Bipolar disorder (BD)is a mental health condition causing extreme mood shifts. During a person’s menstrual cycle, they may experience a worsening of their BD symptoms.

This makes the premenstrual period, or time before menstruation, particularly difficult for some people. Hormonal fluctuations during the menstrual cycle may be responsible for this.

Read more to learn more about how premenstrual syndrome (PMS) affects people with BD, how it is treated, and more.

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BD is a mental health condition characterized by shifts in mood, concentration, and energy levels. These changes affect a person’s ability to perform day-to-day tasks.

According to the National Alliance on Mental Illness (NAMI), about 2.8% of adults in the United States live with BD.

BD is usually diagnosed by a doctor, psychologist, or psychotherapist in the later teen years or early adulthood. However, it can also appear during pregnancy or after childbirth.

Although symptoms can be managed with a treatment plan, lifelong treatment is usually needed.

NAMI reports that rates of bipolar disorder in males and females is similar. In the past year, 2.9% of adult males experienced bipolar disorder, compared to 2.8% of adult females.

One 2021 review claims that studies are skewed by a recent increase in the diagnosis of BD in females. This does not necessarily mean that BD is becoming more common in females — it indicates that healthcare professionals are getting better at recognizing their symptoms.

Researchers theorize that fluctuations in reproductive hormones exacerbate BD symptoms during the menstrual cycle, during pregnancy, and after childbirth.

However, more research is needed to understand this link.

Learn more about bipolar disorder in females.

A person’s menstrual cycle lasts approximately 28 days. It is broken down into two parts: the follicular phase and the luteal phase.

The first half of the cycle is the follicular phase. It is marked by low levels of progesterone, a pro-gestational hormone. Levels of estradiol, a type of estrogen, increase. This results in the release of an egg from the ovaries.

The second half of the cycle is the luteal phase. During this time, progesterone increases, and estradiol spikes again. If fertilization of the egg does not occur, hormone levels fall, and menstruation begins. The cycle then repeats.

PMS and premenstrual dysphoric disorder (PMDD) are caused by these hormone fluctuations. They cause both emotional and physical symptoms.

Mental and emotional symptoms include:

  • irritability
  • tiredness
  • sleep pattern changes
  • appetite changes
  • trouble with concentration
  • tension or anxiety
  • depression or sadness
  • changes in mood
  • decreased libido

Physical symptoms include:

  • swollen or tender breasts
  • bowel changes
  • bloating
  • cramping
  • headache
  • clumsiness
  • lower tolerance of noises or lights

Because the symptoms of PMS and PMDD overlap, it can be hard to tell the difference between the two. A person’s individual symptoms may also vary month-to-month.

PMDD is more severe than PMS. It can significantly affect a person’s quality of life and relationships. People with PMDD may miss days from work or school due to their symptoms.

Learn more about the differences between PMS and PMDD.

Even with adequate BD treatment, some people experience a worsening of symptoms around their menstrual cycle.

This is because the hormone changes causing PMS also affect BD symptoms. A 2019 literature review described how these hormone fluctuations can affect a person’s BD symptoms.

They can cause:

  • more depressive episode
  • less manic episodes
  • shorter time between episodes
  • more severe episodes

These changes are relatively common.

One 2014 meta-analysis examined how many women with BD were affected by premenstrual symptoms. Results suggest:

  • 25-77% experience PMS
  • 15-27% experience PMDD
  • 44-68% experience premenstrual-related mood changes

Managing a person’s PMS and/or PMDD symptoms can prevent the worsening of their BD symptoms. There are several treatment options available.

Medication

Before prescribing prescription drugs, a doctor may suggest over-the-counter (OTC) medications.

Some medication options include:

  • OTC pain relief medications: Medications such as ibuprofen (Advil), naproxen (Aleve), and aspirin can help manage cramps, breast tenderness, and headaches.
  • Prescription medications: A doctor may prescribe contraceptive pills, antidepressants, anti-anxiety medication, and/or diuretics, depending on a person’s symptoms and needs.

Vitamins and minerals

Certain vitamins and minerals may help in relieving symptoms.

The best evidence exists for calcium and vitamin B6. These can be found in certain foods, such as dairy products, or taken as a supplement. There is weaker evidence for the PMS-relieving effects of magnesium and polyunsaturated fatty acids (omega-3 and omega-6).

All supplements should be used with caution as they may interact with other medications. Additionally, because vitamins and supplements are not FDA regulated, they should be purchased and consumed very carefully.

Lifestyle factors

There are other things that a person can do to help relieve PMS and PMDD symptoms.

  • Exercise: Physical activity may improve mood, concentration, and energy.
  • Maintain a balanced diet: Avoiding caffeine, salt, and sugar may lessen the symptoms of PMS.
  • Rest: A good night’s sleep may help prevent moodiness and anxiety.
  • Seek stress relief: Yoga, massage, meditation, and journaling may be effective stress relievers for some people.

Learn more about home remedies for PMDD.

Avoiding certain medications

Some medications used to treat PMS and PMDD should not be used in people with bipolar disorder. One type that should generally be avoided are selective serotonin reuptake inhibitors (SSRIs).

Commonly prescribed SSRIs include:

Although a doctor may prescribe these medications for the depressive symptoms of PMS or PMDD, they can cause manic episodes in people with bipolar disorder.

It is important to contact a doctor if a person is worried about the potential safety of any medication they are taking.

People with diagnosed bipolar disorder who notice a worsening of their symptoms during the premenstrual period should contact a doctor. They can assess a person’s symptoms and adjust their treatment plan accordingly.

Additionally, individuals who think they may have bipolar disorder should contact a doctor. If a person or someone they know is in crisis or considering suicide, they should call 911.

The hormone fluctuations of the menstrual cycle can cause PMS and PMDD. However, people with bipolar disorder may be more affected than others. These changes can worsen their bipolar symptoms.

A person who notices significant mood changes around their menstrual cycle can seek treatment for their symptoms. Adjusting their treatment plan accordingly will help stabilize their mood.