AAPEL
Hormonal, estrogen level, menopause, contraceptives
BPD dysphoria, mood swings and PMS (premenstrual syndrome) premenstrual cycle ?

Introduction:

Connection between borderline personality and menstrual cycles. On the face of it, there is no doubt about links between both of them even if it seems that we cannot speak about "real" PMS (PreMenstrual Syndrome) or PMDD (PreMenstrual Dysphoric Disorder) . You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering
Meme page en Francais / Same page in french
Data, studies
What they say ?
Aapel view
.
Data, studies (statistics, prevalence, comorbidity, co-occurency)
* Friedman RC, Hurt SW, Clarkin J, Corn R, Aronoff MS.
1982 Am J Psychiatry - Sexual histories and premenstrual affective syndrome in psychiatric inpatients.
Of 45 female inpatients with schizophrenia, depression and/or borderline personality, 28 met criteria for probable or definite premenstrual affective syndrome. Of the 12 patients with both depression and borderline personality disorder, 9 (75%) had both premenstrual affective syndrome and abnormal sexual histories. The 6 patients who had been raped all met the criteria for premenstrual affective syndrome. The authors suggest that premenstrual affective syndrome may signify unresolved sexual conflicts in subgroups of psychiatric patients.

* ZIV, B.; HURT, S.; MOLINE, M., et al
1995 Journal of Personality Disorders - Menstrual Cycle Influences on Mood and Behavior in Women with Borderline Personality Disorder
"Patients with borderline personality disorder (BPD) often report that affective and impulsive symptoms worsen premenstrually. An association between symptom severity and phase of menstrual cycle was not found.
Despite the finding that all subjects interviewed following the study reported having experienced a premenstrual worsening of symptoms, none of the subjects met criteria for premenstrual dysphoric disorder."

* Wyatt KM, Dimmock PW, O'Brien PM. - Royal Devon and Exeter Hospital UK
Cochrane Database Syst Rev 2OO2 - Selective serotonin reuptake inhibitors for premenstrual syndrome.
RESULTS: The primary analysis of reduction in overall symptomatology included data on 844 women with premenstrual syndrome. SSRIs were found to be highly effective in treating premenstrual symptoms

* DeSoto MC, Geary DC, Hoard MK, Sheldon MS, .... - Dept. of Psychology, University of Northern Iowa
Estrogen fluctuations, oral contraceptives and borderline personality.
" Results from three studies suggest fluctuation in estrogen level may influence the expression of borderline personality disorder (BPD) symptoms.
In study 1, BPD symptoms were most common in women using oral contraceptives and during times in the menstrual cycle when estrogen level is rising.
In Study 2, The principle finding was that variation in estrogen levels predicted the presence of BPD symptoms.
Study 3 employed a pre-post Oral Contraceptive (OC) design with a control group. It was found that for women with high pre-existing levels of BPD, symptoms became significantly worse after starting pill use. Research findings that link the serotonin system and estrogen are reviewed and theoretical and practical implications are discussed."

We did not find any data about menopause and bpd (july 2OO3)


Menstrual cycle and BPD, what they say
"PMDD is distinctive from other mood disorders because there is a clear interval of 7 – 10 days during each month where the woman feels “well” mentally and physically.  This interval doesn’t take place on a traceable, reoccurring basis with other mood disorders.  Another important difference is that PMDD does NOT occur during pregnancy or when breastfeeding (at least for the first few months until the menstrual cycle starts again) and after menopause.  Other mood disorders continue throughout all of these scenarios" (Terry J. Coyier, "The Edge of Madness", 2OO1)

"Fluctuations in estrogen levels during the menstrual cycle may significantly worsen symptoms for women who are at risk for developing the disorder. It is the first study to link estrogen levels and BPD" (David Geary and Catherine DeSoto University of Missouri-Columbia, "Researchers link estrogen to borderline personality disorder", 2OO3)

"Is there any data on estrogen or progesterone and BPD? If the hormonal changes that occur around ovulation are triggering panic then yes" (Leland M. Heller, M.D,"Borderline Personality Disorder and a Successful Marriage")

"There's nothing in the literature about menopause and the BPD.  There is literature that lack of estrogen worsens or causes depression, reduces stamina and intellectual function, and can increase anxiety.
From experience I know menopause can worsen the BPD, and the symptoms get better dramatically when estrogen therapy is initiated. The BPD is worsened by any significant stress, and menopause with it's low estrogen is a definite stress" (Leland M. Heller, M.D)

"I do not know about estrogen in BPD, but if low estrogen can effect mood, and it seems to do so in some individuals, then depression of some form could result. This is turn will worsen the BPD. I do not know about estrogen supplement as to even venture a guess about what to do, so I would talk to our OB/GYN." ("Borderline Personality Disorder and Estrogen Count", bpdsanctuary)

"Is there any evidence that taking hormonal meds (birth control/estrogen/and the like) have any effect on the severity/frequency of symptoms (i.e. depression, self-destruction, emptiness, identity crisis) ?
Yes, but its very complicated. I've seen symptoms get better with birth control pills and other estrogen preparations and I've seen them get worse." (Richard Moskovitz M.D,"Borderline Personality Disorder Chat Conference",bpdsanctuary)

"The frequency in women is two to three times greater than men. This may be related to genetic or hormonal influences. An association between this disorder and severe cases of premenstrual tension has been postulated" (Richard J. Corelli, M.D ,“Borderline Personality Disorders”, stanford university CA)


Aapel view of Menstrual cycles and Borderline Personality Disorder
Here is our feeling
What is a pms ? (premenstrual syndrome)
It's a combination of "physical" and "emotional" (or behavioral) symptoms that occurs premenstrually and is absent the rest of the cycle

What is a pmdd ? (premenstrual dysphoric disorder)
Symptoms (dysphoria, irritable mood, labile affect) occurs regularly prior to menses, remits shortly before menses, and is absent during the week after menses. It is often considered a severe form of normal premenstrual syndrome (PMS) in women

Can we speak about links between mood and menstrual cycles with bpd ?
The answer seems yes, even if studies are saying that the "level" is not enough to speak about a "disorder".
In fact it is not really a surprise when we know that borderline womens are more emotionaly affected by changes and also able to have somatoform disorders.
This is about the psychological side but speaking about biological side seems not stupid. Both PMS and BPD are linked with brain serotonin levels

What about estrogen levels and bpd ?
Changes in estrogen levels seems to have effects on bpd symptoms
In that ways oral contraceptives and menopause can worsen bpd

Is there some effect about Bpd medication on menstrual cycles ?
Yes, some medications can also cause menstrual irregularities (like "older" neuroleptics). please read medication page

Is there some effect to taking hormonal meds on mood ?
Hormonal cycle is a very very complex and delicately balanced chemical cycle. Changing a little could have unexpected consequences in both ways (positive and negative). It is then very important to speak about any changes to their doctor

Please read BPD and somatoform disorders
 

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Warning:
All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
 

last update  2008
Copyright AAPEL - All rights reserved
Author, Alain Tortosa, psychotherapist, founder president of the Aapel