Women can experience bipolar disorder differently than men do. Reproductive cycles and stigma can worsen existing symptoms.

Women who manage bipolar disorder, in 3 different reproductive phases of lifeShare on Pinterest
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Bipolar disorder is a mental health condition characterized by intense and sudden shifts in mood, energy, and activity levels.

According to the National Institute of Mental Health, 4.4% of U.S. adults will have bipolar disorder at some point in their lifetimes.

Bipolar disorder can be a severe condition that affects your ability to function. Yet, there are many effective treatments and strategies to help you or someone you know manage symptoms and overall well-being.

While bipolar disorder occurs in women and men at nearly equal rates, the types and symptoms of the condition differ between genders.

The exact reason for these differences isn’t totally clear, but researchers believe estrogen and the reproductive cycle may have a lot to do with it.

The chart below details the differences in how bipolar disorder presents in men and women:

Gender differences in bipolar disorderFemalesMales
More often diagnosed
Later onset
More shifts in mood following seasonal patterns
More frequent episodes of depression, mixed mania, and rapid cycling
More episodes of mania throughout lifetime
More prevalent bipolar II disorder
More co-occurrence with other medical or psychiatric disorders
More cases of intermittent or inconsistent treatment
(often due to pregnancy or breastfeeding)
Occurs more frequently alongside substance use disorder

Types of bipolar disorder

There are three main types of bipolar disorder:

  • Bipolar I. This type of bipolar disorder is characterized by episodes of mania.
  • Bipolar II. People with bipolar II have episodes of hypomania (a less severe form of mania) and depressive episodes. Bipolar II disorder is diagnosed more in women than men.
  • Cyclothymic disorder. Also called cyclothymia, this condition is marked by symptoms of depression and hypomania that don’t meet the criteria for full mood episodes.

Symptoms

Though women may have unique or amplified effects of bipolar disorder, many symptoms apply to anyone with the condition.

Mania

Manic episodes last at least 1 week and are most often characterized by:

  • high energy
  • euphoria
  • irritation
  • racing thoughts
  • restlessness
  • impulsivity

Women tend to experience fewer episodes of mania than men.

Depression

During a depressive episode, you may feel:

  • sad
  • hopeless
  • tired
  • sluggish
  • apathetic

Symptoms of depression can make it hard to go about daily life, complete activities, fall or stay asleep, and maintain relationships, among other things.

Women with bipolar disorder have episodes of depression more often than men. They also have these episodes more frequently in the fall and winter months.

Hypomania

During a hypomanic episode, symptoms are similar to mania, but typically less severe and for less time.

An episode of hypomania may only last for 4 days and doesn’t significantly interfere with daily functioning. Of course, hypomania can still be challenging to manage without treatment and tools.

Specifiers of bipolar disorder

Specifiers are additional characteristics the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) uses to describe various mental health conditions beyond what the diagnostic criteria already tells us.

Common specifiers among women include rapid cycling, psychosis, and mixed features.

Rapid cycling

If you have bipolar disorder with rapid cycling, you may move through mood episodes quickly.

Rapid cycling involves having 4 or more episodes of mania, hypomania, or depression within a 12-month period.

Women are more likely to experience rapid cycling.

Psychosis

Psychosis is often described as a “break with reality.” While people do experience psychosis in different ways, it usually involves hallucinations or delusions — altered perceptions of reality that feel very real to whoever is having them.

From an outside perspective, someone may notice disorganized thoughts or speech.

Some people with bipolar disorder — but not all — may have psychosis symptoms at some point. If it occurs, it often happens during mood episodes, especially mania, and is more often seen in people with bipolar I.

Mixed features

Mixed features describes someone having mixed episodes — symptoms of depression along with mania or hypomania occurring at the same time or in rapid succession.

It’s estimated that around 40% of people with bipolar disorder have mixed episodes, but they’re seen more often in women.

Co-occurring conditions

Anyone with bipolar disorder can have other conditions at the same time as bipolar disorder — but this is more likely to occur in women.

Physical and mental health conditions more often seen in women with bipolar disorder include:

  • asthma
  • Crohn’s disease
  • thyroid disease
  • migraine
  • multiple sclerosis
  • obesity
  • anxiety disorders

Co-occurring conditions can sometimes make diagnosing and managing bipolar disorder more difficult. It’s important for anyone with several health conditions to consult specialized doctors in addition to mental health professionals.

Reproductive cycles and hormones may change the way women experience bipolar disorder.

According to one study, hormonal fluctuations associated with menstruation, pregnancy, and menopause can alter or worsen symptoms like mood instability in 77% of women with bipolar disorder.

Periods and PMS

Many women (adults and adolescents) may have more frequent and severe mood episodes during the premenstrual phase.

Between 15 and 27% of women with bipolar disorder also have premenstrual dysphoric disorder (PMDD), a condition with symptoms similar to PMS but much more severe.

Between 44–65% of women with bipolar disorder have mood changes related to their menstrual cycle, even if the symptoms aren’t severe enough to be classified as PMDD.

The premenstrual period seems to pose an especially heightened risk for depressive episodes as well.

Pregnancy

Research on if pregnancy worsens or improves symptoms of bipolar disorder is conflicting. Regardless, we do know that it can be a particularly tricky time to manage your condition.

Some pregnant people continue medication throughout their pregnancy, while others temporarily stop — in large part due to the possibility of exposing the fetus to certain psychoactive drugs.

This decision on continuing or discontinuing medications is generally made by weighing the possible risks of the specific med to the pregnancy versus the benefits of the med to the mother.

Some mood stabilizers commonly prescribed for bipolar disorder — such as valproate and carbamazepine — are considered unsafe to take during pregnancy. Lithium tends to be safer when used after the first trimester.

Lamotrigine (Lamictal) is a mood stabilizer that has shown favorable results for pregnant women.

Similar considerations should be taken if you choose to breastfeed, though the medications to be aware of may not be the same.

The postpartum period (after childbirth) can be a challenging time for some women with bipolar disorder. Research has found higher rates of relapse and an increased risk of experiencing psychosis.

Research in 2015 reports that 66% of women who stopped taking their medications during pregnancy relapsed postpartum, versus 23% of the women who continued their meds.

The best way to make your decisions and manage your treatment throughout pregnancy and beyond is to work with your OB-GYN and mental health professional. What’s right for one person might not be right for you.

Menopause

Menopause greatly affects many women in both mind and body, so it’s not surprising that for those with bipolar disorder, symptoms may worsen.

Though research into the relationship between menopause and bipolar disorder is ongoing, research in 2016 suggests that reduced levels of estrogen are likely responsible for worsening symptoms.

Many women report more intense but shorter-lived episode of mania and depression. Around 20% report worse mood symptoms after menopause.

In a 2020 study, they found that menopausal transitions posed an especially high risk for worsening depression.

Some women experience symptoms they’ve never had before during menopause, which can be unnerving or confusing.

It can also be challenging to know whether your symptoms are a response to the hormonal changes during menopause, your bipolar disorder, or distressing life events that tend to happen around menopausal age.

Thankfully, you don’t have to figure it all out yourself — use the support of your treatment team.

You may want to consider finding a gynecologist who’s willing to collaborate with the doctor treating your bipolar disorder.

Having this open communication between both sides of your treatment team doesn’t mean they’ll be talking to each other regularly, but it can give each of them access to any modifications the other might be making to your treatment plan.

It can also help if you’re assertive and proactive in sharing test results and prescriptions to ensure the pros are in tune with what’s going on with all parts of your health.

Managing the stigma

It’s not just about hormones and physiology when it comes to how women manage bipolar disorder. Stigma matters, too.

In a 2013 study, 50% of respondents with bipolar disorder said their self-esteem had suffered due to stereotypes surrounding the condition. This study included both men and women.

The stigma associated with bipolar disorder can be just as harmful to your mental health as hormonal changes — particularly when stigma becomes internalized.

But internalized stigma can be overcome with support, therapy, and advocacy.

Bipolar disorder can be a part of who you are without defining your whole sense of self. Building confidence, identity, and interpersonal relationships can help you counter the stigmas that persist in society.

To diagnose bipolar disorder, mental health professionals often use a combo of symptom assessments, family and life history, and previously diagnosed medical conditions.

Still, it can be somewhat challenging to get the right diagnosis. About 69% of people with bipolar disorder reported being misdiagnosed at least once. More than a third remained misdiagnosed for more than 10 years.

Because of the higher frequency of depressive episodes among women, an earlier misdiagnosis of major depressive disorder (MDD) is common.

When someone receives an incorrect diagnosis, or isn’t diagnosed accurately for a long time, it can affect their quality of life and condition management.

The age that women are diagnosed tends to be later. This may be due to misdiagnosis, but in some cases, symptoms may not appear until pregnancy, following childbirth, or until menopause.

For those who have been treated for major depressive disorder, they may now know how to at least treat depressive episodes and can focus on learning how to treat other symptoms.

While there’s no cure for bipolar disorder, there are many treatment options to help people manage their symptoms.

Finding the best treatments for you will likely take some trial and error — not to mention good communication with your doctors.

The type of treatments you use will depend on many factors, including health history, symptoms, age, and reproductive phase.

Medication

If you don’t have one already, your doctor may refer you to a psychiatrist who can talk to you about your thoughts, feelings, and behaviors, then proceed with tailored prescriptions to manage them.

Mood stabilizers like lithium are among the most commonly prescribed and most effective drugs for managing bipolar disorder.

Your doctor may also recommend the use of additional medications, like anticonvulsants, atypical antipsychotics, or antidepressants.

Anti-anxiety meds may be given to women who experience co-occurring anxiety disorder.

Some people going through menopause may find hormone replacement therapy (HRT) to be an effective means of increasing mood stability and relieving depression symptoms.

For some people, these drugs cause mild to severe side effects. You can always speak with your doctor if the negative effects of any treatment outweigh the positive.

Pregnancy and breastfeeding may impact the type of drug or the dosage you’re able to take. For advice, you can reach out to both your gynecologist and a mental health professional. It’s important to always reach out before stopping or starting anything new.

Psychotherapy

Many people living with bipolar disorder also participate in talk therapy, such as cognitive behavioral therapy (CBT).

Speaking with a therapist can help in many ways. They can provide you with tools to cope with sudden or significant mood changes and symptoms.

Unlike medication, therapy can help you identify thought patterns, plus learn strategies for dealing with the stressors of everyday life and significant life events, which are often triggers for mood episodes.

When used in combination with meds, talk therapies have shown significant benefits to women with bipolar disorder.

If you’re experiencing symptoms of bipolar disorder or know a woman who is, consider reaching out to loved ones and a mental health professional for help.

Even though the condition can be disruptive and feel isolating, it’s important to know that you’re far from alone.

With treatment, a routine, and a solid inner circle, a happier and more fulfilling life is possible.

No matter how late in life you get diagnosed, effective treatments and support are available. Just by taking steps to learn more about your symptoms and mental health
(like reading this article!) you’re moving toward advocating to ensure you’re properly diagnosed.