Tuesday, 19 November 2013

Hypokalemic Periodic Paralysis and Hormonal Birth Control (HKPP and The Pill)

My HKPP has always significantly worsened in the two weeks before my period (during PMS; the luteal phase of the menstrual cycle).  HKPP is clearly mediated in some ways by hormonal changes as symptoms typically appear at puberty, and typically worsen premenstrually for (many) women.

I'm in my 30's now and thus I've had the problem of premenstrual flareups for nearly 20 years; however, it was increasing in severity as I aged, along with other PMS symptoms that many women experience, particularly moodiness that was becoming bothersome.  Essentially half of my life, two weeks every month, was very unpleasant because of my own hormonal fluctuations.  My ability to function was so compromised that I finally decided to consider oral contraceptives to try to control both problems.  I had avoided them for all my life out of fear that the hormones in the pill would make me very ill for four weeks of the month instead of two.

Because one of the premiere HKPP researchers, Dr. Lehmann-Horne, suggests that estrogen may be a trigger for women with HKPP, but because I also didn't want a progestin-only method (I'm hoping for acne and mood control), my doctor prescribed a low dose combination triphasic pill - Ortho Tri Cyclen Lo.  The low estrogen level remains the same for 3 weeks whereas the progestin level increases 3 times (to more closely mimic a woman's natural hormonal fluctuations).  After 3 weeks, 7 hormone free days allow for a period.

I have finished my first pack of the pill and it has almost completely eliminated the premenstrual increase in PP attacks, and most of my other PMS symptoms.  It's been fantastic to get through a month with so much less angst than usual, for the first time ever.  I mean, fantastic.  I wish I'd been brave enough to try this years ago.  If I continue to react as I have, this pill will have changed my life.

It's possible that women with HKPP might do best on a monophasic low-estrogen pill.  Monophasic pills contain the same hormone levels for the entire month eliminating all fluctuations. This might take care of the mild but residual remaining (but still fairly mild) flareup I experienced the last week of the month when progestin levels were highest.

2015 Update: I have experimented with several pills over the last two years and my most favorable experience has been on Alesse, a monophasic low dose pill.  I still feel far better and more stable on artificial hormones and intend to take them as long as possible.

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