Does BPD Get Worse Approaching Menopause?

[HurtAndTired]

My uBPDw is 45 and we have been together for more than a decade. I knew that there was something seriously wrong with her after 4 to 6 months into the relationship but didn't figure out it was BPD until a few years ago, and then all of the symptoms made sense and everything clicked into place. Over the past year, I have been placing and enforcing boundaries because I don't want our 2-year-old to learn that the way Mom treats Dad is okay. As I have placed and enforced these boundaries in a way that I never would have had the courage to do before our son was born (I called the police to diffuse a situation a few months ago when she started to get physical), she has predictably reacted poorly and I have been weathering some pretty bad extinction bursts. However, now that I have had some time to think about why I chose now to make a stand, it is not just that I don't want our son to see me get abused, but it is also that her outbursts have been getting worse over the past several years. Yesterday a realization hit me like a lightning bolt...has she been getting worse because of hormonal changes due to perimenopause?

I have read over and over again that BPD tends to get better with age, but that seems counterintuitive to someone who has lived with a pwBPD for more than a decade. This disease is lifelong and doesn't seem like it will have a chance of getting better without serious therapy and effort (and possibly medication) on her part. Could it be that pwBPD seem to "get better" with age because so many of their partners have either left and the pwBPD has to rely on children or another family member as an FP (likely to hide or minimize BPD behaviors), or the partners have accepted caretaking roles that enable the pwBPD to vent on them as a FP and thus hide or minimize symptoms?

The tools found on this board have been immensely helpful, and I have expected things to get worse before they get better. Riding out extinction bursts is no walk in the park, and there is no guarantee that boundaries will hold or that tools will consistently work.  I know that I have a long, hard haul ahead of me to try to keep this marriage and family intact, but I would like to know from folks of "a certain age" if their female partners wBPD got significantly worse before and during menopause. Do symptoms tend to subside once menopause is complete? Do they improve on the other side or go back to about how they were before "the change?" I'm just trying to get a realistic picture of what to expect as we move into her late 40s and early 50s.

[RELATIONSHIP PROBLEM SOLVING]

RELATIONSHIP PROBLEM SOLVING This is a high level discussion board for solving ongoing, day-to-day relationship conflicts. Members are welcomed to express frustration but must seek constructive solutions to problems. This is not a place for relationship "stay" or "leave" discussions. Please read the specific guidelines for this group.

[Cat Familiar]

I don’t know about BPD getting worse during perimenopause and later, menopause. What I do know is that many otherwise emotionally healthy women can have extreme mood swings during that phase in their life. However many women are not much affected and great improvement can result from both medical and non-medical treatment modalities. It all depends upon the individual.

I think that BPD getting “better” with age is largely due to people having less energy as they get older. It is possible that over time they learn strategies such as being more able to regulate their emotions and ways of self soothing, so I guess some improvement can come through life lessons, even if they’re not in therapy.

[Broken Record]

I absolutely believe BPD gets worse when entering perimenopause. Google it and you’ll find research to back that - worst when its in adolescence and perimenopausal stage. My wife has entered perimenopause and the hormonal imbalances have sent our life into chaos triggering all the BPD symptoms - only realised it 22 years into the marriage. Also in our 40’s now and I’ve effectively been painted black. Its a tough pill to swallow.

[Pook075]

My marriage completely went off the rails around the time my wife was diagnosed pre-menopause, and I often wondered if there was a connection as well.  My wife's depression went from an average daily 3/10 for the past 20+ years to a steady 9/10 in maybe 4-6 weeks time.  We were making huge life plans a few months beforehand and everything was going very well, but then she just shut down completely.  I still can't make any sense of it, to be honest. 

There was another thread started maybe 6-8 months ago and two or three people shared similar experiences.  Whether it actually makes a difference or is just coincidental is anyone's guess.  In my personal situation though, I believed it played a huge factor.

[SaltyDawg]

BPD generally gets better to from puberty to +/- 30 years of age, plateaus to about +/- 50, and then gets worse.

My wife is 52, was getting worse, but now is getting better under treatment.

Here is a link from facebook that highlights this (from a licensed professional):

https://www.facebook.com/100063607657642/posts/pfbid02Wym1qQLyvnZ5gTK3LbHT6p8s2SnPpvRtm4M47L5Cbdsev92HRi7BmfnrhhKe96mMl/

[Notwendy]

Interesting article in FB as I have an elderly mother with BPD. It affects her quality of life and her behavior. One of the interesting things (unfortunate too) is that she engages in drama with any caregiver who becomes close to her- which caretakers usually do. BPD involves the most intimate relationships the most so for much of the time it seemed to be with her family but now it includes caregivers too. Due to her behavior she has strained her relationships with family and caregivers.

In her younger years, BPD was not known, so looking at elderly people now- there isn't information about if they were diagnosed or treated early on. It will take some time to know this.

Her outbursts are less physical but still- verbally and in her actions- she can paint people black to others and strain relationships.

Older people in general can be more irritable at times- one thing I noticed with both parents is that they seemed to lose their filter and say mean things from time to time. I think that is common. With my father, I could see that if he said something mean, it wasn't something he would ordinarily say. That to me was more attributed to age than to him, but with BPD mother - it's more in line with her having BPD,

She was also the generation that was given hormones during menopause, so she didn't actually go through it. They have stopped doing this in general due to other risks of the hormones although some women choose to use them either briefly or long term thought an alternative health practitioner. She is not on them now though. I don't know if stopping them had any impact on her behavior.

I'd be cautious not to blame all on menopause. Menopause might make women more irritable but it doesn't make them behave like someone with BPD. Symptoms vary a lot as well.

[Augustine]

Yes, it’s well documented in medical literature that there’s a direct correlation between menopause and the worsening of the symptoms of BPD.

There is also a body of research stating that menopause may be a contributing factor in the late manifestation of BPD.

Anecdotally, this was my personal experience as well, as my former partner’s symptoms were predominantly sub clinical until the final two years.

The final two years were like trying to live with a banshee. Ultimately, the behaviour was so uncongenial and disharmonious that it very quickly tore our relationship apart.

Additionally, menopausal symptoms are a function of a woman’s BMI, with thin women having a particularly bad experience.

[HurtAndTired]

Thank you all for sharing your experiences. I want to make clear that I am not trying to place any stigma on menopause whatsoever, nor am I blaming my wife's symptoms solely on the hormonal changes that she is going through. However, I have noticed that symptoms have been worsening as she progresses through her 40s and that symptoms worsen with hormone changes and have done so consistently throughout our long relationship.

In our early relationship, she was on the BC pill and she blamed her "mood swings" on the hormone changes that came with the pill. She said that she found herself getting angry without even knowing why and not being able to control it. She also noted that the symptoms got worse in the week before her period. This was years before I heard about BPD and the hormone imbalance/BC pill theory sounded like it was plausible to me. I was okay with using other methods of BC if it meant that we could avoid those "mood swings." However, when she went off of birth control a few years later, her symptoms only improved for a few months and then the "mood swings" came right back with a vengeance.

Likewise, when she was pregnant, her mood was all over the place. By this time I was well aware of her BPD and was concerned that the mood changes naturally occurring for many women during pregnancy would be even worse for her given her underlying mental condition. Add to that the stress of a "geriatric pregnancy" (doctors really need to come up with a better term for a woman who is over 35 and pregnant) and a previous miscarriage and I knew that we were both in for a really rough ride. Once our son was born (beautiful and perfectly healthy, thank God) my wife suffered through debilitating post-partum depression and voluntarily went on anti-depressants (she was having terrible nightmares about awful things happening to our child in the weeks after we brought the baby home) for a year.

During the year that she was on sertraline (Zoloft) her rages virtually vanished. She still had symptoms of BPD and they still got worse during the week leading up to her period, but the intensity of the anger was greatly diminished. It was a blessedly peaceful year. Unfortunately, toward the end of the year, she began to complain about how she didn't like how the medicine made her feel. She said that she felt numb and that she couldn't stand not feeling anything. I wonder now, looking back, if she missed being able to have the release of the rage. As expected, soon after going off the medication she began to rage again but this time it was worse than before the pregnancy.

This was about a year before I found this board and made my resolution to stop caretaking her BPD and put healthy boundaries in place to protect our son (physically, emotionally, mentally, and spiritually). I have only been on this journey for a few months and am constantly trying to uncover any kind of information that might help me manage my own self-care so that I can maximize my ability to care for our son. I have been reading posts on this board like crazy along with several books on BPD and many academic studies online. Additionally, I am trying to observe patterns in her behavior to look for triggers/warning signs so that I can better anticipate when to bunker down. I guess in a way I had always known that her "moods" were tied to her hormonal cycles, but outside of the pregnancy I had never connected worsening symptoms of BPD with her "mood swings." I now can see in retrospect that what she had passed off as basically severe PMS caused by BC pills was really just spikes in her BPD that coincided with her cycle. The BC pills may well have made them worse, but the fact remains that changes in her hormones have demonstrably contributed to worsening symptoms over the years.

As I have mentioned in other posts here, I am sympathetic to the powerful changes that hormones have on our moods. I have a non-cancerous micro-tumor on my pituitary gland that has thrown all of my hormone levels off. I am now under the care of a great endocrinologist and my hormone levels are all back to normal to optimal levels. However, before I was under his care I went through hot flashes, weight gain, bloating, ED, depression, emotional volatility (I would cry during emotional commercials for gosh sakes!). You name the symptom, I had it. I do not envy anyone having to go through that type of hormonal disruption for years (I went through it for about two years off and on before I got effective treatment). My point is that I imagine that for a person with BPD this disruption could trigger all kinds of dysregulation. Add to that my wife already having a track record of hormonally induced symptoms I am just hoping that we can ride out this change in life together in one piece.

[kells76]

Does your W experience the big mood swings and other (possibly) hormonally related symptoms as problems for her?

I.e., is she distressed/upset by when they happen and/or does she wish they would not happen?

People generally don't get help for things that don't trouble them, but as "every woman" (broadly speaking) has experienced hormonal impacts and will go through menopause, could that be a lower-shame route for her to get help and support?

If she's not bothered by what's going on, then a different approach may be necessary.

[Notwendy]

From my own observations, if pwBPD have difficulty with uncomfortable feelings- and their BPD behaviors are dysfunctional ways of coping with them, any situation that exacerbates them can increase the behaviors- and so menopause can be one of those situations.

Everyone has some stressors as part of being human. Any change, even wonderful ones,  like the birth of a child, or taking on a new job can feel stressful too. However, one aspect of BPD is looking at external reasons for uncomfortable feelings and as an explanation for their behaviors rather than being accountable for them. So yes, with my mother there's always a reason for it to not be about her.

The reason can contribute but is it not the reason. Does that make sense?

I think that hormonal swings can exacerbate discomfort but even so, most people, unless they are completely mentally ill or intellectually impaired are still accountable for their own behaviors.

So for my mother, there is always a reason.- it's someone else's fault, or she isn't feeling well, but what is consistent is that she has BPD and this influences how she responds to the reasons. At times of stress, her BPD behaviors increase because these are her coping mechanisms.

Menopause symptoms can vary. Sometimes antidepressants have helped with some of them but there are side effects that some people don't like. It is possible that if your wife can get some help with her symptoms, that her BPD behaviors will diminish, since  they are how she copes. It won't change that she has BPD.

It's worth a visit to her medical provider to see if there's something she can have help with for her hormones. I think this will also give her an explanation that is understandable to people and allows her to "save face" and not feel shamed.

[HurtAndTired]

Does your W experience the big mood swings and other (possibly) hormonally related symptoms as problems for her?

While they are problems for me, she has not blamed her symptoms on hormonal changes since being on the pill years ago. This is just something that I have noticed, but have not dared to say anything about. After giving birth, she followed the OB's recommendation and had a Mirena (progestin-releasing) IUD implanted. I don't know if it has had any direct impact on her moods or not, but the research I have found says that progestin-only BC doesn't seem to exacerbate BPD symptoms the way estrogen and progesterone BC does. However, she is unhappy about it. The doctor told her that it should stop her periods, but it hasn't. The heavy periods that she had before pregnancy and the IUD and the continued periods after the IUD have been something that she has frequently complained about. Before getting pregnant she said that her periods bothered her so much that she wanted to have a hysterectomy. She even asked the OB about having a hysterectomy/C-section done while she was pregnant. The OB talked her into the IUD instead. The thought being on the part of the OB (I am guessing) "why take out a uterus that is getting ready to go dormant in a few years anyway?" and "insurance won't pay for it if there is nothing physically wrong with the organ."

She says that in addition to not stopping her periods, the IUD has made her gain weight and killed her libido. I have encouraged her to get it taken out as I have recently switched over from taking clomiphene citrate to treat my low testosterone caused by the pituitary tumor to testosterone cypionate injections. Long story short, the clomiphene worked great to treat my condition but a new company bought the rights to the drug and jacked up the price. The testosterone shots are cheap but have basically made me sterile while on the treatment, so no pregnancy worries.

As with many people with BPD, there is nothing wrong with my wife. It is everyone else who has a problem. I do like the idea of using a lower-shame way of getting her to seek help though. During her most recent split (still ongoing) she berated me for not getting marriage counseling set up as she had requested a few months ago. It doesn't matter that she rescinded her offer to attend marriage counseling just days after first offering to go and told me not to bother setting something up, it is still my fault for not setting up the appointment. Well, I have an initial consultation with a counselor recommended by my therapist today.

During this initial consultation where it will just be the counselor and me, I plan on giving him the background on my wife's BPD so that he can proceed with therapy cautiously (he specializes in working with couples with BPD involved and my wife has been spooked out of MC on two previous occasions by a therapist who had the audacity to suggest that she might need to do some individual counseling.) I am hoping that this will be the lower-shame way of getting her help. We can talk to the counselor about how we can improve our interactions as a team, but coming from the therapist and I both knowing that those strategies need to be how to work through BPD-driven problems (SET, no JADE, BIFF, validation, etc.).

It may be that she goes to marriage counseling once I get it set up, or it may be that I am wasting my time. Either way, I will have done what I promised I would do. I really do hope that she takes this opportunity to get help though as I am no longer caretaking and shielding her from the natural consequences that result from acting out. This will either cause her to hit rock bottom and admit that she needs help, teach her to self-soothe and stop the dysfunctional behavior, or she will have to shift her dysfunction to a new FP.

[GaGrl]

The person with BPD in our life is my husband's ex, mother to my three adult stepchildren. Her uBPD/NPD behaviors have changed significantly over the years.

I'm not sure my H would label them better or worse/before or after menopause -- but definuitely diffetent.

Early in their marriage, uBPD/NPD ex displayed excessive jealousy, an inability to be denied anything she wanted, tantrums, eventually moving to infidelities and violent confrontations with the lovers. She was quite young and left her culture to come to the U.S. (military marriage).

As children came along, she created a Golden Child and a Scapegoat. The children were enmeshed. Infidelities started again after the children were older. She eventually moved out when the children were kids teens but did not attempt divorce.

Peri-menopause and menopause happened sometime in this timeframe.

Final phase has been that she has had a live-in relationship with a fellow for 20+ years. Her paranoia about his suspected infidelity is off the charts. She accuses him of leaving the house while she sleeps. She has installed cameras, and the windows are nailed shut. She now locks the door to the bedroom each night and sleeps with the key on a chain around her neck. The children and her SO have told her she needs to see a psychiatrist -- she made an appointment then cancelled it.

So...not better or worse, but...different.