Family and Caregiver Schizophrenia Discussion Forum

Insight on SZ and menopause

Hi there,

This is my first post to this forum, so please forgive any rookie mistakes. I am the husband of a 51yo woman with SZ; we have been married for 17 years. My wife’s SZ is fairly controlled most of the time; she takes her meds consistently, we do everything possible to manage her stress, and we avoid certain people and situations that seem to cause flare-ups like paranoid or delusional thinking, etc. I realize we are fortunate things are stable much of the time, and am very grateful for that.

Over the past 9 months my wife has had three episodes where she experienced a ‘break’ and went into full paranoid/delusional mode for between 24 and 48 hours. These seem to have coincided with points in her hormonal cycle where she also gets very emotional/cries, and experiences migraines that flare up just before her period. She has consulted with her PCP and OB/GYN about the migraines and they have recommended a blood pressure med (she also has high BP) that can help migraines as a side benefit. However if you read the fine print the BP meds like propranolol can also cause mood swings in some cases. My wife has now been switching between BP meds and still experiencing periodic flare-ups/breaks, plus the migraines sometimes come back.

In between SZ flare-ups, my wife has insight into her situation, at least partially recognizes what’s going on and wonders (like me) whether menopause is exacerbating things recently. I’ve done a lot of reading online about SZ and menopause and have gotten mixed messages, some articles saying things may flare up during and then calm down after, some saying SZ may flare up and then stay heightened after menopause is complete. I’m just wondering if anyone here has any insight, stories to share, resources, or even words of encouragement. I realize we’re fortunate in a lot of ways but the flare-ups/breaks are still pretty scary and have led us to have to distance ourselves from loved ones and friends, and they take their toll over time.

Thank you in advance!

Hi spouse_ca, welcome to the forum!

I consulted my friend about your question, she taught Family to Family for several years. She wondered if your wife’s gynecologist had considered prescribing hormone therapy to help keep your wife’s hormone levels balanced during this time of change? Hormone therapy is considered to be quite controversial to some people, while others simply need the relief hormone therapy can provide.

Sadly, the world of perimenopause is like this regarding an amazing number of women’s health concerns. Woman can have many different symptoms from their hormones changing. For classic examples, some women can get quite (!) moody, others can actually suffer from some speech issues. Little things like saying one word when you meant another or actually forgetting the names of things. One of my friends passed around several perimenopause books for all of her friends to read. She had originally thought she was suffering from dementia when she kept forgetting words. Another thought she was having a heart attack the first time a hot flash woke her up with what felt like “sparkles” in her chest.

We do know that stress is one of the most common triggers for episodes. Hormonal changes do produce a great deal of personal stress.

Hot flashes can ruin sleep and for many people hot flashes occur in the daytime as well. Many people have to learn to dress with lighter weight clothing year around to keep hot flashes at bay, for me personally, it would be best if I could pull around a large battery fan on wheels. I did try the hormone therapies, they did give me relief for several years before they started causing eye migraines.

My DIL suffers from severe bipolar. Her husband is fully convinced her monthly hormonal changes play havoc with her bipolar. Even more so, after their first child was born, she suffered from delusions and was treated for postpartum depression. The delusions subsided until after the birth of their second child, ten years later. He was like “aha I knew it!” Just like it did before, she had more bipolar episodes in the years following the birth of her second child. While it anecdotal, her husband is a huge believer in her hormones triggering episodes.

I am sorry that you are finding yourselves having to put some distance between loved ones and friends while you try to figure out the best path forward. My husband and I call it knocking stuff off our plate - its usually temporary- but not fun in the meantime. Good luck!

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First, spouse, welcome here. You’ve brought up some excellent things that you have me pondering on.
Hope, all awesome stuff! Spot on. When you find that strap-on battery pack box fan, lemme know! :wink:
Honestly spouse, sounds like you guys thought of all the right questions and consulted with all the right people. Hope pretty much covered my thoughts on hormone supplements. If you go that route, I’m extremely interested to know how it works out for you. Please keep us posted!
My only other fleeting thought, only because of the suddenness of it by the sounds of it, and because it’s so prevalent now, had she been sick at all with covid? There are some lingering effects for recoverees that sound like it affects the brain intermittently (they suggest the virus attacks nerve cells and neurons which can leave long lasting damages to cognitive abilities, memory issues, mood swings, they call it ‘mental fog’) Like I said just a fleeting thought. Best of luck to you guys. Hope we hear back about your progress and again welcome.

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Thank you so much for your reply, hope… I really appreciate it. You and wisdom have both made me feel very welcome here.

You raise a good point about hormone therapy; my wife told me that her OB/GYN has mentioned it to her, but her OB/GYN seems to take a very hands-off approach so unless my wife pursues it further I think it’s unlikely to happen.

One thing that has been tricky about working with my wife on her health issues in general (both her mental health and other issues) is that she has not granted me access to her medical records. I discovered this about a dozen years ago when she experienced a severe psychotic episode that led to her being put on a 72-hour involuntary hold and then being hospitalized twice in a three-week period. This was the first time anything this severe had occurred since we’d met, and I was shocked to find that I could not even ask basic questions of the doctors in the psychiatric unit where she was hospitalized because she hadn’t granted me access. That has still not changed to this day; however, we are planning to work with a lawyer to set up a trust/living will/etc soon, and I’m hoping to leverage that opportunity to have a frank discussion about access to medical information.

Regarding putting distance between us and loved ones and friends, I like your “knocking stuff off our plate” term. I’m often doing this to help my wife manage stress. One of the unexpected upsides of the pandemic is there are far fewer social engagements that we have to say no to, and for those that do come up (e.g., socially distanced birthday cake on a patio) we can chalk up not attending to COVID concerns, not my wife’s mental health.

Again, thank you so much for your suggestions and for making me feel welcome.

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Hello wisdom, thank you so much for your help… you and hope have really made me feel welcome after my first post!

As I mentioned in a reply to hope, I’m not sure if hormone replacement therapy will actually happen because of my wife’s OB/GYN’s hands-off approach, but if it does I’ll share updates here.

You raise an interesting thought about COVID. We did actually travel to Florida to gather with my wife’s parents and brothers in mid-March 2020, right before the stay-at-home orders kicked in. It was a tough call but we went ahead because her grandmother had passed away a few months before during the 2019 holidays and the family hadn’t been able to all gather then. There’s always the chance she (or both of us) caught COVID then and were asymptomatic at the time, but she’s showing delayed symptoms now. But since then we’ve pretty much lived like hermits (I’ve been fortunate to be able to work from home) so unlikely we picked it up since. Reading the recent coverage on the heightened risk of serious COVID with schizophrenia, I’m going to push for her to be vaccinated early in her age group (50+) if at all possible.

Again, thanks for your reply and for making me feel welcome here!

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While I know little about this subject, I recall antipsychotic medications can affect prolactin and other hormone levels. Perphenazine (Trilafon) and risperidal were the main offenders, as Trilafon was indicated in breast tumors of Elyn Saks (of The Center Can Not Hold fame) and Risperidal was the target of a class action lawsuit for gynecomastia (male breasts).

Closapine, olanzapine , aripiprazole, ziprasidone, and quetiapine are said to be said to be prolactin sparing alternatives, but hormones levels are often a balancing act. Possibly worth mentioning this to her gynecologist along with her antipsychotic medication history and dosages. Everyone is an individual in both AP medication response and menopausal experience, however.

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Yes, her gynecologist isn’t going to push hormone replacement therapy, its a controversial subject. Some doctors want you to press the case for it, while others are more supportive. My friends who opted for hormone replacement were the ones that had bigger issues with hot flashes.

You had good reason to be shocked to learn you were still denied access to medical information after 5 years of marriage. On one hand, I do understand your wife feeling very private about her mental health care, on the other hand, I’m glad you plan to re-open the subject. After 17 years of marriage, she should be able to trust you to see that her medical preferences are abided by when she is experiencing an episode. That is the angle I have planned to take with my son at some point. One of the things I do worry about is that my son will be involuntarily hospitalized at some point without any sort of advocate present.

You are very welcome :slight_smile: