Signs of bipolar disorder in women and treatment options

Bipolar disorder symptoms in females

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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

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. In 75% of females with the condition, this is the first sign of bipolar disorder, compared with 67% of males.

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.

Learn more about the symptoms of bipolar disorder.

A higher risk of depression

In females, research suggests that bipolar II is more common than bipolar I. A person with bipolar II experiences depression and hypomania, a less extreme form of mania.

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.

Learn more about the different types of bipolar disorder.

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 30% of females with bipolar disorder experienced rapid cycling, compared with just over 16% of males.

According to the DSM-5, a female with bipolar II is more likely to alternate rapidly between episodes.

What causes rapid mood changes?

Seasonal impact

Females are more likely to need hospital treatment for bipolar disorder in the spring and fall, compared with males, whose symptoms are more likely to peak in the spring.

Females may also have a higher risk of depressive symptoms in the fall and winter, compared with the spring and summer.

Other conditions

The DSM-5 reports that females with bipolar disorder are more likely to have a higher genetic risk of alcohol use disorder and a higher rate of lifetime eating disorders than males.

Other conditions and factors affecting health more commonly linked to bipolar disorder in females include:

• borderline personality disorder
• impulse control disorder
• obesity
• migraine
• thyroid disease
• a history of sexual and physical abuse

Suicide risk in females with bipolar disorder

A 2015 review found that females with bipolar disorder were two to three times more likely to attempt suicide than males.

Research from 2014 also reviewed the risk of suicide in males and females with bipolar disorder. The team found that predictors of suicide risk in females included:

• 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.

What is the difference between borderline personality disorder and bipolar disorder?

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.

Learn more about how race affects the experience of bipolar disorder.

Do people who are gay have a different experience of bipolar disorder?

Can bipolar disorder start later in life?

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 in their 50s.

Menstruation, pregnancy, and menopause

Menstruation, pregnancy, and menopause can influence how bipolar disorder affects females.

Pregnancy

Research suggests that among females with bipolar disorder:

• 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.

One 2006 study found that becoming a new parent strongly increased the risk of a severe episode among females with bipolar disorder, but not males.

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.

Menstruation

Research suggests that symptoms of bipolar disorder may worsen at the premenstrual stage of the menstrual cycle. One study found that 25% of females with bipolar disorder experienced premenstrual depression.

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.

Menopause

Around 20% of females with bipolar disorder have a worsening of symptoms — mainly depression — around menopause. Some research has found that females over 40 may have higher dosages of medication than younger females.

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.

Treatments

Treatment for bipolar disorder varies widely, depending on a person’s specific symptoms.

Options include:

• medication
• 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
• the increased risk of 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.

Here, learn more about treatments for bipolar disorder.

Bipolar treatment risks around pregnancy

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 experts recommend this only as a last resort.

Anyone with bipolar disorder who is considering pregnancy or pregnant should speak with their healthcare team, especially if bipolar symptoms are present.

Can natural remedies help manage bipolar disorder?

Summary

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 linked conditions.

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.