Naomi's story: "Perimenopause is proving to be a challenging time"

A bit about me
I experienced postpartum psychosis after the birth of both my daughters in 2005 and 2011.  When I turned 40 in 2015, I was diagnosed with bipolar disorder after an admission to hospital with severe depression. I then had six years of being extremely well with a combination of mood stabilising medication and good strategies to look after my wellbeing, including my love of wild swimming here in Devon

Now that I’m 46, the conversation in my group of friends often turns to the trials and tribulations of perimenopause! Perimenopause is the time before a woman’s periods have stopped completely for 12 months. During perimenopause hormone levels tend to fluctuate significantly. Lots of my friends are experiencing symptoms such as hot flushes, difficulties sleeping, loss of concentration and increased anxiety or low mood.

As I began to notice similar symptoms, I was really worried that entering the perimenopause might trigger a relapse of my bipolar disorder. There’s unfortunately currently very little research on risks at menopause for women who have a history of postpartum psychosis and/or bipolar disorder. However, the most recent statistics from the Bipolar Disorder Research Network suggest that around 59% of women with bipolar experience a mood episode during the menopause (depression, anxiety, mania or more rarely psychosis). This study also found that women who have had an episode of PP are more at risk of mania or psychosis at menopause rather than depression.

Challenges I’m experiencing
For around the last six months, I have found that my mood has been a lot more up and down, and I’m suffering regular migraines (which can also be linked to perimenopause). I tend to have about a week every month where I suffer from fatigue, migraine and low mood. I’ve been quite tearful at times, worrying that I might be starting to have a relapse of depression.  However, after about two or three days my mood lifts again and I have a few settled weeks where I feel back to my old self. I’ve noticed occasional periods of sleeplessness and high energy, but for me these are less common.

What’s helped so far?
I’ve had conversations with both my GP and a psychiatrist about the possible interaction of my bipolar disorder with the start of perimenopause. It’s been a bit of a battle to ensure that my GP listens to my concerns that this is not a typical relapse for me, but much more of a cycle of ups and downs alongside physical menopause symptoms. I use a mobile phone app called Daylio to track my mood, symptoms and activities which helps inform my discussions with health professionals. I’ve just started on a six-month trial of Hormone Replacement Therapy (HRT) and we’ve also adjusted my mood stabiliser to a slightly higher dose (as HRT can sometimes affect medication).

I’ve found that educating myself with lots of information about menopause has been very helpful. I would highly recommend the Bipolar UK webinar on menopause and bipolar disorder and the Balance website which has loads of information about symptoms, self-care and treatments. During my ‘steady weeks’ I try to do lots of wild swimming and exercise to support my wellbeing. I also keep up those chats with my friends!