The cause is unclear, but genetic and hereditary factors appear to play a role. Triggers include a family history of the condition, alcohol or drug abuse and intense stress or traumatic life events.
Bipolar disorder affects around 2.6 percent of the adult population in the United States. Men and women are equally likely to have it, but it impacts them in different ways, so treatments may be different.
Some of the the differences in how bipolar disorder manifests in men and women may relate to the female menstrual cycle. Pregnancy can also play a role.
Untreated, bipolar disorder can impact all aspects of life, potentially causing serious problems at school or work, in relationships, and with finances.
Bipolar disorder in women compared with men
In women, hormonal events may play a role in triggering symptoms.
Women with bipolar disorder are more likely to experience depression than men with the condition.
Compared with men, women with bipolar disorder are more likely to experience:
- Bipolar II disorder
- Depressive episodes
- Rapid cycling between highs and lows - around 3 times as many women as men experience rapid cycling
- Mixed episodes, in which highs and lows occur at the same time, as part of the same episode, or even in rapid sequence
Some of the differences between men and women with bipolar disorder are discussed below.
Bipolar II disorder does not involve the full-blown manic episodes seen in type I.
The average age at which bipolar disorder appears is 25 years, but it often develops later in women than in men.
Bipolar disorder type
Women are more likely to have bipolar II disorder. This is similar to bipolar I, in that a person has highs and lows. In bipolar I, however, the highs reach mania, while in bipolar II they do not. Bipolar II features hypomania, a milder form of mania marked by elation and hyperactivity.
Rapid cycling is more common in women than in men. Rapid cycling is the occurrence of four or more mood episodes within 12 months, alternating between hypomania and depression.
Research suggests that these differences between men and women could be connected to abnormal thyroid levels or hypothyroidism. Imbalanced thyroid levels have been shown to be more common in women than in men.
Women experience more frequent depressive episodes, fewer manic episodes, and more mixed episodes than men.
Depression is the main characteristic in women with bipolar disorder, both at the start and ongoing, while manic episodes are more common in men. These differences may change the treatment approach for each sex.
The differing features between men and women with bipolar disorder also mean that women are often misdiagnosed with depression. Men are more likely to be diagnosed with schizophrenia.
Studies show that other mental health issues sometimes arise at the same time as bipolar disorder in women.
In women, eating disorders, weight changes, appetite changes, and insomnia are more likely to occur during phases of depression than they are in men.
Men have been shown to have higher rates of alcohol abuse, substance abuse, and gambling addiction than women. They are also more likely to develop conduct disorder.
Men are also more at risk of developing behavioral problems and not being able to hold a conversation while in the mania phase of bipolar disorder.
Women and men sleep differently, and sleep problems are common in people with bipolar disorder. Poor-quality sleep and bipolar disorder seem to make each other worse.
For example, in women with bipolar disorder, poor sleep quality increases the symptoms and frequency of depression and mania.
Menstruation, pregnancy, and menopause
The biggest difference between men and women is the impact that reproductive life events, such as childbirth, have on women with bipolar disorder.
Menstruation, pregnancy, breastfeeding, and menopause can all influence the course of bipolar disorder, or even the way it is treated.
Bipolar disorder may be unique in its course and presentation in women due to the impact of the reproductive cycle.
Hormonal changes may affect how bipolar disorder appears in women.
Symptoms may worsen during certain phases of the reproductive cycle, especially after childbirth, but also in the premenstrual phase of the menstrual cycle and during perimenopause and menopause.
Depressive episodes occur more often in women with bipolar disorder who are perimenopausal or postmenopausal.
Hormones may be partly responsible for some of the symptoms seen in women with bipolar disorder.
Researchers suspect that symptoms such as mood swings - that correspond with menstruation, perimenopause, and menopause - are linked to fluctuating levels of estrogen.
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) often happen simultaneously with bipolar disorder II. Women with PMS and PMDD also have a greater risk of developing bipolar disorder I.
Women who are susceptible to hormonal changes often experience more severe symptoms, frequent relapses, and a poorer response to treatment.
Bipolar disorder peaks in women in the main reproductive years, between the ages of 12 and 30 years. This raises the risk of severe symptoms during pregnancy and the postpartum period.
Treating women with bipolar disorder who are pregnant and breastfeeding is challenging. Mood stabilizers, which are used to treat bipolar disorder, may pose potential risks to the unborn baby or infant.
Research indicates that pregnancy does not protect against bipolar disorder, but it does not make it worse either.
Women who have bipolar disorder and are pregnant need to discuss their medication with a doctor.
Some will need to continue medication throughout pregnancy, but there are disadvantages to this. For example, some drugs used to treat bipolar disorder are associated with congenital abnormalities.
There are risks linked to both treating and not treating bipolar disorder during pregnancy, so advice from a doctor is important. A doctor will consider all possible treatment options.
Within the first 4 weeks after childbirth, around 50 percent of women with bipolar disorder will stay well. The other 50 percent may experience an episode of illness. About 25 percent of women with bipolar disorder could experience postpartum psychosis and a further 25 percent may have postpartum depression.
It remains unclear why women with bipolar disorder are vulnerable to postpartum psychosis or postpartum depression following childbirth, but it could be related to hormones, changes in sleep patterns, or sleep deprivation.
Some medications for bipolar disorder that are taken while breastfeeding may have potentially harmful effects.
The mood stabilizer lithium can cause lethargy, hypotonia, hypothermia, cyanosis, and changes in the heart's electrical activity.
Breastfeeding may disrupt sleep, and this can trigger severe mood episodes.
Options such as arranging for other adults to feed the infant or expressing milk ready for night feeding may help mothers with bipolar disorder to get adequate sleep.
A doctor will provide advice on the best course of action for treatment during breastfeeding.
There is no cure for bipolar disorder, but it can be managed with medication. Some lifestyle changes may also help, such as reducing stress as far as possible and getting enough sleep.
Recommended treatments for bipolar disorder may include:
- Mood stabilizers that control manic or hypomanic episodes
- Antipsychotics in combination with mood stabilizers when other treatments are unsuccessful
- Antidepressants to manage depressive episodes
- Combined antidepressant-antipsychotic treatments for depressive episodes in bipolar I disorder
- Antianxiety medications to reduce anxiety and improve sleep
- Psychotherapy, or talking therapies, to learn about mood, feelings, thoughts and behaviors
- Electroconvulsive therapy (ECT), in which electrical currents are passed through the brain to help severe mania or depression
- Transcranial magnetic stimulation, where magnetic fields stimulate nerve cells to relieve symptoms of depression
In certain situations, women may need to alter their medications or discuss them with their doctor.
Birth control medications do not work as well when taken alongside some bipolar disorder medications. Birth control options may also need to be reassessed.
Treatment options need to be considered when planning a pregnancy or while breastfeeding, in order to reduce the risk of congenital abnormalities, or of medications passing through breast milk to the infant.
All women of childbearing age should discuss how best to manage bipolar disorder during and after pregnancy.