Welcome to the first blog in our series on reproductive health and bipolar disorder, in collaboration with the Women’s Health Research Institute (WHRI). In this series, we will be drawing from our World Bipolar Day “Ask Me Anything’ and WHRI members Dr. Catriona Hippman and Dr. Jehannine Austin to answer your pressing questions about reproductive health and bipolar disorder. To learn more about women’s health research in BC, check out WHRI.org.
Each year in our Reddit ‘Ask Me Anything’ events, we receive your questions about how menstrual cycles, hormone fluctuations, and irregular periods can impact mood disorder symptoms. In this series, we’ll be answering your top questions on bipolar disorder and reproductive health, in collaboration with the Women’s Health Research Institute. In this first blog, read about the impact of bipolar disorder on menstrual cycles, as well as reproductive menstrual disorders like polycystic ovarian syndrome (PCOS), and premenstrual dysphoric disorder (PMDD).
How do menstrual cycles impact bipolar disorder symptoms, if at all? Well, we’re not completely sure. This article, published in 2014, reviewed current research into menstrual cycles and bipolar disorder. They found that for some people with periods, mood disorder symptoms were related to their menstrual cycle, but not for everyone. For those with hormone sensitivity, most mood episodes involved hypomanic or manic episodes in the premenstrual phase. However, more research is needed to fully understand the impact of menstrual cycles on bipolar disorder symptoms.
In addition to menstrual cycles, we’ve had lots of questions about menstrual reproductive disorders and bipolar disorder. We’ve compiled answers from our AMA’s and asked Drs. Catriona Hippman and Jehannine Austin to answer your questions here.
What do we know about the relationship between bipolar disorder and premenstrual syndrome (PMS)?
Premenstrual syndrome (PMS) refers to a wide array of symptoms that occur in the week before a person’s period such as agitation, sadness, and heightened emotional states. PMS is common – most people with periods will experience it at some point in their lifetime. Premenstrual dysphoric disorder (PMDD) is similar, but is much more severe than PMS, and is chronic, requiring lifestyle changes and/or medication.
As Dr. Catriona Hippman highlighted in our 2021 AMA, it’s true that research has historically been based on male presentations. However, this is starting to change with major funding bodies now recognizing the importance of including diverse people in health research.
With this, research into PMDD and bipolar disorder is starting to increase, but there still remains a lot of unknowns. There is some research into PMDD and bipolar disorder that indicates the following:
- PMDD can exacerbate bipolar disorder,
- PMDD can lead to an earlier age of onset for bipolar disorder, and
- It is important to recognize the unique treatment needs of people with both PMDD and bipolar disorder. For example, in PMDD, the first line of treatment is antidepressants. However, for people with bipolar disorder, hormonal treatments can be effective for PMDD and clinicians should suggest trying this first.
What do we know about the relationship between polycystic ovarian syndrome and bipolar disorder?
Polycystic ovarian syndrome (PCOS) is a hormonal disorder, with symptoms including irregular periods, enlarged ovaries, and elevated levels of male hormones. The cause of PCOS is unknown.
Research has shown that having PCOS is a risk factor for developing bipolar disorder. While the reason for this association is unknown, this study indicates that treatment with metformin may reduce the likelihood of individuals with PCOS developing bipolar disorder.
What do we know about bipolar disorder and menopause?
Going through menopause can be a challenging transition for many people with periods, regardless of pre-existing conditions. For folks with bipolar disorder, speaking with your care team to discuss available options can be the first step in adjusting. Accessible treatments can include non-pharmacological treatments, hormone replacement therapy, and specific medications for mood and anxiety disorders.
Victoria Maxwell shared her experience going through menopause, and changing her coping tools in our 2022 AMA. “My usual coping tools weren’t working like they did in the past… So I worked with my psychiatrist to find either new amounts of my standard meds or try new ones… It took more time that I’d like to admit for me to come back to my solid baseline and out of the depression and anxiety. But I did. You can too. It’s important not to give up hope and work with a good health provider. If you’re not happy with what they are doing, keep advocating for yourself or get a buddy to help you advocate with you. It’s hard if you’re depressed to say what you need sometimes. I found depression whispered the lie, that it wasn’t worth the effort and that anything I did wouldn’t help anyway. But that’s depression talking, it’s not the truth. Tara Brach has a great saying: It’s real, but not true. That is depression is real, feels real, but what it tells you isn’t true. I wish you all the best.”
We hope this blog has been helpful in highlighting what we know about menstrual cycles, menstrual reproductive disorders, and bipolar disorder. Do you have more questions about reproductive health and bipolar disorder? Stay tuned for our next blog in collaboration with the WHRI, which will cover pregnancy, medication, and bipolar disorder.