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DocHarrison, Doctor
Category: Mental Health
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Experience:  Physician
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I am 47, showing early signs of menopause; used to be

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I am 47, showing early signs of menopause; used to be regular, but now getting irregular and different degrees of heaviness. I also may be having hot flashes - not very hot if that's what they are - maybe 2x a week, and increasing trouble waking up earlier and earlier and being unable to sleep again. The complication is that I have bipolar, very unstable, worse over 20 years, now seemingly untreatable. I'm calm due I think to 30 mg valium, and now 60 mg Celexa but still enough depression that I need help coping. My question is, is it really as simple as an estrogen blood level - I heard they can vary even during the day? - to tell if I need HRT for menopausal mood swings? (I'm decided on HRT if/when I need it despite the cancer risks - life is too hard right now) Can I start a low level of HRT just to see if it helps? The days are so hard - I feel up/down like a low-key yet life-limiting roller coaster. How do I tell the difference between bipolar and menopausal mood swings?


This is a difficult situation, but there are some suggestions I have for you. First, the fact that you are 47 and now having less regular periods is strongly suggestive that you are peri-menopausal. Your body is likely changing hormonally, and this may have the effect of making your mood swings more variable. Since you have bipolar disorder, the hormone fluctuations could theoretically trigger either a depressive or manic episode. Since your body's chemistry is changing, your celexa and Valium may no longer be adequate for your depressive symptoms.

Instead of an estrogen level, you should get two other blood tests. Follicular Stimulating Hormone (FSH) and Leutenizing Hormone (LH) are the best tests for you to see exactly what your menopausal state is. These are reliable tests.

Regardless of the cause, if your mood is poor you need to see your physician to better stabilize your bipolar disorder, likely with medications other than hormone therapy. Once this is better controlled, the hot flashes etc may benefit from a small dose of HRT, but I would be reluctant to treat this before getting good control of your mood.

I know you have seen many different doctors and are frustrated, but I recommend first getting your medications re-evaluated by a psychiatrist, and perhaps changing your mood stabilizing medication what looks like your peri-menopausal state.

Good Luck and stay strong.

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