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I am experiencing extreme mood swings for the first time, at 40. However, I have an IUD and do not get a period, so I have no idea if they have to do with a certain point in my (nonexistent) cycle or not. What is the best way to figure this out?
—Feelin’ 13 again!
One of the benefits of progestin-eluting IUDs like Mirena and Kyleena — in addition to being effective contraception, of course — is that many women won’t have menstrual bleeding while they have one in place. But your pituitary gland and ovaries keep plugging along as usual.
That means that your estrogen and progesterone levels still rise and fall in the same way whether you have an IUD or not. However, without the physical sign of menstrual bleeding to tell you where you are in your menstrual cycle, you probably don’t know. But you can still have premenstrual symptoms. You just might not know that that is what they are.
That said, you can still employ the same tracking techniques that you might use if you didn’t have an IUD; there just won’t be any menstrual bleeding to record. Pull out your calendar (I still track on paper, but your digital calendar will work too) and make a note when you are having symptoms. If a pattern emerges and symptoms are roughly monthly, they could very well be related to your menstrual cycle.
If your symptoms are affecting your functioning, though, you may not want to wait to sort out whether they are tied to your menstrual cycle before seeking help. Two of the treatments that help with premenstrual dysphoric disorder — SSRIs and cognitive behavior therapy — are effective treatments for depression and anxiety regardless of the cause. Both take some time to start to work, so it would be reasonable to talk to your doctor about starting treatment now and to track your symptoms to see if they are related to your menstrual cycle at the same time.
The takeaway: Tracking your symptoms and looking for patterns can help you determine whether they are connected to your menstrual cycle even if you have a progestin-eluting IUD in place. And if your symptoms are affecting your daily functioning, you don’t need to wait to talk to your doctor about treating them.
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What about the utility of adding estrogen to help level out those hormonal swings? It was impression that women are offered SSRIs but may just actually need more stable hormones with the use of hormonal therapy…?