The biggest difference between men and women is the impact that reproductive life events, such as childbirth, have on women with bipolar disorder.
Menstruation, pregnancy, breastfeeding, and menopause can all influence the course of bipolar disorder, or even the way it is treated.
Menstruation
Bipolar disorder may be unique in its course and presentation in women due to the impact of the reproductive cycle.
Symptoms may worsen during certain phases of the reproductive cycle, especially after childbirth, but also in the premenstrual phase of the menstrual cycle and during perimenopause and menopause.
Depressive episodes occur more often in women with bipolar disorder who are perimenopausal or postmenopausal.
Hormones may be partly responsible for some of the symptoms seen in women with bipolar disorder.
Researchers suspect that symptoms such as mood swings – that correspond with menstruation, perimenopause, and menopause – are linked to fluctuating levels of estrogen.
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) often happen simultaneously with bipolar disorder II. Women with PMS and PMDD also have a greater risk of developing bipolar disorder I.
Women who are susceptible to hormonal changes often experience more severe symptoms, frequent relapses, and a poorer response to treatment.
Pregnancy
Bipolar disorder peaks in women in the main reproductive years, between the ages of 12 and 30 years. This raises the risk of severe symptoms during pregnancy and the postpartum period.
Treating women with bipolar disorder who are pregnant and breastfeeding is challenging. Mood stabilizers, which are used to treat bipolar disorder, may pose potential risks to the unborn baby or infant.
Research indicates that pregnancy does not protect against bipolar disorder, but it does not make it worse either.
Women who have bipolar disorder and are pregnant need to discuss their medication with a doctor.
Some will need to continue medication throughout pregnancy, but there are disadvantages to this. For example, some drugs used to treat bipolar disorder are associated with congenital abnormalities.
There are risks linked to both treating and not treating bipolar disorder during pregnancy, so advice from a doctor is important. A doctor will consider all possible treatment options.
Within the first 4 weeks after childbirth, around 50 percent of women with bipolar disorder will stay well. The other 50 percent may experience an episode of illness. About 25 percent of women with bipolar disorder could experience postpartum psychosis and a further 25 percent may have postpartum depression.
It remains unclear why women with bipolar disorder are vulnerable to postpartum psychosis or postpartum depression following childbirth, but it could be related to hormones, changes in sleep patterns, or sleep deprivation.
Breastfeeding
Some medications for bipolar disorder that are taken while breastfeeding may have potentially harmful effects.
The mood stabilizer lithium can cause lethargy, hypotonia, hypothermia, cyanosis, and changes in the heart’s electrical activity.
Breastfeeding may disrupt sleep, and this can trigger severe mood episodes.
Options such as arranging for other adults to feed the infant or expressing milk ready for night feeding may help mothers with bipolar disorder to get adequate sleep.
A doctor will provide advice on the best course of action for treatment during breastfeeding.