Expert: Ivan Goldberg, M.D. - 5/11/2011

Question
I am a highly functional 35 year old living with Bipolar Disorder. After having been misdiagnosed for most of my life, being hospitalized numerous times, often up to 30 days at a time. I finally have come to understand my illness. I have been well managed with the most minimal of dose of Lamictal (50mg) for about 3 years now and am happy to report (and can hardly believe it myself) I haven't had a suicidal thought in years. I have been able to do this by being very aware of my moods and cycles. I strive to manage stressers but recognize their affects at times. I value the state of my mind and life now and am terrified to introduce anything new that may throw me back into the extremely tramatic past that I have lived.
With all this being said, I have been diagnosed with endometriosis and have 3 options;
1) birth control pills, 2) mirena, or 3) complete histerectomy.
First, I have tried birth control pills and they make me psycho and throw me way off balance. I have tried many so unless there is a really safe new alternative for people with this disorder I am just not really willing to risk this.
Second, I am considering the IUD Mirena but am frightened by the list of the side effects like depressed mood, etc. How will this work with my meds and disorder?
Third, my doctor and I are leaning toward the histerectomy because there is an issue with my ovary being attached to my unterus but he says it is still my choice. My concern with this option is the hormone replacement that I will need for the next 15 years. I understand that there are newer ones that are almost identical to my natural hormones but I fear that it will not work the same for me.
Unfortunately my gynocologist can not answer these questions (admittedly as he is retiring in the next month) and I see a PA for my meds and therefore do not have a psyciatrist to consult with.
The fact of the matter is I HAVE to choose something as the alternative is no longer bearable and is endangering my life.
Do you have any information that is relevant to my situation? All that I can find online are blogs. Perhaps there hasn't been enough research into this situation? Please help, I am absolutely terrified. I never want to go back where I was.
Thank you so much for your time.

Answer
Hi Christine . . .

I am sorry for the delay in getting back to you but I was unexpectedly called out of town.

A number of my patients have faced the same choice as you are facing. Hysterectomy was the answer most of them chose and it worked out well. However, after the hysterectomy and the start of hormone replacement therapy they did require a readjustment of their psychiatric medications. I think it is important that you find a psychiatrist with whom you can work until the hormone treatment and the probably necessary change in the psych meds have been worked out.

Best regards . . .

Ivan
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