My wife (30) has been diagnosed with BPII with Psychotic episodes.  We have been married almost 8 years and I always thought her mood swings were PMS related.  She has had multiple ovarian cysts which she had to have laperoscopy surgery and was diagnosed with endometriosis. 

We had to go on clomid to give birth with two of our three kids.  We concieved our third child without help but she has had consistent abnormal menstrual cycles.  I saw your article "Does BPII cause menstrual cycle changes"  She continues to have episodes once a month (almost like cycling) but it coincides with her period almost every time.  What can be done to take the hormones out of the picture and just deal with the BP disease?  Otherwise, how is the PDOC supposed to know what dosage she should have for her meds?

Thanks.

Dear Mr. B' -- 
1.  What can be done to take hormones out of the picture?  I've not seen research on this, although I'm sure we're going to have some on this topic soon.  Meanwhile, one of my local colleagues, an OB/GYN/endocrinology specialist, is of the opinion that "stabilizing the hormonal environment" can be helpful, and a couple of my patients have benefited from seeing him for consultation (that's Dr. Doug Austin in Eugene, OR; in case anybody was wondering).  His general strategies are: 

    a) low dose birth control pills, with no withdrawal phase; i.e. no "placebo" pills, just steady same-dose use;
    b) relatively low dose estrogen, almost always combined with progesterone in women who've not had a hysterectomy; 
    c) GNRH antagonists (e.g. "Lupron") which block the signal from the hypothalamus that maintains menstrual cycling; and if that works: 
    d) ovarectomy. 

I had one patient who after the ovarectomy was dramatically improved, and he has described several such women to me, including one who had a diagnosis of "borderline personality disorder" which remitted after ovarectomy.  

2. Meanwhile, what's the Pdoc' to do?  I generally increase the mood stabilizers when I see symptoms, which were monthlong before, now appearing only just prior to menses.  That seems to work most of the time.  It's as though she's just a little too close to still cycling and so does, but only when the changes in reproductive hormones are driving the cycling right at the end of the menstrual cycle.  Often women in that situation will also have mood symptoms with other, minor, stimuli like mild sleep deprivation, or even moderate alcohol use -- again, suggesting that she's just a little too close to the edge of "stability".  

Hope that helps.

Dr. Phelps