Bipolar Disorder in Women: Symptoms & Signs

Bipolar Disorder (BD)

Bipolar disorder is a mental illness known as a mood disorder, that causes changes in a person’s mood, energy level, and the ability to think clearly. They might experience highs and lows known also as depression and mania. Onset is usually around 25-years old but can occur in adolescence and less commonly in children.² The severity levels can vary and individuals can be diagnosed as bipolar disorder I, bipolar disorder II, cyclothymia, or bipolar disorder unspecified.

Bipolar Disorder in Women

Bipolar disorder in women involves extreme mood swings that go from depressive lows to either hypomanic or manic highs. Fluctuations in hormonal changes during pregnancy and during the menstruation cycle can impact bipolar symptoms in women, and women will have different needs and focuses of attention for bipolar treatment. The most efficient treatment for bipolar disorder in women involves therapy, medication management and a strong support system.

When Do Signs of Bipolar Start to Appear in Women?

Even though bipolar disorder symptoms can impact both men and women, research has found that onset for women can be found later in life than in men.¹ Usually symptom onset appears in the early twenties. However, women face delays in diagnosis, sometimes up to 11 years, and may receive more awareness and attention around the 45-50 age range.³

Delayed Diagnosis or Misdiagnosis of Bipolar in Women

Although both genders will be impacted by bipolar disorder there are reasons why it’s more common for women to receive a misdiagnosis or delayed diagnosis. In women, bipolar disorder may present with more depressive episodes which will lead women to report mostly depressive symptoms. This can lead to a diagnosis of unipolar depression due to women not seeking treatment as often when experiencing hypomanic and manic episodes. This can also lead to treatment with mainly antidepressants.⁴

Emotional Bipolar Symptoms in Women

The emotional presentation of bipolar disorder in women leads to more depressive episodes or rapid cycling than in males. Women tend to be diagnosed with bipolar disorder II more often than men, and experience more rapid cycling of highs and lows. Additionally, hormonal changes, such as menopause or pregnancy in women tend to impact the severity of the disorder.⁵

Severe mania, found in bipolar disorder I, can sometimes lead to psychosis which can cause hallucinations, delusions, and a loss of touch with reality. Women tend to have less episodes of severe mania and psychosis than men. Women are also less often hospitalized. However, high risk for suicide can be found in both women and men.¹

Physical Symptoms & Co-Occurring Disorders

Physical symptoms more commonly found in women with bipolar disorder include disorders such as thyroid disease, polycystic ovarian syndrome(PCOS), and chronic pain problems. Additionally, weight gain can commonly occur due to medications and co-occurring mental health disorders of depression and anxiety disorders are common as well.³

Common co-occurring disorders in women with bipolar include:

• Borderline personality disorder
• Obesity
• Migraine
• Thyroid disease
• Substance abuse
• Menstrual abnormalities
• Polycystic ovarian syndrome

Challenges in Bipolar Disorder Diagnosis in Women

A diagnosis of bipolar disorder will often come with a variety of challenges depending on severity and treatment required. One of the challenges that women might face is that menstruation has an impact on a woman’s symptoms. Additionally, BD tends to impact a woman’s reproductive cycle more commonly in the later stages of the menstrual cycle. Women will report more mood changes during the menstrual cycle that are more likely to cause onset or a relapse of symptoms. Pregnancy and the postpartum phase can contribute to different episodes of hypomania, mania, and even lead to postpartum psychosis.⁴

How to Cope With Bipolar Disorder in Women

Bipolar disorder treatment takes a lot of care and requires support. Clinicians working with women living with bipolar need to make sure they are building a therapeutic rapport and are informed with issues that women may face. Primary medications for bipolar disorder involve Lithium, Lamotrigine, or Divalproex Sodium. However, the rates of drug absorption differ between men and women. Careful titration of the medication is necessary. For better outcomes, relapse prevention, and medication compliance adding psychotherapy can be beneficial when paired with medications.³

Here are some coping strategies for bipolar disorder in women:

• Self-care: One of the best treatments for BD is self-care. Women often struggle with taking care of their own needs and often forget to take time for themselves. Self-care are basic activities that one can do to create relaxation and fill one’s own emotional reserve.
• Follow medication recommendations: Although taking medications might sometimes cause anxiety. It is important to have a strong relationship with the prescribing clinician in order to ease concerns and increase compliance.
• Practice mindfulness: The activity of mindfulness involves the individual to focus on the here and now. This can be done via meditation or via a mindfulness walk in nature.
• Journaling: Journaling for mental health might seem intimidating for some individuals. However, it can involve simply writing down the thoughts or emotions one is struggling with.
• Joyful movement: The relationship one has with movement and exercise can greatly improve mood as well as provide a closer relationship with one’s body.
• Counseling: Counseling is a collaborative treatment and involves working together with a provider to address any concerns one is having. Therapists can help guide people who are struggling with their symptoms.
• Group counseling: Group counseling involves a structured and safe environment where others can come partake and learn from.
• Support systems: Support systems involve anyone who an individual might feel safe and comforted by when discussing issues.
• Watch movies: Consider watching movies about bipolar disorder to see different perspectives and learn more about how the disorder affects people.

Treatment for Bipolar Disorder in Women

Bipolar disorder treatment options are similar for both males and females but with females, age and different situations such menstruation and pregnancy need to be considered. For example, in adolescent females, sometimes bipolar medication is avoided as it can lead to an increased occurrence of PCOS or polycystic ovarian syndrome. In terms of pregnancy, clinicians sometimes have to outweigh the risks with the benefits. Psychiatrists have to make decisions in treatment based on what will benefit the mother and her infant. Postpartum and lactation is also an area that must be monitored to make sure no medications impact the mother’s newborn.⁴

Medication

Medications such as mood stabilizers, antipsychotics, anticonvulsants, and antidepressants will be the main treatment of bipolar disorder regardless if it is type one, type two, mixed episodes or cyclothymia. These medications help with the varied range of mood swings. It is important to understand and report symptoms to the psychiatrist. It is also important to know that antidepressants being used alone can lead to a relapse of symptoms.

Depending on how the individual is doing the practitioner might prescribe a mood stabilizer or add on antipsychotics if an individual continues to struggle with symptoms such as mania or psychosis. Certain medications such as lithium will require close monitoring via lab visits. Bipolar disorder medications and pregnancy can sometimes lead to complications and medications such as Valproate will not be prescribed. If a woman with BD is planning on getting pregnant she should have a conversation with her psychiatrist to update the treatment plan.⁶

Therapy

Therapeutic approaches for bipolar disorder in women include finding a therapist that provides a therapeutic safe environment, preferably trauma-informed and understanding the unique issues of women’s needs. Different approaches such as dialectical behavioral therapy have been found helpful in addition to cognitive behavioral therapy, due to its heavy emphasis on helping work on distressing thought processes.

Therapy options for bipolar disorder in women include:

• Cognitive Behavioral Therapy(CBT): CBT for bipolar disorder will involve working on the thoughts that create cognitive distortions that impact a person with BD’s behaviors.
• Dialectical Behavioral Therapy (DBT): DBT for bipolar disorder will involve helping individuals increase their emotional intolerance and maladaptive behaviors by learning different skills.
• Acceptance and Commitment Therapy(ACT): ACT for bipolar disorder will involve helping individuals learn about mindfulness techniques and provide clients to look at their problems via a different perspective to help manage symptoms.
• Family-Focused Therapy(FFT): FFT for bipolar disorder involves including the person who is struggling with BD to include their family for support and encouragement.

The Importance of Personalized Treatment Plans

Individualized treatment plans are necessary due to the varied nature of bipolar in women. Each treatment team involving medication management and the therapist can help create a plan designed to meet the needs of the individual. Women also have special unique concerns that need addressing in a safe space to help make them feel seen and validated. No two women are alike and each deserves their own unique treatment plan based on their needs, whether it is medication management, frequency of therapy sessions, or attending group sessions.

Where to Find Professional Help for Bipolar Disorder in Women

If you are interested in knowing where to find a new therapist or are unhappy with your current provider, the first thing to do is find a mental health clinician that can help you in your mental health journey. Resources such as an online therapist directory can be a helpful resource in finding a therapist that is a good fit for you based on what your presenting needs and concerns are.

Medications are also an important part of the process for treatment; therefore, it will also be important to find a good psychiatrist or psychiatric nurse practitioner. Sometimes therapists can help clients find prescribing providers or individuals can speak to their primary care provider.