Menopause and Bipolar Disorder

Menopause and Bipolar Disorder

 

Fluctuating hormones during menopause can worsen bipolar symptoms.

A woman with bipolar disorder may experience a double whammy during a

 profound time in life — menopause

The Estrogen Effect

“Unfortunately, menopause can exacerbate bipolar disorder,” says Ahsan Y

Khan, MD, professor in the department of psychiatry and behavioral

sciences at the University of Kansas School of Medicine-Wichita and director

 of Via Christi Psychiatric Outpatient Clinicalso in Wichita. “You can

irritable and dysphoric [anxious] at the same time. And then here come

hormones into play. They compound the problem.”
Although doctors don’t completely understand the complex biochemistry

behind the reaction,  clinical research consistently suggests that a

significant number of women with bipolar disorder are more sensitive to

hormonal shifts during menopause and the powerful changes

going on in the body. At menopause in particular, they report more

depressive episodes  than women without bipolar disorder, at least partly

 because of a normal menopausal decrease in the powerful hormone

estrogen.
The connection between estrogen and mood disorder is not completelyclear.

What researchers do know is:

High levels of estrogen tend to have a “brightening effect” on mood, while

 low levels promote a dampening of mood.

Estrogen will decrease during menopause and the five- to 10-year period

before menopause, known as perimenopause.

A drop in estrogen can have particular consequences for the bipolar patient,

 doubling susceptibility to depressive episodes.

 

Not Everyone Gets an Increase in Symptoms;
Does this mean all women with bipolar disorder will experience a return of

depression an complications of mood as estrogen levels decrease during

menopause? Not necessarily.

While psychiatrists consistently field an increase in depressive reports

 during their bipolar patients’ menopausal years, research suggests that a

 high percentage of, but not all, women experience an escalation of 

depressive symptoms during menopause.

By the time you’re in your mid-30s, your doctor should begin checking your

 hormone levels to make sure menopausal hormone fluctuations are not

 overlooked as a contributing factor to your mood issues.

“If there is a worsening of symptoms without any other change in life, I

would ask my patient if they are going through menopause,” says Dr. Khan.

 “I would ask them to contact their primary care doctor to look at hormone

levels.”

Khan recalls the case of a 51-year-old bipolar patient who was being

unsuccessfully treated for a sudden increase in mood symptoms. It wasn’t 

 until her doctors measured her hormone levels that they realized she was in

 menopause. As soon as she started on hormone replacement, her symptoms

dramatically decreased, says Khan.

 

Options for Treatment;

If your doctor finds a hormonal imbalance, he or she may suggest one or

 both of these options:

 

Hormone replacement therapy (HRT).
If your symptoms don’t improve after adjusting the dosage of or otherwise

 make changes in the current regimen of bipolar medications, HRT might be

 beneficial. However, HRT must be considered carefully because it increases

the risk of heart disease, stroke, and blood clots.

Some women are advised against HRT because of existing health conditions

 that may be  worsened by it.

 

Talk therapy.
Speaking with a qualified therapist may help. Some women may need or want

 to talk about pessimistic thoughts, about their life, and about the fact that

they can no longer bear children, says Khan. Sometimes the problem gets

 worse with treatment before it gets better.

Synthetic estrogen, for example, has been known to increase stimulation and

 anxiety in some women — exactly what you don’t want. A lower dose

 or  another hormone combination might work better. This may take time

 and patience to discover.

Indeed, just as there is no one way to combat bipolar disorder and just as it

takes time to find the right combination of medications, so it is for managing

 your menopausal symptoms. Your care team is there to help.