Bipolar disorder is a mental health condition that involves significant changes in mood and other symptoms. Some characteristics of the condition and its impact can be different for females, compared with males.
Bipolar disorder can start at any age, and it develops in males and females at equal rates. However, there are differences.
For example, the condition may
Females may also have a higher risk of conditions that can accompany bipolar disorder, such as migraine, thyroid problems, obesity, and anxiety disorders.
In addition, and crucially, pregnancy, menstruation, and menopause can affect symptoms and treatment options for bipolar disorder.
Below, we explore ways that a female’s experience of bipolar disorder may be different from a male’s.
For a diagnosis of bipolar disorder, a person needs to experience at least one episode of mania or hypomania, which is a “high” mood. This is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Symptoms of mania or hypomania in males and females include:
- feeling “high”
- feeling jumpy or irritated
- having increased energy
- having elevated self-esteem
- feeling able to do anything
- experiencing reduced sleep and appetite
- talking faster and more than usual
- having rapid flights of ideas or racing thoughts
- being easily distracted
- taking more risks, such as spending a lot of money or doing dangerous activities
Many people with bipolar disorder also experience at least one episode of depression, which can be severe. In
Symptoms of depression include:
- feeling sad or “down”
- feeling slow and speaking more slowly
- experiencing restlessness
- eating more and gaining weight, for some people
- losing interest in activities that were once enjoyable
- feeling as if there is nothing to say
- feeling hopeless
- having difficulty concentrating
- having problems with sleep
- thinking or speaking about death or suicide
Bipolar psychosis, which may involve delusions, paranoia, or hallucinations, can happen when episodes of mania or depression are severe.
A higher risk of depression
In females with bipolar disorder generally, depressive symptoms are more likely to be dominant. In fact, females with the condition are twice as likely to experience depression as males. Females are also more likely to experience psychosis with depression.
Because depressive symptoms tend to be dominant, females with bipolar disorder often receive an incorrect diagnosis of depression.
Different symptom patterns
People with “mixed episodes” of bipolar disorder experience a high mood with some depressive symptoms at the same time. Some studies have suggested that mixed episodes are more common among females.
Rapid cycling, in which moods change quickly in a short period, also seems to be more common among females. In one study, almost
According to the DSM-5, a female with bipolar II is more likely to alternate rapidly between episodes.
Females may also have a higher risk of depressive symptoms in the fall and winter, compared with the spring and summer.
Other conditions and factors affecting health
- borderline personality disorder
- impulse control disorder
- thyroid disease
- a history of sexual and physical abuse
Suicide risk in females with bipolar disorder
- having many mixed episodes, or having symptoms of depression and mania at the same time, over a lifetime
- having psychiatric symptoms begin earlier in life
- having a personality disorder alongside the bipolar disorder
- “social problems” concerning close relationships, such as with family
In males, by contrast, a key predictor was substance use.
Social impact and prejudice
Research confirms that the social, as well as the more clinical, effects of bipolar disorder can be different for females.
A 2014 review concluded that females are more likely than males to face:
- stigma and isolation
- changes to relationships
- a loss of self-determination and a sense of a lack of control
- a lack of understanding from healthcare professionals and others
- pressure to appear “normal” or face consequences such as losing custody over children
Economic factors also influenced the experience of bipolar disorder among the study participants. Those who reported having a safe place to live and help with childcare and family responsibilities tended to manage better.
Participants with less privileged socioeconomic backgrounds and participants from marginalized groups, including Black Americans, were more likely to face abuse and experience other risk factors for psychosis. These participants were also more likely to work full-time and have full responsibility for caring for their families.
A lack of support and safe living conditions, abuse, and other factors can increase the risk of severe symptoms of bipolar disorder and make the symptoms harder to manage.
Bipolar disorder usually starts in early adulthood, though the symptoms can develop at any time.
Research indicates that the symptoms tend to emerge later in females than in males and that females are more likely to experience the first symptoms
Menstruation, pregnancy, and menopause can influence how bipolar disorder affects females.
- One-third experience symptoms around the time of childbirth.
- About 20–30% experience psychosis after delivery.
- Around 36% first experience bipolar symptoms in the weeks following delivery.
- There may be a 24–40% chance of symptoms returning in the weeks after childbirth.
- Some 10–20% experience hypomania after delivery.
This supports the idea that hormonal factors may play a role. However, the authors noted that females are also more likely than males to experience sleep problems in the early days as a parent, which can also be a trigger.
Anyone with bipolar disorder who is pregnant or planning to become pregnant should discuss the possible effects and any necessary changes to treatment with their healthcare team.
Research suggests that symptoms of bipolar disorder may worsen at the premenstrual stage of the menstrual cycle. One study found that
The hormones present around menstruation may slightly alter the effect of lithium (Eskalith, Lithobid), a treatment for bipolar disorder. This may reduce the effectiveness of the medication.
In addition, females who use hormone-based treatment for menopause symptoms seem less likely to have a worsening of bipolar disorder symptoms.
These findings may indicate a link between falling estrogen levels and worsening symptoms.
Treatment for bipolar disorder varies widely, depending on a person’s specific symptoms.
- counseling and psychotherapy
- electroconvulsive treatment (ECT)
- other treatments administered in a hospital setting
Treatments for females may be different from treatments for males due to:
- how bipolar disorder is affecting menstruation, menopause, and possibly pregnancy
- the effects of treatments on birth control
- considerations concerning treatments and safe pregnancy and breastfeeding
increased riskof an additional condition, such as a thyroid disorder
- the presence of migraine, obesity, and other conditions that are more common in females than males with bipolar disorder
- the increased risk of depressive symptoms
Some medications for bipolar disorder, such as carbamazepine (Tegretol), can affect how birth control pills work because they increase the production of liver enzymes.
While there are clear reasons for some differences in treatment, some experts in Sweden have suggested that gender bias may lead to other disparities.
Bipolar disorder itself does not appear to affect the safety of a pregnancy. However, some treatments can pose a risk to the unborn or breastfeeding baby. On the other hand, stopping treatment may increase the risk to the pregnant person.
In some cases, medications can worsen or trigger symptoms of bipolar disorder. For example, treating postpartum depression with antidepressants may increase the risk of psychosis, mania, and rapid cycling. In people with a family history of bipolar disorder, it may trigger the first symptoms.
It is crucial for a person and their doctor to weigh the risk of symptoms with the risk of adverse effects when developing a treatment plan. This may change before, during, and after pregnancy.
For a person with severe symptoms, a doctor may recommend ECT, but
Anyone with bipolar disorder who is considering pregnancy or pregnant should speak with their healthcare team, especially if bipolar symptoms are present.
Bipolar disorder affects females and males at equal rates. However, the characteristics and the effects of the condition can be different for females, who are more likely to experience depressive symptoms and a range of
Menstruation, pregnancy, and menopause can all affect bipolar disorder symptoms and the treatment options.
In addition, females may face additional pressures, especially if they have little support and are otherwise marginalized or underprivileged.