Alice Roberts 

Mood swings? It might be more than PMS…

Alice Roberts: The most commonly prescribed combined contraceptive pill has a potential side-effect that more women – and GPs – should know about
  
  

Contraceptive Pill
Many GPs are ignorant of the potential side-effect of the most commonly prescribed combined pill. Photograph: Alamy Photograph: Alamy

It's that time of the month again. If you're a woman, you might be feeling a bit low, irritable, edgy and perhaps craving something sweet and cake-like. If you're a man in close proximity to such a woman, well, you're probably lying low. The tendency for many women to get moody in the days before their period starts is so well known it's practically the stuff of legend, or at least, the stuff of comedy routines. As a card-carrying feminist, I'm probably not meant to laugh at PMS jokes – PMS jokes aren't funny, period. Except they are – because they're about something that is so familiar, so much a part of everyday life. If you don't suffer from PMS yourself, you'll certainly know someone who does.

But for up to one in 12 women, PMS turns into something that really is less than funny. We're not just talking about being grumpy here. We're talking about flashes of real anger, a descent into depression, and a lack of concentration and energy – and it's impossible for these extreme mood swings not to impact on relationships and work. This more severe form of PMS is called PMDD – premenstrual dysphoric disorder.

I learned about this more extreme form of PMS a couple of weeks ago, at a conference dinner, where I ended up sitting next to Peter Greenhouse, consultant in sexual health in Bristol. Before long the conversation had turned to premenstrual syndrome and disorder, and the overlap between sexual health and mental health. Quite often, it seems, women with PMDD are diagnosed as suffering from depression or bipolar disorder – and treated accordingly. But antidepressants are likely to be ineffective, whereas stabilising hormone levels with an oestrogen patch can work wonders. But there was something else that Greenhouse said that immediately caught my attention: for some women with more extreme cyclical mood changes, going on the pill could be disastrous.

It caught my attention because I'm well aware of my own susceptibility to quite severe mood swings in the days before my period. I can quickly become very irritable, tearful and dejected. My husband is, of course, very familiar with this pattern, and I have learned not to snap his head off when he suggests a correlation between my grumpiness and my hormone levels at a particular time of the month. When I became pregnant with my first child, we were both aware of an amazing improvement. Talking to Greenhouse, I learned that this is a very common experience. And it makes sense – for nine months, fluctuating hormones are replaced with stable, high levels of oestrogen; during pregnancy, I felt calm, well and happy. This continued over the months I breast-fed my baby (meaning my oestrogen levels would have been low, but stable)… and then I went back on the pill. The mood swings were back with a vengeance – plunging me into unplumbable depths of despair and turning me into an irascible harpy in the days before my period. My husband tentatively suggested that I should, perhaps, think about stopping the pill. I did, and he was right – the mood swings were still there, but infinitely more containable and benign. So I talked to my GP. Having had this reaction to a pill that combined oestrogen and progestogen, he suggested I try the progestogen-only "mini-pill", which I did – and I'm happy to say that family life has remained much more harmonious in its wake.

The thing is, I thought that I was a bit of an oddity, responding to a combined pill in this way. But talking to Peter Greenhouse, and other GPs that evening, I realised that this is actually a common experience. Some GPs I spoke to wouldn't even prescribe the particular brand of the combined pill that I took – for this very reason. But, weirdly, it seems that this potential side-effect of the most commonly prescribed combined pill (Microgynon, Ovranette or Levest) is far from being common knowledge among GPs – or indeed among women. It's also distinctly lacking in the warning notes that come with the pills. And this all seems even more odd when it's well known that mood changes are the main reason for women stopping taking the pill. Perhaps physical side-effects are considered to be more important, somehow more tangible – but surely a side-effect that could derail and even wreck relationships is one that needs to be taken seriously. At the very least, women need to be warned about the possibility.

I've taken the combined pill Ovranette since I was 16, when I was prescribed it to help manage period pain. As an adolescent, I was already pretty hormonal and moody. But did the pill make it worse? As a young, twentysomething doctor, I was diagnosed with depression and took Prozac for a while… but would coming off the combined pill – or, more likely, switching to another combination – have solved the problem? Perhaps I would even have been better treated with an oestrogen patch than an antidepressant. Bouts of depression have occasionally threatened to sink my relationship with my now-husband. Just how much of that angst could have been avoided had I thought about switching to a better pill way back? I'll never answer these questions, but it's certainly a sobering thought. And there must be other women out there who have had similar experiences – and who have never been warned about these potentially incredibly damaging side-effects of such a routinely dished-out contraceptive pill. And that makes me just a little bit angry. Not irrationally angry. Not irritable. Just proportionately, understandably angry.

• This article was amended on 14 August 2014 to replace the term progesterone with progestogen, the synthetic hormone used in contraception.

 

Leave a Comment

Required fields are marked *

*

*