Bipolar disorder is a mental health condition that involves significant changes in mood. Some characteristics of the condition and its impact can be different for females.
While bipolar disorder can affect anyone, there are certain differences based on sex.
For example, bipolar disorder symptoms may start later in females. They may also have longer depressive episodes than males.
Females may also have a higher risk of conditions that can accompany bipolar disorder. Pregnancy, menstruation, and menopause can affect symptoms and treatment options for bipolar disorder as well.
This article explores ways bipolar disorder may be different for females.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) is a handbook doctors use to diagnose and treat mental health conditions.
According to the DSM-5-TR, for a diagnosis of bipolar disorder, a person needs to experience at least one episode of mania or hypomania, which is a “high” mood. Hypomania is not as intense as mania.
Symptoms of mania or hypomania in males and females
- 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
Researchers have not found that symptoms of mania affect females differently from males.
Many people with bipolar disorder also experience at least one episode of depression, which can be severe.
According to a
Symptoms of depression include:
- feeling sad or “down”
- feeling slow and speaking more slowly
- experiencing restlessness
- appetite and weight changes
- 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, depressive symptoms are more likely 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. Research from 2013 suggests that mixed episodes are more common in females.
Rapid cycling, in which moods change quickly in a short period, also seems to be more common in females. A
According to the DSM-5-TR, a female with bipolar II disorder is more likely to alternate rapidly between episodes.
According to the same
Females may also have a higher risk of depressive symptoms in the fall and winter.
A 2010 study suggests they may also experience a higher rate of eating disorders than males.
Other conditions and factors affecting health
- borderline personality disorder (BPD)
- 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 bipolar disorder
- “social problems” concerning close relationships, such as with family
In males, by contrast, a key predictor of a suicide attempt was substance use.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Social impact and prejudice
Research confirms that the social, as well as the more clinical, effects of bipolar disorder can be different for females.
- 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 of children
Economic factors also influenced the experience of bipolar disorder. Those who reported having a safe place to live and help with child care and family responsibilities tended to manage their condition 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 bipolar disorder symptoms and make the symptoms harder to manage.
Bipolar disorder typically starts in adolescence and early adulthood, though symptoms can develop anytime.
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, researchers note 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 can discuss the possible effects and any necessary changes to treatment with their healthcare team to help maintain their mental health after childbirth.
Research suggests that symptoms of bipolar disorder may worsen at the premenstrual stage of the menstrual cycle. A 2015 review notes 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.
Those over age 40 years may take higher doses of bipolar disorder medication than younger females. But those 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 menstruation, menopause, and possibly pregnancy affect bipolar disorder
- the effects of treatments on birth control
- considerations concerning treatments and 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 suggest 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 a fetus or breastfed baby. On the other hand, stopping treatment may increase the risk to the person who is pregnant or breastfeeding.
In some cases, medications can worsen or trigger symptoms of bipolar disorder. For example, treating postpartum depression with antidepressants
A person and their doctor can weigh the risk of symptoms with the risk of adverse effects when developing a treatment plan. A treatment plan may change before, during, and after pregnancy.
For a person with severe symptoms, a doctor may recommend ECT. However, experts typically
Anyone with bipolar disorder who is pregnant or considering becoming pregnant should speak with their healthcare team to get support, especially if bipolar symptoms are present.
The following are some questions people frequently ask about bipolar disorder.
What is behavioral disengagement in bipolar disorder?
“Behavioral disengagement” is a term for giving up. It is a part of the maladaptive coping strategies
When does bipolar disorder start in females?
Bipolar disorder symptoms typically begin in adolescence or early adulthood. For some people, symptoms start later.
Some research suggests symptom onset in the 50s is
Bipolar disorder affects females and males at equal rates. However, the symptoms and effects of the condition can differ for females. For example, they are more likely to experience depressive symptoms and a range of linked conditions.
Menstruation, pregnancy, and menopause can all affect bipolar disorder symptoms and the treatment options as well.
In addition, females may face additional pressures, especially if they lack support.
Working closely with a healthcare team can help people support their mental health and well-being, no matter their sex or age.