Do Antidepressants Affect Your Menstrual Cycle? the Connection - Psychiatry

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Do antidepressants affect the menstrual cycle?


Hello Doctor: I have been experiencing anxiety and irritability for the past one to two years, along with intrusive thoughts (I tend to be particularly sensitive and anxious when I hear ominous statements).
After the 403 earthquake, my anxiety and panic increased (I have a strong fear of earthquakes).
Therefore, I began treatment in the psychosomatic department on April 6 of this year.
I have also been taking Chingna pills, a menstrual regulation medication, at a dosage of 21 pills per month.
Since I am on a higher dosage of menstrual regulation medication, the side effects are more pronounced, so my gynecologist mentioned that Chingna is a lower-dose option.
The medications prescribed by my psychosomatic doctor are as follows: Liyou 10mg, one in the morning and one in the evening; Jing'an Ning 0.5mg, one in the evening (I take this around 8 PM after my husband leaves for his night shift, as I tend to feel anxious during aftershocks); and Lipingjing 0.5mg, taken before bed.
I have been diligent and consistent in taking my psychosomatic medications without skipping any doses.
After taking these medications for a month and a half, my menstruation unexpectedly started in the last few days of taking the menstrual regulation medication.
At that time, I thought it was due to the stress from my foot injury, as I had been using crutches for over a week and needed help with household chores, which caused additional pressure and led to menstrual irregularities.
My psychosomatic doctor also considered this possibility.
However, a month later, I experienced light bleeding again on the 15th day of taking the menstrual regulation medication, so I went to see my gynecologist (I also had a Pap smear done), and everything was normal.
The gynecologist believed it was due to emotional stress and prescribed medication to stop the bleeding and strengthen the menstrual regulation.
Later, my foot injury improved significantly (though I still occasionally feel some soreness), and since it no longer affects my daily life (I can perform household chores normally), my mood has also improved.
However, on the fifth day after my last menstruation, I started taking the menstrual regulation medication again, and I experienced light bleeding on the third day (which has not happened before).
I found online that a psychiatrist mentioned that long-term side effects of antidepressant medications may include menstrual irregularities and sexual dysfunction.
Typically, menstrual irregularities are not specifically treated because the body has an automatic regulatory mechanism.
When female hormones are affected by medication, the feedback mechanism in the brain adjusts accordingly.
Generally, after two to three cycles, the patient's menstrual condition can return to normal.
I am uncertain whether my situation is part of the process associated with psychosomatic treatment or if I should see my gynecologist for further examination.
Should I ask my gynecologist to continue prescribing hormonal medications for support? I am concerned that my written description may not be clear, so I have diligently recorded my medication times and conditions.
I will attach my timeline for your reference and kindly ask for your advice.
Timeline:
- 4/6: Started taking psychosomatic medications
- 5/26: Foot injury (mood began to deteriorate)
- 6/4: Light bleeding began (last three Chingna pills)
- 6/22: Light bleeding again (12th Chingna pill)
- 6/24: Gynecological check-up, no issues found (started following the doctor's advice to take hormonal medications to stop bleeding)
- 7/13: Light bleeding again after menstruation (third Chingna pill).
Since my next appointment with the psychosomatic department is still over a week away, this situation has caused me to feel anxious again.
I would appreciate your advice on these concerns.
Thank you, Doctor.

eMILY, 40~49 year old female. Ask Date: 2024/07/13

Dr. Qiu Junda reply Psychiatry


Hello.
Medications and emotions can affect the menstrual cycle.
You may not need to visit the obstetrics and gynecology department for an examination at this time.
Please discuss your situation, including the use of Xinna tablets, with your psychiatrist during your next appointment.
This will help the doctor assess whether any adjustments to your medication are necessary.

Reply Date: 2024/07/13

More Info


Antidepressants can indeed have an impact on the menstrual cycle, and your concerns are valid. The relationship between antidepressants and menstrual irregularities is complex and can be influenced by various factors, including the type of medication, dosage, individual hormonal balance, and overall mental health status.

Firstly, it’s important to recognize that antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and other classes of antidepressants, can affect neurotransmitters in the brain, which in turn can influence hormonal regulation. The menstrual cycle is governed by a delicate balance of hormones, including estrogen and progesterone, which are regulated by the hypothalamus and pituitary gland in the brain. When antidepressants alter the levels of serotonin and other neurotransmitters, they can inadvertently affect this hormonal balance, leading to changes in the menstrual cycle.

In your case, you mentioned experiencing anxiety and panic attacks, particularly after a traumatic event like an earthquake. This heightened state of anxiety can also contribute to menstrual irregularities. Stress is known to affect the hypothalamus, which can disrupt the normal release of hormones that regulate the menstrual cycle. Therefore, both the antidepressants and your emotional state could be playing a role in your menstrual irregularities.

You have been prescribed a combination of medications, including antidepressants and hormonal treatments. It’s not uncommon for women to experience changes in their menstrual cycle when starting or adjusting medications. The fact that you have experienced light bleeding at various points during your treatment could be a side effect of the antidepressants, the hormonal medication, or a combination of both. It’s also possible that your body is still adjusting to the medications, and it may take a few cycles for your menstrual pattern to stabilize.

Given your situation, it’s crucial to maintain open communication with both your psychiatrist and gynecologist. Since you have already consulted with your gynecologist and undergone tests that returned normal results, it may be beneficial to continue monitoring your symptoms. If the irregular bleeding persists or worsens, or if you experience any additional concerning symptoms, it would be wise to follow up with your gynecologist for further evaluation. They may consider adjusting your hormonal medication or exploring other options to help regulate your menstrual cycle.

Additionally, it’s essential to consider the psychological aspect of your treatment. Managing anxiety and stress through therapy, lifestyle changes, and possibly adjusting your medication regimen can also help improve your overall well-being and potentially stabilize your menstrual cycle. Cognitive-behavioral therapy (CBT) is often effective for anxiety and can provide you with tools to cope with stressors more effectively.

In summary, while antidepressants can affect your menstrual cycle, it’s essential to consider the broader context of your mental health and hormonal balance. Keep track of your symptoms, maintain regular check-ups with your healthcare providers, and don’t hesitate to voice your concerns. Your mental and physical health are interconnected, and addressing both aspects will be crucial in finding a treatment plan that works for you.

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