An Overview of Bipolar Disorder in Women

Bipolar disorder in females includes many of the symptoms, like severe mood swings, that males have with the same diagnosis. Yet there are differences. Females, for example, are more likely to be diagnosed with bipolar 2 disorder. They may face a higher risk of depression and suicide, though males are often diagnosed earlier.

Identifying and treating bipolar disorder in females can be more difficult due to co-occurring conditions. They may be more likely to relapse during treatment, especially during pregnancy and its challenges. Researchers are increasingly looking at female hormonal influences in bipolar disorder.

This article discusses the causes and symptoms of the condition, the risks and differences for females, as well as its treatment methods. 

Symptoms of Bipolar Disorder in Women

People with bipolar disorder experience manic or hypomanic episodes, depressive episodes, mixed states, or rapid cycling. The "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) outlines symptoms of bipolar disorder based on the state of the condition.

Females with bipolar disorder are more likely to experience depressive episodes than males. They may require hospitalization during these times to help manage symptoms and potential safety concerns.

Females are more likely to be diagnosed with bipolar II and have more episodes with mixed states and rapid cycling.

Mania

In mania, symptoms may include:

• Euphoria or elevated mood
• Inflated sense of self
• Racing thoughts
• Decreased need for sleep
• Lack of judgment
• Distractibility
• Engagement in dangerous activities or ones that could have negative consequences 
• Psychosis (delusions, hallucinations, disorganized thoughts, speech, and behavior), in severe cases

How symptoms present in males and females can be different, though. Studies show that certain symptoms, like grandiosity and aggression, are more common in males than females with bipolar disorder and similar mental health conditions.

Hypomania

Episodes of hypomania include the same symptoms of mania to a lesser degree of intensity, and cannot include psychosis. Hypomania may present with irritability, increased productivity, changes in sleep habits, pressured speech, and grandiose thoughts.

Depression

In depressive states, symptoms may include:

• Low mood for significant portions of the day
• Feelings of despair
• Feelings of hopelessness
• Irritability
• Lack of interest or pleasure in daily activities
• Difficulty with memory and concentration
• Changes in appetite and sleeping patterns
• Lack of energy
• Thoughts of death or suicidal ideation

Symptoms of depression tend to be more of a risk for females when compared with males.

Mixed Mania

In mixed states, symptoms may include:

• Depression and mania, both occurring during a short period of time
• Anxiety
• Impulsiveness
• Agitation
• Suicidal thoughts
• Possibility of psychosis
  

Studies that show mixed features of bipolar disorder tend to appear in the research more often with mixed mania episodes, with symptoms more often reported in females.

Genetic and environmental factors can play a significant role in the onset of the condition:

• Bipolar disorder has a strong genetic component. People who have a relative (parent or sibling) with bipolar disorder are more likely to have the condition.
  
• Significant and stressful life events can trigger bipolar disorder, as the brain experiences changes when a person endures chronic stress or trauma.
• Changes in environment or routine—such as changes in sleeping patterns, hormonal fluctuations, increased or decreased levels of physical activity, and the use of medications or substances—may influence mood or symptoms.

Certain mental health conditions also are considered risk factors for developing a co-occurring bipolar disorder, but they're not always as readily identifiable in females. They include:

• Early-onset panic attacks and panic disorder
• Anxiety, including separation anxiety and generalized anxiety disorders
• Conduct disorder
• Attention-deficit/hyperactivity disorder (ADHD)
  

The onset of symptoms of bipolar disorder in most people is late teens to early 20s. However, females may see a later onset of symptoms, sometimes into their 40s and 50s. If you believe you might have bipolar disorder, schedule an appointment with a mental health professional.

Pregnancy, Menstruation, Menopause, and Bipolar Disorder in Women

Natural fluctuations in hormones that occur in females may contribute to changes in mood. They also may play a role in bipolar disorder that is unique to how females experience it.

Pregnancy

Individuals who are pregnant or considering getting pregnant may want to consult with a healthcare provider, as hormonal changes during pregnancy may also influence mood. The manic symptoms of bipolar disorder have been shown to increase the risk of relapse during pregnancy.

Additionally, certain medications used to treat bipolar disorder can be harmful to pregnant people or the developing fetus. This leads to treatment challenges in pregnant people with bipolar disorder.

Menstruation

People observe differences in energy and mood during a menstrual cycle. People with bipolar disorder may find mood swings challenging due to hormonal changes. They also may experience drug interactions related to treatment.

Depakote (valproate) is a common mood stabilizer used to treat bipolar disorder that can lead to menstrual irregularities and may interact with hormonal birth control pills.

Menopause

Studies estimate up to 15% of people experiencing menopause also are diagnosed with a mood disorder like bipolar disorder. These females may experience an increase in depressive, hypomanic, or manic symptoms at menopause or perimenopause (the time around it).

Though the connection between hormones and bipolar disorder in females needs to be studied further, working closely with a care team can help determine the best course of treatment.

Seasonal Mood and Bipolar Disorder in Women

Mood symptoms in females with bipolar disorder may be more affected by the seasons than in males.

For example, episodes of depression may be more prevalent during the autumn and winter months than in spring and summer. During these times of the year, females with bipolar disorder may notice lower energy levels and changes in their sleeping patterns, often with an increased need for sleep.

Complications of Bipolar Disorder in Women

Certain complications of bipolar disorder are more common in females.

Co-Morbidities

Research indicates that people with bipolar disorder are at a greater risk of having other mental health and physical conditions that occur alongside the disorder.

Some common co-occurring conditions include:

• Substance use disorder (this is a high incidence in males but occurs in females, too)
• Eating disorders
• Thyroid conditions
• Migraine headaches
  

Suicide

By some accounts, one in five people with bipolar disorder dies by suicide. Between 20% to 60% of them attempt suicide at least once in their lifetime.

Other factors that increase a risk of suicide in females diagnosed with bipolar disorder include:

• The presence of a personality disorder
• Experiencing mixed states
• Lack of social support
• A history of mental health symptoms throughout their life
  

Types

There are various types of bipolar disorder, including bipolar I, bipolar II, cyclothymic disorder, and unspecified bipolar disorder.

Bipolar I Disorder

• Bipolar I is characterized by at least one episode of mania that lasts for at least one week or requires hospitalization. A bout of depression or hypomania can occur before or after the mania.
• Symptoms of bipolar I disorder can have a significant impact on a person’s level of functioning, including interpersonally, professionally, and physically.
• Bipolar I disorder occurs equally in males and females.

Bipolar II Disorder

• At least one episode of hypomania and one episode of depression must occur. An episode of mania is not required.
• People may return to their normal level of functioning between episodes.
• Bipolar II is diagnosed more frequently in females and males.

Cyclothymic Disorder or Cyclothymia

• This is characterized by at least a two-year span where symptoms of hypomania and depression are present at least half of the time.
• The symptoms do not meet the criteria for a major depressive, hypomanic, or manic episode.
  

There is some evidence to suggest that a cycle of bipolar disorder symptoms linked to anxiety that includes cyclothymic traits may be more common in females, but these sex and gender differences require more study.

Unspecified Bipolar Disorder

• A person experiences the symptoms of bipolar disorder that cause distress and impact a person’s quality of life.
• A person’s experiences do not meet the full criteria for other types of the disorder (e.g., bipolar I, bipolar II, cyclothymia).
  

Management and Treatment in Women

It can be challenging to diagnose a person with bipolar disorder accurately. Females may be misdiagnosed due to a lack of understanding about how the condition impacts them, or due to the presence of a co-occurring disorder.

Yet bipolar disorder is a mental health condition that requires lifelong management. A priority in treatment is stabilizing the person’s mood, typically through the use of medication and therapy.

Some studies suggest that females experience longer times until they receive treatment. They also show a less positive response to some drugs, including anticonvulsants like Depakote that are used with bipolar disorder.

Medication

Medications are available to help with symptom management:

• Mood stabilizers, such as Lithobid (lithium) or Lamictal (lamotrigine) are often used to treat bipolar disorder.
• Antidepressants can be used to treat depressive symptoms in bipolar disorder. Patients should talk with a healthcare provider before taking antidepressants, especially if diagnosed with bipolar I disorder, as they may trigger mania.
• Antipsychotics, particularly the new “atypical” antipsychotics, can be prescribed to manage mania and depression.
• Sedatives, such as Igalmi (dexmedetomidine), may be used to treat agitation associated with bipolar I or II disorders.  

Because some medications can increase the risk of birth defects, females should discuss with their healthcare provider the benefits and risks of taking medication during pregnancy and while nursing. Side effects also may be a concern.

Therapy

Therapy can be very beneficial for people with bipolar disorder. In therapy, a person will talk through their diagnosis and learn coping skills.

Cognitive behavioral therapy can aid with challenging unhealthy thoughts and behaviors, while family-focused therapy can help loved ones gain understanding and offer support.

Therapy, especially in combination with medication, can be an effective way to manage bipolar disorder. Therapy can also support people with adhering to a medication regimen.

Exercise

Exercise plays an important role in managing mood and a person’s circadian rhythm (the natural daily cycle). A review of studies on health interventions and bipolar disorder indicated that exercise can reduce stress and symptoms of depression.

Summary

Bipolar disorder is a mood disorder that can present differently in females. Hormonal changes in females can impact mood, and they have a higher risk of having other, co-occurring mental health conditions. Patterns of symptoms also may be different in females and males.

Timely diagnosis and treatment are key to managing the condition. Bipolar disorder can be treated with medication, therapy, or a combination of both.

Learning ways to cope with mood fluctuations also can help with well-being. Creating a daily routine of exercise, along with self-care habits of quality sleep and healthy eating, can benefit your mood.