Bipolar Disorder In Women: Diagnosis, Symptoms, and Treatment

Biology can change how women experience and are treated for bipolar disorder. Many people are misdiagnosed because the mental condition's characteristic symptoms—bouts of depression interspersed with periods of an abnormally elevated mood known as mania—can be missed or misread.

However, diagnosis and treatment can become even more complicated for cisgender women because symptoms can vary by biological sex. In the same way that healthcare providers can fail to catch heart disease in women because they look for the common symptoms of the disease in men, mental health professionals may not be aware of bipolar disorder symptoms in women. This can lead to misdiagnoses or no diagnosis at all.

Biological sex, pregnancy, and symptom differences can further affect how bipolar disorder is diagnosed and treated.

What Is Bipolar Disorder?

Although each case of bipolar disorder falls on a spectrum, there are two main diagnoses:

• Bipolar I disorder is characterized by pronounced manic—and even psychotic—episodes that often lead to hospitalization.
• Bipolar II disorder features a more moderate form of mania known as hypomania, which can be mistaken for mood swings.

In both cases, bipolar disorder causes swings in mood and energy. They may go from a manic episode (feeling high energy) to a depressive episode (feeling low in energy) or have a "mixed state" which is having symptoms of both mania and depression at the same time.

How Does Bipolar Disorder Affect Women?

There are a few differences in bipolar disorder for women. This includes a difference in diagnosis, symptoms, treatment, and associated health conditions.

Diagnosis

For women, there may be delay in a bipolar diagnosis. Women are often diagnosed later than men are—especially women with bipolar I disorder.

There are more women with bipolar II disorder than there are men with bipolar II disorder. This makes sense because women are more often diagnosed with bipolar II disorder than bipolar I disorder.

Symptoms

General symptoms of bipolar disorder can include:

• Feeling overly happy or outgoing
• Having an irritable mood
• Feeling wired
• Talking fast
• Difficulty sleeping
• Acting impulsively
• Having problems concentrating
• Changes in eating
• Thoughts of death or suicide

Women with bipolar disorder are more likely to have depressive symptoms and rapid cycling, in which four or more episodes of mania or depression occur in a year.

Women also experience frequent fluctuations in hormones throughout their life—during their menstrual cycle, pregnancy, and menopause. This change in hormones can affect the severity of bipolar symptoms.

Treatment

Antidepressants and mood stabilizers are common treatments for bipolar disorder but, for women, one of the side effects is weight gain. You may gain weight on these medications because of how your body processes it or because the medication increases your appetite.

Other Health Conditions

Women are more likely to have other health conditions, along with bipolar disorder. This may include:

• Problems with alcohol use
• Thyroid disease
• Obesity (caused by bipolar medications)
• Migraine headaches

Does Bipolar Disorder Treatment Affect Pregnancy?

Bipolar disorder is mainly treated through medication, but those drugs have been linked to birth defects and complications. For example, the Food and Drug Administration (FDA) has warned that taking Valproate during pregnancy could impair children's cognitive development and cause birth defects of the brain, spine, or spinal cord.

On the other hand, not treating bipolar disorder could be harmful both to you and your unborn child. Researchers found that the risk of bipolar disorder relapse was much higher for people who stopped taking their medication during pregnancy. Depending on your symptoms, an untreated disorder can prevent you from taking care of yourself or your child.

Healthcare providers may recommend staying on mood stabilizers throughout your pregnancy, especially if you have severe bipolar I disorder. Their goal is to keep patients stable and well while choosing the safest medication for the developing fetus.

If you have milder symptoms, you may be able to stop medication for your first trimester or the whole pregnancy. Ask your healthcare provider about the best options for your health and your child's.

Can Bipolar Disorder Be Misdiagnosed?

People may confuse the symptoms of bipolar disorder with those of premenstrual dysphoric disorder. Premenstrual dysphoric disorder (PMDD) is a condition when people have extreme emotional and physical changes before their period.

The following are symptoms of both bipolar disorder and PMDD:

• Anger
  
• Becoming distracted easily
• Difficulty sleeping
• Feelings of sadness
• Irritability
• Loss of interest in daily activities
• Mood swings
  
• Tiredness

Changes in the levels of hormones, like estrogen, could affect bipolar disorder symptoms. Researchers found that people with bipolar disorder and PMDD were more likely to have worse and more frequent symptoms.

Since both disorders share similar symptoms, it is possible that people who experience these symptoms may be misdiagnosed for one or the other. People can also have both PMDD and bipolar disorder as well.

If you think you have PMS, PMDD, or bipolar disorder, start keeping a daily calendar of symptoms and mark which days you have your period. This can help you determine whether symptoms occur around the time of your period or if they also occur at other times of the month.

A Quick Review

Bipolar disorder may look differently for women. Women may experience more depressive symptoms and rapid cycling. Since they often experience a change in hormones, this fluctuation can also affect the severity of their symptoms.

Since bipolar disorder shares similar symptoms to PMDD, it is possible that someone may be misdiagnosed for one or the other. If you are having symptoms of bipolar disorder or PMDD, talk to a healthcare provider so they can help determine the cause of your symptoms.