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
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
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.
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.