Halimatus Sakdyah, Egy Atthahirah Septina, Linda Ramadhanty Pramesta, Muhammad Ikhsan, Alsa Shafira , Endi Nurhayati , Hafid Algristian

Hormonal Influence on Mood Dysregulation: A Case of Bipolar Disorder with Endometriosis

Introduction

Hormonal influence on mood dysregulation: a case of bipolar disorder with endometriosis. Discover how hormonal therapy for endometriosis can destabilize mood in women with bipolar disorder. This case emphasizes interdisciplinary care, psychiatric screening, and mood monitoring.

Abstract

Bipolar disorder often coexists with gynecological conditions such as endometriosis, presenting clinical challenges due to overlapping hormonal and neuropsychiatric influences. The impact of hormonal therapy on mood stability in women with affective disorders remains underexplored. We report the case of a 30-year-old woman with bipolar II disorder, stable for nearly two years on lamotrigine, who developed mood destabilization after initiating hormonal treatment for stage III endometriosis. Sequential regimens—dienogest, norethisterone, and ethinylestradiol–levonorgestrel—were temporally associated with new or worsening mixed affective symptoms, including agitation, insomnia, irritability, and emotional lability, despite adherence to mood stabilizers. Her Hamilton Depression Rating Scale score increased from 9 to 21 within three months, with laboratory evaluation showing elevated estradiol and suppressed luteinizing hormone, supporting a hormone-related mechanism. A structured literature review (PubMed, Scopus, Google Scholar, 2000–2024) identified limited but consistent evidence that synthetic progestins may exacerbate psychiatric symptoms in mood-vulnerable populations through neuroendocrine and neurotransmitter modulation. This case underscores the importance of recognizing hormonally induced mood dysregulation in women with pre-existing psychiatric disorders and highlights the need for proactive management strategies. We recommend pre-treatment psychiatric screening, structured and longitudinal mood monitoring throughout hormonal therapy, and close interdisciplinary collaboration between gynecology and psychiatry to optimize outcomes. Integrated care approaches may reduce the risk of mood destabilization, enhance safety, and improve quality of life for women facing the dual burden of bipolar disorder and endometriosis.

Review

This compelling case report effectively highlights the significant and often overlooked interplay between hormonal therapy for gynecological conditions and mood regulation in women with pre-existing psychiatric disorders. The authors present a detailed account of a 30-year-old woman with well-controlled bipolar II disorder who experienced acute mood destabilization, characterized by worsening mixed affective symptoms, following the initiation of various hormonal treatments for stage III endometriosis. The temporal association between sequential hormonal regimens (dienogest, norethisterone, ethinylestradiol–levonorgestrel) and a marked increase in her Hamilton Depression Rating Scale score, coupled with supporting laboratory findings of elevated estradiol and suppressed luteinizing hormone, strongly suggests a hormone-related mechanism. This case contributes valuable clinical insight into the potential neuroendocrine vulnerability of individuals with affective disorders to exogenous hormonal influences, underscoring a critical area for clinical attention. While a single case report, the meticulous presentation of clinical data, including specific hormonal agents, mood symptom progression, and relevant laboratory markers, provides a robust foundation for the authors' hypothesis. The integration of a structured literature review, albeit acknowledging its limited scope, further strengthens the argument that synthetic progestins may exacerbate psychiatric symptoms in mood-vulnerable populations through neuroendocrine and neurotransmitter modulation. This methodological approach, combining detailed clinical observation with a targeted literature synthesis, offers a comprehensive yet concise exploration of the phenomenon. The study's main limitation, inherent to its case report design, is the inability to generalize findings, which necessitates further research to validate these observations across broader populations. However, its strength lies in its ability to raise critical awareness about a complex clinical challenge that might otherwise go unrecognized. The clinical implications derived from this case are profound and actionable. The authors’ recommendations for pre-treatment psychiatric screening, structured and longitudinal mood monitoring throughout hormonal therapy, and, critically, close interdisciplinary collaboration between gynecology and psychiatry are highly pertinent and practical. These suggestions underscore the need for integrated care approaches to mitigate the risk of mood destabilization, enhance patient safety, and ultimately improve the quality of life for women grappling with the dual burden of bipolar disorder and endometriosis. This paper serves as an important call to action for clinicians across specialties to consider the psychiatric ramifications of hormonal interventions, advocating for a holistic patient-centered approach in the management of complex co-morbid conditions.

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