put on your old OCP, and if there is an increased risk you are willing to take that risk.

 

But as far as if there really is a risk-- Do you have migraines with aura?  Or without aura?

 

If migraines without aura, there isn't really evidence that OCP raise stroke risk.  I had a long conversation with my neurologist about this recently.  The reason people are worried about migraines and OCP is because of migraine with aura.  She said not to be concerned if you don't have aura because OCP doesn't raise risk in that case.  I have read research on this, too.  I could dig up the articles if you need scientific looking support when talking to the obgyn-- But I wouldn't recommend arguing with the obgyn about that-- I would rather suggest just saying that you are willing to take the risk.

 

The neurologist did say that she would not recommend Yaz or any of the late generation progestins because the progestin is more likely to cause clots.  But the progestin used in Lo Loestrin FE is as safe as any.

 

If migraines with aura, there is increased risk with estrogen containing OCP and you would have to consider that with your obgyn.  But you might try to find a different obgyn who is less rigid in her/his opinions.

Edited February 10, 2014 by tamagotchi

[tamagotchi]

I have the exact same problem as you. Doctors will not prescribe me estrogen-based pills due to migraines. I highly recommend heeding their concern. In fact,  the first migraine I ever had was due to taking the Pill. It really can increase risk of stroke. 

 

If your migraines started when you took OCP, my understanding is that you are in a different risk category from someone who has migraines that are not caused by OCP.  In your case the risk is higher because the OCP contribute to your migraines.  However the OP isn't in the same risk category as you are, unless OCP contribute to her migraines also.