Bipolar disorder may be different in women — here's how menstruation and pregnancy can exacerbate symptoms

Bipolar disorder is a condition that occurs in an estimated 46 million people worldwide, and about 52% are women. While symptoms are very similar across all genders, women experience certain symptoms at a higher rate, most likely due to hormonal fluctuations during pregnancy and menstruation. 

Here's everything you need to know about bipolar disorder symptoms in women and how to best manage the condition.

Bipolar disorder symptoms in women 

According to Aimee Daramus, PsyD, a clinical psychologist based in Chicago, Illinois, common symptoms of bipolar disorder include:

• Impulsivity
• Grandiose delusions
• High energy
• Limited sleep  
• Depression

While bipolar disorder symptoms are similar across all genders, women appear to experience the disorder in a few distinct ways. For example, women are more likely to be diagnosed with bipolar disorder II. 

Additionally, Gail Saltz, MD, an associate professor of psychiatry at the New York Presbyterian Hospital Weill-Cornell School of Medicine in New York City, says women with bipolar disorder are more likely to experience: 

• Rapid cycling, classified as four or more episodes — either manic, depressive, or hypomanic — within one year. 
• Mixed states, in which a person experiences mania and depression within a single episode for at least seven days. 
• Depressive episodes, which can cause feelings of hopelessness, despair, and isolation

Some of these differences may be due to hormonal fluctuations, as research indicates menstruation and pregnancy may trigger certain symptoms.

Menstruation and bipolar disorder

While research is still emerging, it appears that hormonal changes that occur during menstruation and menopause can exacerbate symptoms of bipolar disorder in women. 

In a 2014 review, between 64% and 68% of women reported experiencing bipolar episodes related to their menstrual cycle.

A large 2007 study found that women with either major depressive disorder or bipolar disorder were twice as likely to report premenstrual symptoms (PMS) than women without the disease.  

While the fluctuation of hormones caused by a person's menstrual cycle or menopause can worsen existing symptoms of bipolar disorder, it cannot cause the condition on its own. 

Pregnancy and bipolar disorder

When a person with bipolar disorder becomes pregnant, a delicate balancing act must be performed to simultaneously treat the condition and prevent harm to the baby. 

Many medications used to treat bipolar — such as mood stabilizers, antipsychotics, or anticonvulsants — can harm fetal development. For example, the use of the anticonvulsant valproate during the first trimester can cause developmental delays and an increased risk of autism. Another anticonvulsant, carbamazepine, has been linked to major fetal malformations.

"A doctor must look at [a patient's] past history, the severity of illness, response to past medications, and the data on the fetal risk to help make these decisions," says Saltz.

If you are pregnant and have to discontinue your bipolar medication, Saltz recommends the following to help prevent an episode from occurring: 

• Avoiding substances, like alcohol and drugs
• Relying on supportive relationships
• Staying active
• Reducing stress whenever possible

Additionally, hormonal changes during and after pregnancy can increase the severity or frequency of bipolar episodes, says Daramus. In a small 2002 study, two-thirds of women reported experiencing a postpartum bipolar episode. Saltz says that a bipolar episode — whether depressive, hypomanic, or manic — is more common during postpartum than other phases of a person's life. 

Experiencing severe bipolar disorder symptoms while pregnant can increase the risk of harm to both the mother and the developing fetus. "A pregnant woman becoming depressed or manic also comes with substantial risk to the fetus, and to herself," says Saltz.

Women are more likely to have co-ocurring conditions 

Women with bipolar disorder are also more likely to experience co-ocurring mental health conditions than men. These commonly include:

• Alcoholism 
• Depression
• Anxiety disorders
• Eating disorders

Many of these conditions can exacerbate symptoms of bipolar disorder, or make finding the right treatment more difficult. Daramus says that substance abuse is a common problem she sees with bipolar disorder patients that can impact the severity of their episodes. 

Takeaways 

While all genders experience similar bipolar disorder symptoms, women are more likely to have bipolar disorder type II, and therefore are more likely to experience depressive episodes. It is also more common for women to experience rapid cycling, mixed states, and concurrent conditions, like anxiety disorders and substance abuse. Changes in hormones during menstruation, menopause, and pregnancy can also trigger episodes or exacerbate bipolar symptoms.

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