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.

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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 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.

According to a 2015 review of previous studies, a depressive episode is the first sign of bipolar disorder in 75% of females compared with 67% of males.

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, research suggests that bipolar II disorder is more common than bipolar I disorder. A person with bipolar II disorder experiences depression and hypomania.

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 2015 review notes studies have found almost 30% of females with bipolar disorder experienced rapid cycling compared with just over 16% of males.

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

Seasonal impact

According to the same 2015 review, 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.

Other conditions

According to a 2012 review, females with bipolar disorder may be more likely to have a higher genetic risk of alcohol use disorder (AUD).

A 2010 study suggests they may also experience a higher rate of eating disorders than males.

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

Suicide risk in females with bipolar disorder

The 2015 review also notes that females with bipolar disorder were two to three times more likely to attempt suicide than males with the condition.

A 2014 study reviewed the risk of suicide in males and females with bipolar disorder. Researchers 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 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.

Suicide prevention

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 it’s safe to do so.

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.

Find more links and local resources.

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 concludes 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 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.

Females tend to receive a bipolar disorder diagnosis later in life than males. It is also more common for symptoms to start in the 50s for females than males.

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.

A large 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, 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.

Menstruation

Research suggests that symptoms of bipolar disorder may worsen at the premenstrual stage of the menstrual cycle. A 2015 review notes that 25% of females with bipolar disorder experience 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

The same 2015 review notes that around 20% of females with bipolar disorder have worsening symptoms, mainly depression, around menopause.

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.

Options include:

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
  • 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 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 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.

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 only recommend ECT if other treatments do not work.

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 some people with bipolar disorder may use.

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 more common in females than males.

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.