Q:  Perimenopause & Bipolar

I have read everything you have written about the effects of perimenopause on bipolar disorder, but I am left with more questions than answers. I am 43, and started rapid cycling this year, I now get an abrupt and severe mood swing every 28 days or so. My psychiatrist, therapist and OB/GYN can only tell me that "perhaps" my increased symptoms are being caused by perimenopause.  I am not a candidate for birth control pills or HRT due to a history of blood clots, and being a smoker.  What can I do? Or am I to suffer every month until menopuase strikes?

Thank you for your time
 

Dear Ms. C' -- 
Understood.  First, you can sample from a website that's trying to sell estrogen patches (thus caveat emptor, let the buyer beware) which will try to explain to you why a transdermal patch might be an acceptable form of estrogen with your history (although you should probably stop smoking first; I haven't looked, but it would be interesting to see what the relative risk is for smoking causing blood clots, versus estrogen without smoking causing blood clots; it could be that you're avoiding a possibly helpful treatment in order to continue a harmful one?  I'm sure the irony of that has not escaped you, and I know from watching folks try that stopping cigarettes is worse than trying to stop using heroin...).  Here's that estrogen site, starting with an article that explains in doctor lingo why patches are different than oral estrogens: http://www.womenfirst.com/gateway/cpcenter.asp?center=4&article=26 .  

You'll notice there an explanation of why the liver does not seem to react to the patch the way it does to pills, and how that may lead to a lower risk of clotting.  This view is widespread but I had a tough time confirming that it's really a demonstrated difference.  I'll be writing up my findings on my site on a page on hormones' risk, which you can find within a few weeks through the "what's new?" link at the top of the home page.   

The rest of the womenfirst site has a lot of interesting stuff as well, but note that after telling you why their estrogen might be worth considering, at the bottom of the page appears the smaller print with the official legal lingo telling you that there's risk despite them just having told you that maybe there isn't (i.e. they're trying to have it both ways...). 

Then, I'd refer you to the reply I just posted for Ms. Anonymous, some of which I think might be relevant.  I just revised the whole perimenopause section of my site based on new input from Dr. Shuer, in case you haven't seen the revision (November 15, 2002 or so).  

Dr. Phelps