I was contacted by one of our readers who shall remain anonymous. She suffers from Polycystic Ovary Syndrome (PCOS) and Bipolar Disorder. Her OBGYN suspects she has Endometriosis; however, she had to return to college out-of-state and wasn’t able to have her diagnostic surgery. In the meantime, her physician is encouraging her to remain on birth control pills to suppress the possible Endo symptoms. Her symptoms are worsening…
She had heard that there may be a link between Endometriosis and Bipolar Disorder, and that it may be difficult to treat both at the same time due to complications with the medications interacting with each other, or even cancelling the medicinal effects of the pills.
She piqued my interest. And the research begins! Is there a link? What about negative interactions with medication? What can she do now?
If you’re reading this, you’re probably already familiar with Endometriosis. But what is bipolar disorder? I’ve heard of it, but haven’t actually asked what it is.
It’s considered a chronic illness which affects the brain and moods, often switching between extreme emotions : happy moods (manic) and incredibly depressed moods (depressive). They don’t know what causes bipolar disorder, but it can run in families. There are ongoing studies to greater understand and hopefully one day cure bipolar disorder. Treatments can include medications which help soothe and control moods, therapy, and/or electroconvulsive therapy.
There is; however, one very interesting theory by Dr. Jory Goodman that many people who have been diagnosed with Bipolar Disorder have been misdiagnosed and instead suffer from hormone imbalances, including PMS and PCOS. I’m not saying this to lessen your bipolar diagnosis, if you are reading this and suffer from it. I’m simply pointing out another person’s perspective. As they say, “knowledge is power.”
There are several studies that find people with Endometriosis seem to be more prone to mood disorders. In 2006, 16 women with Endometriosis (diagnosed via laparoscopy) were evaluated. Seven of them were bipolar disorder mixed, 3 for bipolar disorder manic, and 2 suffered from major depression. Of those women, 9 had a parent, sibling, or relative who also suffered from a severe mood disorder.
In 2011, the study was revisited, but this time compared 27 women with Endometriosis to 12 women who suffered from pelvic pain, but did not have Endometriosis. It found that there was a “significantly greater proportion” of women with Endo and Bipolar Disorder than women without Endometriosis. They suggest as part of managing Endometriosis, a psychiatric evaluation may be conducted to diagnose or rule out the comorbidity (existence of 2 chronic conditions at the same time) of Bipolar Disorder.
A review of 18 English studies in 2015 found that 56.4% of women with Endometriosis met the criteria of suffering from a psychiatric disorder. It does not identify a cause/effect relationship, nor what the relation between the two conditions may be. But it is a staggering figure.
Many people who suffer from Endo and Bipolar Disorder have issues balancing out their medications. They cancel the effects of one another, or heighten the symptoms of the other disease. Doses, or types, of medication may need to be adjusted to lessen any potential interactions. It is a balance game; one which needs to be carefully monitored by your physician until a proper dosage (of either medication) can be found for you.
Are you worried about possible interactions between your Bipolar meds and Endo meds? Please, talk to your doctor. HelpGuide.com offers this amazing list of questions to ask your:
- Are there any medical conditions that could be causing or exacerbating my mood swings?
- What are the side effects and risks of the medication you are recommending?
- When and how should I take this medication?
- Are there any foods or other substances I will need to avoid?
- How will this drug interact with my other prescriptions?
- How long will I have to take this medication?
- Will withdrawing from the drug be difficult if I decide to stop?
- Will my symptoms return when I stop taking the medication?
A wonderful resource to check if your medications have interactions may be found at Drugs.com. I ran a few common Bipolar meds with Endo meds to see if they had any interactions and/or lessen their effectiveness. I’ve listed a few of them below:
Amethyst (birth control pill) & Depakote – may cause loss of seizure control, tremors, poor muscle coordination, increased seizures, and changes in behavior.
Amethyst (birth control pill) & Klonopin – may prolong the half-life of benzodiazepines in your system
Amethyst (birth control pill) & Lamotrigine – may reduce blood levels that effect lamotrigine.
Amethyst (birth control pill) & Topamax – can make birth control pills less effective.
Amethyst (birth control pill) & Xanax – may prolong the half-life of benzodiazepines in your system
Depo-Provera & Depakote – may cause loss of seizure control, tremors, poor muscle coordination, increased seizures, and changes in behavior.
Depo-Provera & Lamotrigine – may reduce blood levels that effect lamotrigine.
Lupron Depot & Celexa – may increase the risk of irregular heart rhythm, which may be life threatening.
Lupron Depot & Lithium – may increase the risk of irregular heart rhythm, which may be life threatening.
Lupron Depot & Prozac – may increase the risk of irregular heart rhythm, which may be life threatening.
Lupron Depot & Seroquel – may increase the risk of irregular heart rhythm, which may be life threatening.
Lupron Depot & Trazodone – may increase the risk of irregular heart rhythm, which may be life threatening.
Lupron Depot & Venflaxine – may increase the risk of irregular heart rhythm, which may be life threatening.
Mirena (IUD) & Depakote – may cause loss of seizure control, tremors, poor muscle coordination, increased seizures, and changes in behavior.
Mirena (IUD) & Lamotrigine – may reduce blood levels that effect lamotrigine.
Naproxen Sodium (NSAIDs) & Celexa – may increase the risk of bleeding.
Naproxen Sodium (NSAIDs) & Lithium – may increase blood levels, which effects the lithium.
Naproxen Sodium (NSAIDs) & Prozac – may increase the risk of bleeding.
Naproxen Sodium (NSAIDs) & Venflaxine – may increase the risk of bleeding.
Naproxen Sodium (NSAIDs) & Yasmin (birth control pill) – may increase potassium levels in the blood, which may lead to the development of hyperkalemia (elevated levels of potassium in the blood).
Yasmin (birth control pill) & Depakote – may cause loss of seizure control, tremors, poor muscle coordination, increased seizures, and changes in behavior.
Yasmin (birth control pill) & Klonopin – may prolong the half-life of benzodiazepines in your system
Yasmin (birth control pill) & Lamotrigine – may reduce blood levels that effect lamotrigine.
Yasmin (birth control pill) & Naproxen Sodium (NSAIDs) – may increase potassium levels in the blood, which may lead to the development of hyperkalemia (elevated levels of potassium in the blood).
Yasmin (birth control pill) & Topamax – can make birth control pills less effective.
Yasmin (birth control pill) & Xanax – may prolong the half-life of benzodiazepines in your system
If you suffer from Endometriosis and Bipolar Disorder, know a few things :
- You are NOT alone. Many women have been diagnosed with both conditions;
- Talk to your doctor about any potential interactions with treatments for both conditions;
- Hold onto hope. There are ongoing studies and trials to help with Endometriosis and with Bipolar Disorder.
I hope I was able to answer some questions and offer some guidance today. I would like to thank our reader for bringing this to my attention. I never would have known otherwise…
(Updated March 27, 2019)
Resources:
Bipolar Reddit – Bipolar & Endometriosis: Meds that Do Not Cancel One Another Out?
Depression and Bipolar Support Alliance – Research Studies : Bipolar Disorder
Depression Forums – Endometriosis & Bipolar 2
Disassociated Press – Remission?
Drugs.com – Drug Interaction Search
Examiner.com – (Dec. 2015, Article) Endometriosis Associated with Psychiatric Disorders, Say Researchers
HelpGuide.com – Bipolar Medicaiton Guide : Medications and Drugs for Bipolar Disorder Treatment
Journal of Obstetrics and Gynaecology Canada – (Nov. 2015, Abstract) A Systematic Review of the Association Between Psychiatric Disturbances and Endometriosis
National Institute of Mental Health – Bipolar Disorder
Psych Central – Endometriosis, Bipolar, and Birth Control
Psychology Today – (Oct. 2013, Article) Hormone Imbalance, Not Bipolar Disorder
The American Journal of Psychiatry – (April 2006, Abstract) Bipolar Mood Disorder and Endometriosis : Preliminary Findings
Journal of Obstetrics and Gynaecology Canada – (Nov. 2011, Abstract) Revisiting the Association Between Endometriosis and Bipolar Disorder
~ Again, I am a layman. I do not hold any college degrees, nor mastery of knowledge. Please take what I say with a grain of salt. If curious, do your own research Validate my writings. Or challenge them. And ALWAYS feel free to consult with your physician. Always. Yours ~ Lisa
Bloomin' Uterus 
I’m getting my master’s in psych, and honestly, I just think there’s a big overlap between the 1 in 10 women who have endo and the 1 in 5 adults (so approximately 1 in 10 for women) who are mentally ill. This study reviews a lot of the studies going on now and shows that while there’s a correlate, it’s not necessarily causative.
I found another study that said there was some correlation, but it only had 27 people in its study, which is way too small to be of any statistical significance.
Usually in psych cases, any sort of physical ailment is ruled out before psych medication is given unless the client is in acute mental distress, but I think there’s also a lack of information with how large a part hormones play in a woman’s mental health as well. I’d rephrase the idea that hormones could be exacerbating her pain. In terms of treatment, yeah, the medicine part is always going to be a nightmare. A lot of times doctors want to use anti-depressants because they can limit neurotransmitters that also effect pain, but at the same time, a person shouldn’t be on too many or they can get serotonin toxicity, which can be fatal in extreme cases. But none of that should stop her doctor from treating her; if he can’t manage her medicine, he should refer her to someone who can, IMHO.
Sorry for the info dump!
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I LOVE a good info dump! THANK YOU!
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A bit late, but thank you so much for linking to my blog! I love this post and think it’s so important to recognize the mind-body connection (which, admittedly, I was skeptical of until it began to really hit me hard). I also wrote a post regarding the link between abuse and chronic pelvic pain, if you’re interested:
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Oh man, your blog on pain & sexual abuse was awesome! Thank you for sharing. I’ll be stalking you…erm, I mean following you from here on out 😉
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It’s interesting because being on Birth Control exacerbated my psychosis that ended up on my Bipolar diagnosis but it was also the Bipolar medications that were keeping me from discovering I had Endometriosis. For the longest time, they thought I had a bladder infection because they didn’t take me seriously but I had to get off Lithium to feel pain and realize that I had two cysts swimming around in my uterus. It’s run through my family – especially through my paternal grandmother – and I’m hoping that they are able to understand a cure. Honestly it’s a no win situation because you are drinking and drugging up to numb the pain but also trying to regulate moods. If I had stayed on Lithium, I probably would have died from Hypothyroidism. My grandmother also died from narcotic withdrawal. Hopefully they will come up with some affective treatments in the future. I’m suspecting inflammation and chemical imbalances could be linked.
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Hello, I know this is a very old post, but maybe someone will see this and help me out…
Im a going on 34yr. female with severe ptsd, bipolar , severe PMDD, IC ( interstitial cystitis-Chronic Bladder inflammation ) and endometriosis too. Yes, a lot !!! Well, Im scheduled in a few weeks to get my Lupron 3 month shot…. Im very iffy about because of all my other health and mental disorders. I wonder if I will be much worse than I am now… So for the PMDD for me, every single month before, during and a week after my period, I am a wreck !!! I cry a lot, start thinking suicidal, extreme mood swings/ massive irritability- so its like I am going thru a severe case of menopause every month!! I need some advice on anyone who has similar problems like me, and that has already had the Lupron shot and the 3 month one at that… I still have my ovaries… and everything else there.. was thinking that route of a hysterectomy but… ugh just NO!!! Not ready for that!! Please any help would be greatly appreciated!!! Thank you all for your time and help !!!
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I’ll post this on our Facebook page and see if anyone provides some help ❤ I'll paste anything I receive here. ❤
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Also, I found that my Lupron made me SEVERELY depressed. If you’re already suffering with a lot of mood swings, depression, and suicidal thoughts…you may want to rethink using Lupron Depot. And Lupron is simply a bandaid – perhaps talk to your doctor about doing the one-month shot instead to see how it balances with your emotions? You can read my experience here: https://bloominuterus.com/2015/01/20/lupron-depot-my-experience/ and the experiences of a lot of other women here: https://bloominuterus.com/2015/07/08/life-after-lupron/
The decision is yours. Please, do you research. Talk to your doctor. And be careful. Don’t be afraid to say “no” or insist on the shorter, more frequent injection. And, again, I’ll let you know if anyone replies on Facebook. ❤ Best of luck!! Lisa
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