Some women with bipolar disorder may experience worsening symptoms during the menopause transition. There are also cases in which women without a history of severe mental illness may develop late-onset bipolar disorder during this phase of life.(1)
Certain symptoms of menopause and bipolar disorder can present similarly, including mood swings and sleep issues. The severity of bipolar disorder symptoms may also vary depending on whether a woman is in the perimenopause, menopause, or postmenopause stage.(2)
While there’s still much unknown about the relationship between bipolar disorder and menopause, new research is emerging. This article will discuss how bipolar disorder symptoms may be affected by different stages of menopause and will explore treatment options to support women’s mental health.
Understanding Bipolar Disorder
Bipolar disorder is a mental health condition that impacts mood, behavior, and concentration, as well as energy and activity levels. People with bipolar disorder cycle between periods of mania and depression. During a manic episode, the individual is typically in a high-energy mood state, while a depressive episode is characterized by feelings of hopelessness or indifference. It’s estimated that approximately 40 million people around the world are affected by bipolar disorder.(3)(4)(5)
Symptoms of Bipolar Disorder
Symptoms can range from mild to severe, depending on the type of bipolar disorder a person has. There are three different classifications of bipolar disorder (Bipolar I, Bipolar II, and Cyclothymic) that involve varying intensity and duration of manic and depressive episodes.(2)(4)(5)
Manic Episode Symptoms of Bipolar Disorder
Feeling extremely “up” or energized
Feeling jumpy or overactive
Heightened self-esteem
Difficulty concentrating
Racing thoughts
Talking quickly
Sleeping less
Increased risk-taking behavior
Depressive Episode Symptoms of Bipolar Disorder
Feelings of sadness, hopelessness, or worthlessness
Feelings of isolation
Low self-esteem
Loss of interest in previously enjoyed activities
Forgetfulness
Low energy
Changes in sleep patterns
Changes in eating behaviors
Suicidal thoughts
Some people may also have mixed episodes, in which they experience symptoms of mania and depression at the same time.
Prevalence rates for bipolar disorder are similar between men and women. However, symptoms may present differently. Compared to men, women may be more susceptible to depressive symptoms, suicide attempts, and rapid cycling, in which a person experiences four or more manic or depressive episodes in one year.(2)
How Menopause Affects Bipolar Disorder
Research findings on the influence of reproductive hormones on bipolar disorder are mixed. However, some studies suggest that hormonal changes during reproductive life events may play a role in mood disorders among women. These events include the premenstrual phase of the menstrual cycle, the period before or after childbirth, and the menopause transition.(2)
Estrogen is the primary sex steroid hormone in women. It influences the function of mood-regulating neurotransmitters, including serotonin and dopamine, sometimes referred to as the “happy hormones.” As hormone levels fluctuate and drop during different stages of menopause, it may trigger psychological symptoms in some women predisposed to psychiatric disorders.(6)
Women previously diagnosed with bipolar disorder may be more likely to experience an increase in symptoms during the menopause transition, some of which may differ from those experienced during their reproductive years.(2) In one study, a woman described her experience of depression as “sad” or “weepy.” During menopause, she described a sense of “urgency” that developed with her depressive symptoms.(7)
It’s important to note that menopause is not the cause of bipolar disorder. Experts emphasize that mood disorders are multifactorial, with genetics and stressful life events also being potential risk factors.(6)
How Perimenopause and Postmenopause Affect Bipolar Disorder
A link may exist between bipolar disorder symptom severity and different stages of menopause. One study found that symptoms of bipolar disorder increased as women with the condition progressed from premenopause to perimenopause to postmenopause.(8) Similarly, another study showed that the late menopause transition stage and early postmenopause stage were associated with increased symptom severity compared to the early menopause transition stage.(9)
Some women with bipolar disorder may be more prone to specific psychological symptoms during the menopause transition if they’ve experienced additional reproductive life events. Findings from a study published in the Archives of Women's Mental Health suggest that women with bipolar disorder who have experienced premenstrual symptoms and postpartum depression may be more susceptible to depressive episodes during perimenopause.(10)
Does bipolar disorder get better or worse after menopause?
Whether bipolar disorder symptoms improve or worsen after menopause depends on a number of factors, including family medical history, life circumstances, and whether a person receives treatment or not.
While some women may continue to experience symptoms as they age, researchers from a study published in the Journal of Psychiatric Research found that postmenopausal women who reached menopause at the age of 45 or older were at a lower risk for newly diagnosed bipolar disorder in comparison to women who reached menopause at the age of 40 or younger.(11)
Late-Onset Bipolar Disorder and Menopause
Bipolar disorder tends to develop in the early to mid-20s. Cases that develop after the age of 50 are classified as late-onset bipolar disorder. The condition affects more women than men, and menopause may be a contributing factor. A study showed that women who experienced menopausal symptoms were more susceptible to newly diagnosed bipolar disorder during postmenopause.(11)(12)(13)
Hormone Replacement Therapy (HRT) and Bipolar Disorder
Hormone replacement therapy (HRT) is used to treat menopausal symptoms by increasing levels of estrogen and progesterone in the body. Mood changes are common during menopause, and while HRT may help alleviate certain psychological symptoms that overlap with bipolar disorder, it’s not a treatment medication for mental health conditions.
Research on how HRT affects bipolar disorder in menopausal women has produced conflicting results. One study found that HRT may prevent mood symptoms from worsening in perimenopausal or menopausal women. Other studies have demonstrated no effect of HRT on psychological symptoms in perimenopausal and postmenopausal women.(11)
Women taking HRT along with certain mental health treatment drugs should be monitored closely. The combined use of HRT and psychiatric medications may be beneficial for some patients. However, HRT may reduce the effectiveness of certain mood stabilizer medications such as lamotrigine, which is commonly prescribed to manage symptoms of bipolar disorder.(14)(15)
Managing Bipolar Disorder During and After Menopause
Symptoms of bipolar disorder can significantly affect women’s health and quality of life during menopause. While clinical guidance is limited regarding treatments specific to women in this phase of life, a doctor may recommend pharmacological treatment, mental health counseling, or lifestyle modifications.(16)
Psychiatric Medication
Mood stabilizers or antipsychotic drugs may be prescribed to reduce symptoms of manic episodes, while antidepressants may be recommended to manage depressive episodes. However, a study found that antidepressants may be less effective in treating bipolar disorder in postmenopausal women, highlighting the need for further research into individualized treatment options.(5)(17)Professional Mental Health Support
Cognitive behavioral therapy (CBT) is a mental health treatment approach that may reduce and prevent the recurrence of depressive symptoms. Additionally, family psychoeducation programs can offer family members guidance on how to support the mental health of a person living with bipolar disorder.(5)Community Support Groups
Community support groups may help women manage symptoms of bipolar disorder during or after menopause. Group members can discuss coping skills and receive support from others who are going through the same experience.Lifestyle Modifications
Healthy habits can support overall physical and mental health during menopause. The following lifestyle modifications may help in managing symptoms of bipolar disorder in addition to standard treatment methods:(5)(18)(19
Getting enough sleep
Maintaining a healthy diet
Getting regular exercise
Practicing mindfulness
Trying alternative treatment options like acupuncture
Taking nutritional supplements
More research is needed on the efficacy and safety of alternative treatments, particularly those specific to bipolar disorder. Therefore, it’s essential that women consult with their doctor before taking any new supplements or medications.
When to Seek Professional Help for Bipolar Disorder
Because menopause and bipolar disorder share certain symptoms, it’s important that women seek professional medical help from a doctor or psychiatrist if they’re experiencing severe mood swings, suicidal thoughts, or symptoms of mania or depression.
A doctor can determine whether symptoms may be related to a mental health condition or if hormonal changes may be contributing to mood shifts. One important difference between bipolar disorder and menopause is that women in menopause often experience additional symptoms, such as hot flashes or vaginal changes. Upon making a diagnosis, a healthcare provider may recommend HRT, psychiatric medication, psychotherapy, or lifestyle changes.
Although there’s no cure for bipolar disorder, there are ways in which the condition can be managed throughout women’s lives.
