Some people refer to bipolar disorder as manic depression. It is equally common in men and women, but the effects and treatments may have different considerations for each sex.

The cause of bipolar disorder (BD) is unclear, but genetic and hereditary factors appear to play a role. Risk factors may include a family history of the condition, intense stress, and traumatic life events.

In the United States, BD occurs in around 2.8% of the adult population.

Some of the different effects of BD in women might have links to hormones. Pregnancy may also present difficulties in treatment.

Without treatment, BD can impact all aspects of life, potentially causing serious problems at school or work, in relationships, and finances.

In this article, we discuss the impact of bipolar disorder on women and the implications for treatment.

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When a woman has bipolar disorder, some research suggests that the symptoms present differently.

Bipolar disorder has a number of specific variations when women have the disorder.

According to a 2015 review, women have a higher risk of depressive symptoms than men. They may also be more likely to develop BD at a later age.

The same study suggests that BD in women might be harder to treat and recover from, as women more frequently have a co-occurring condition, including:

A different, more recent study also showed that BD was more likely to occur alongside inflammatory disorders, including asthma, Crohn's disease, and multiple sclerosis when presenting in women.

One study from 2015 showed that women also have a higher risk of mixed episodes, in which manic symptoms present during a depressive episode or vice versa.

General symptoms

Bipolar disorder involves episodes of mania and depression.

Mania might cause the following symptoms:

  • high energy
  • a tendency to make errors in judgment
  • becoming easily distracted or bored
  • frequently performing poorly at work and school, or missing it altogether
  • a feeling of invincibility, as if the person with BD could do anything
  • being almost aggressively social and forward
  • exhilaration or euphoria
  • partaking in risky behavior
  • extreme confidence and self-importance
  • rapid speech that switches topic erratically
  • a frantic stream of thoughts

People with hypomania experience these symptoms to a lesser degree. Findings on differences between symptoms of bipolar II disorder in men and women are inconsistent.

Some clinical samples suggest that women are more likely to experience bipolar II disorders than men.

Depressive symptoms include:

  • a near-daily depressed mood that lasts for a large quantity of the day, as reported by the individual themselves or observed by others
  • notably reduced pleasure or interest in every activity (or almost every activity) throughout the day on a daily or near-daily basis
  • weight gain or loss of more than 5% body weight, even though the individual may not be dieting
  • sleep disturbances, including insomnia and hypersomnia
  • observable slowing down or speeding up of speech and movement, displaying restlessness or lethargy
  • daily fatigue or energy loss
  • near-daily feelings of excessive and disproportionate guilt and worthlessness
  • observable or self-reported inability to think clearly, focus, or make decisions
  • repeatedly thinking about death with or without a specific plan around suicidal ideation, or a suicide attempt

For a diagnosis of bipolar disorder, these must cause distress or impairment to the extent that they disrupt a person's ability to function in social, professional, other areas. The doctor must also not be able to attribute these symptoms to other conditions or substance use.

In mixed episodes, a person experiences many of these symptoms at the same time.

The symptoms of BD are complicated. To learn more, visit our page on bipolar disorder by clicking here.

Type

Bipolar II disorder is similar to bipolar I disorder, in that a person experiences extreme emotional highs and lows.

To receive a diagnosis of bipolar I disorder, a person only needs to experience one disruptive manic episode. Some people may experience a major depressive episode, but others might not.

In bipolar II disorder, the person experiences hypomanic symptoms, which are not as severe as the manic symptoms in bipolar I disorder. A person with bipolar II disorder must also experience a manic episode.

One review suggests that rapid cycling is more common in women than in men. This is the occurrence of four or more mood episodes within 12 months. The cycles may not alternate rapidly; however — the four mood episodes can be major depressive, manic, or hypomanic.

Research suggests that these differences between men and women could relate to abnormal thyroid levels or hypothyroidism, and that imbalanced thyroid levels occur more frequently in women than in men.

Misdiagnosis

People with bipolar disorder may receive an incorrect diagnosis. Some research finds that women are more likely to receive a depression diagnosis due to the prevalence of depressive symptoms.

Sleep

Women and men experience 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 one 2015 study that took place over 2 years, poor sleep was a predictor of a poor mood outcome for women but not men.

The biggest difference between men and women with BD is the impact of reproductive life events on women, such as childbirth.

Pregnancy and breastfeeding can influence the way bipolar disorder progresses and the administration of treatments.

Pregnancy

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Pregnancy can make bipolar treatment complicated.

Treating women with bipolar disorder who are pregnant and breastfeeding is challenging. Mood stabilizers, which doctors use 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 does not make it worse either.

Women who have bipolar disorder and are pregnant or are thinking about becoming 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 anomalies.

Both treating and not treating bipolar disorder during pregnancy carries risks, so advice from a doctor is important. A doctor will discuss possible treatment options with you.

Within the first 4 weeks after childbirth, around 50% of women with bipolar disorder will stay well. The other 50% may experience an episode of illness. About 25% of women with bipolar disorder could experience postpartum psychosis, and a further 25% may have postpartum depression.

However, this 4-week period is also the time frame in which 90% of postpartum psychosis and bipolar disorder episodes occur.

The reason that women with bipolar disorder are vulnerable to postpartum psychosis or postpartum depression following childbirth remains unclear. However, it could relate to hormones, changes in sleep patterns, or sleep deprivation.

Breastfeeding

Some medications for bipolar disorder may have potentially harmful effects if a woman takes them while breastfeeding.

Lithium, a mood stabilizer, can cause lethargy, hypotonia, hypothermia, cyanosis, and changes in the heart's electrical activity.

Breastfeeding may disrupt sleep. This can trigger severe mood episodes.

Some options are available to help mothers with bipolar disorder get adequate sleep. This might include arranging for other adults to feed the infant or expressing milk so that it would be ready for night feedings.

A doctor will advise the best course of action for treating BD during breastfeeding.

No cure for bipolar disorder is available, but medications can help manage the condition. Some lifestyle changes may also help, such as reducing stress as far as possible and getting adequate 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 do not have the desired effect
  • antidepressants may be used in some cases to manage depressive episodes or other co-morbid conditions.
  • combined antidepressant-antipsychotic treatments for depressive episodes in bipolar I disorder
  • anti-anxiety medications to reduce anxiety and improve sleep
  • psychotherapy, or talking therapies, to learn about mood, feelings, thoughts, and behaviors
  • electroconvulsive therapy (ECT), in which a medical professional passes electrical currents through the brain to help severe mania or depression
  • transcranial magnetic stimulation, in which 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 are not as effective when taken alongside some medications for BD. A woman with BD may need to reassess options for birth control.

When planning a pregnancy or while breastfeeding, treatment for BD requires careful consideration to reduce the risk of congenital anomalies due to medications passing to the infant in breast milk.

Takeaway

Women experience certain variations of BD. Some researchers believe that women with BD face a higher risk of major depressive symptoms than men with BD and that women might develop it at a more advanced age.

In women, BD might also occur alongside other health issues, such as anxiety disorders, thyroid problems, and obesity. Women might also face a higher risk of developing bipolar II disorder rather than bipolar I disorder.

BD also presents unique problems for women during pregnancy. A doctor must assess the risk of both treating and not treating BD in women who are also pregnant or breastfeeding, as the medications present some risk to the fetus or newborn infant.

Whichever sex a person is, BD is debilitating and requires medical attention.

Q:

Do women have an increased risk of suicidal ideation from bipolar disorder?

A:

Yes, but so do men. In fact, the lifetime risk of suicide among individuals with bipolar disorder is estimated to be at least 15 times that of the general population.

In fact, according to the DSM-5, bipolar disorder may account for up to one-quarter of all completed suicides.

Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.