Bipolar disorder is a psychiatric disorder, diagnosed by an episode of mania. In some people with bipolar disorder, they may experience major depressive episodes. The condition typically begins in young adulthood and tends to be life-long.

However, a diagnosis of bipolar disorder can occur later in life, too. The causes are not clear but might involve genetic factors, as bipolar disorder can run in families.

The condition occurs in men and women alike but may present differently in each.

This article looks at the symptoms of the condition for women and how to treat it.

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Bipolar can cause different effects in women than men.

Some symptoms of bipolar disorder are the same in men and women, while others are more gender-specific.

Symptoms that are common in both men and women include:

  • high or irritated mood
  • more energy and greater goal-driven activity
  • elevated self-esteem or grandiosity
  • reduced sleep
  • higher than usual frequency of talking
  • rapid speech flow and flights of ideas or racing thoughts
  • being easily distracted
  • regular impulses for pleasurable experiences, such as shopping or sex, without understanding the consequences

The typical symptom of depression in both men and women with bipolar disorder is a severe form of feeling "low" or "down." Some people might lose interest in basic parts of life, including eating, while others may be unable to take part in everyday activities, such as going to the store or work.

Other symptoms of depression include feeling guilty without good reason and concentration difficulties. Some people experience sleeping problems or wake up unusually early.

While some people with bipolar disorder will switch between episodes of depression and mania, not everyone with bipolar disorder will have depressive episodes. For those who do switch, the rate at which they may switch varies between people. Some may have mostly depressive symptoms, while others experience more mania.

Research has suggested that women with bipolar disorder are more likely to have mainly depressive episodes. Men are more likely to experience a "mixed state" with depression and mania both occurring.

As women are more likely to visit a doctor about depression, they are more likely to receive an incorrect diagnosis of depression.

If a woman is diagnosed with bipolar disorder, it is likely to be bipolar II, which means they have experienced depression with some hypomanic episodes.

According to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association (APA), a woman with bipolar disorder II is more likely to alternate rapidly between episodes.

DSM-5 also notes that women with bipolar disorder are more likely to have a higher genetic risk of alcohol use disorder and a higher rate of lifetime eating disorders.

Suicide risk in women with bipolar disorder

An article published in PLOS One in 2014 reviewed the risk of attempted suicide in people who have bipolar disorder.

The authors found differences between men and women with the condition. A predictor of suicide risk in men was substance use.

The predictors of suicide risk in women with bipolar disorder included:

  • many mixed episodes, or having symptoms of depression and mania at the same time, over a lifetime
  • psychiatric problems starting earlier in life
  • a personality disorder alongside the bipolar disorder
  • social problems

A review of the evidence, published in the Indian Journal of Psychiatry in 2015, said that women with bipolar disorder attempted suicide more often than men with the same condition, and 2 to 3 times more often than men in the general population.

Childbirth can trigger episodes of bipolar disorder for women. These are known as postpartum episodes.

One study in the journal JAMA found that childbirth strongly raised the risk of a severe episode.

The same study noted that becoming a new father did not carry the same risks for severe mental illness.

The exact mechanism through which childbirth triggers a bipolar episode is not known. Possible causes include hormonal changes, sleep disturbances, and other changes that follow childbirth.

A woman with bipolar disorder should speak to their doctor about the impact of pregnancy and the effects of any medication.

Menstruation

Hormones may play a role in triggering a bipolar episode after childbirth, and the menstrual cycle might make symptoms worse. However, evidence of a link is weaker than it is for childbirth.

The hormones present around the time of menstruation may slightly alter the effect of lithium, a treatment for bipolar treatment disorder, and this may reduce the influence of the medication.

The director of women's mental health at Brigham and Women's Hospital, Dr. Laura Miller, says in an article in Psychiatric Times that menopause may also have an impact.

Hormonal and other changes around the time of menopause mean that women between the ages of 45 and 55 years are more likely to experience depressive episodes.

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Some studies have shown that women are more likely than men to receive psychotherapy.

Women with bipolar disorder may receive different treatment than men, according to the findings of a study that involved 7,000 patients.

The 2015 study, published in the Journal of Affective Disorders, found significant gender differences in the routine clinical treatment of bipolar disorders in Sweden.

Women with bipolar disorder were more likely to receive antidepressant treatment than men, but doctors were more likely to prescribe lithium to men.

Women were also more likely than men to receive electroconvulsive therapy (ECT), lamotrigine, benzodiazepines, and psychotherapy.

Since there was no clinical reason to use different treatments by gender, the authors concluded that doctors showed gender biases.

The article notes that women in general, not just those with bipolar disorder, are more likely to receive antidepressants and combination treatments than men.

Bipolar treatment risks for pregnant women

Bipolar itself does not appear to affect the safety of a pregnancy, but some of the treatments for bipolar disorder can present a risk to the unborn baby.

These medications include:

  • benzodiazepines
  • carbamazepine
  • lamotrigine
  • lithium
  • paroxetine
  • valproate

Women with bipolar disorder who are considering becoming pregnant should discuss their treatment plans with their doctor. Some women may prefer to stop their medications during pregnancy, but they must also discuss any change in medication with a doctor as cessation of medications may result in a return of symptoms.