An Overview of Bipolar Disorder in Women

Bipolar disorder is a mental health condition characterized by severe mood changes, and often presents itself differently in women. Diagnosing and treating bipolar disorder in women may present its own unique challenges.

Read more about the causes and symptoms of the condition, as well as its treatment methods in women. 

Causes

What causes bipolar disorder is still unclear. Researchers are trying to understand more about how specific neurotransmitters (e.g., dopamine and serotonin), as well as activity in the brain, contribute to bipolar disorder.

However, it is known that genetic and environmental factors can play a significant role in the onset of the condition, including:

• Bipolar disorder has a strong genetic component and can be inherited at a rate of 60% to 85%. 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 level of physical activity, and the use of medications or substances—may influence mood or symptoms.

Bipolar disorder causes changes in a person’s mood that can influence their thoughts, feelings, and actions. Though the condition’s prevalence seems equal across men and women, women may experience bipolar disorder differently from men.

Signs and 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-TR) outlines symptoms of bipolar disorder based on the state of the condition.

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

Women 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
  

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
  

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
  

Risks and Triggers

Hormonal Conditions

Natural fluctuations in hormones that occur for women may contribute to changes in mood. For example, a woman may observe differences in her energy and mood during or around her menstrual cycle or menopause. 

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. Additionally, certain medications used to treat bipolar disorder can be harmful to pregnant people and their babies. 

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

Seasonal Impact

Mood symptoms in women with bipolar disorder may be more affected by the seasons than in men.

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, women with bipolar disorder may notice lower energy levels and changes in their sleeping patterns, often with an increased need for sleep.

Co-Morbidities

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

A review of bipolar disorder in women noted that personality disorders, eating disorders, alcohol and substance use issues, thyroid concerns, and migraines are not uncommon.

Suicide

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

Other factors that increase a bipolar woman’s risk of suicide 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 lasted for at least one week or required 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 men and women.

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 women than men.

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.
  

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).
  

Diagnosing Bipolar Disorder

It can be challenging to diagnose a person with bipolar disorder accurately. One obstacle is that the symptoms can mimic those of other mental health conditions. There is also the reliance on a person's self-reporting of their symptoms.

Women may be misdiagnosed due to lack of understanding about how the condition impacts them. This can be devastating, as it may lead to delays in treatment or lack of proper care.

To diagnose someone with bipolar disorder, a healthcare provider must obtain an accurate account of the person's medical and psychiatric history. They should then conduct a thorough medical exam to evaluate for possible medical contributions to bipolar symptoms.

A licensed mental health professional should also conduct a psychiatric evaluation for signs and symptoms of bipolar disorder.

Management and Treatment in Women

Bipolar disorder is a mental health condition that requires lifelong management. A priority in treatment is stabilizing the person’s mood.

With treatment, a person may be able to get their symptoms to a manageable place or even be symptom-free for periods of time.

Many treatment options are available to help women manage their symptoms.

Medication

Medications are available to help with symptom management. These include:

• 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, women should discuss with their healthcare provider the benefits and risks of taking medication during pregnancy and while breastfeeding.

There are often side effects with medications, and finding the right medication combination may take some time. Working with a psychiatrist can help identify the best combination of medications for someone with bipolar disorder.

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 women. Hormonal changes in women can impact mood, and women have a higher risk of having other, co-occurring mental health conditions. Bipolar disorder can be treated with medication, therapy, or a combination of both.

A Word From Verywell

Though bipolar disorder may require lifelong management and care, treatment options are available. Establishing a care team you trust—often including a combination of a healthcare provider, psychiatrist, and therapist—can help you manage the condition.

Learning ways to cope with mood fluctuations can be critical for your well-being. Creating a daily routine of self-care through sleep, exercise, and healthy eating can benefit your mood.

Finally, seeking peer or social support can be a great way to connect with others with similar experiences.