Bipolar Disorder in Women: Know the Facts

The three main types of bipolar disorder are bipolar I, bipolar II, and cyclothymic disorder. Other types of bipolar can be related to substance or medication use, or to another medical condition.

Bipolar I disorder

Bipolar I diagnosis involves at least one manic or mixed episode lasting at least one week or that causes hospitalization. The episode may have come before or after a hypomanic or depressive episode. However, you can have bipolar I without having a depressive episode. Men and women develop bipolar I disorder in equal numbers.

Bipolar II disorder

Diagnosis of bipolar II disorder involves a current or past major depressive episode lasting for at least two weeks. The person must also have had a current or past episode of hypomania. Women may be more likely than men to develop bipolar II disorder.

Cyclothymic disorder

People with cyclothymic disorder may experience ongoing bipolar symptoms that don’t meet the full criteria for a bipolar I or bipolar II diagnosis. Cyclothymic disorder is considered a less severe form of bipolar disorder. It involves the frequent recurrence of hypomanic and depressive symptoms that never become severe enough to be diagnosed as having bipolar II disorder. These symptoms generally persist for a two-year period.

It’s important to understand the basic characteristics of bipolar disorder. This can help you better understand how bipolar disorder affects women. The key symptoms include:

• mania
• hypomania
• depression
• mixed mania

Mania

Mania is a state of elevated mood. During manic episodes, you may feel very high-spirited, energetic, and creative. You may also feel irritable. You may engage in high-risk behaviors, such as substance abuse or increased sexual activity. You may spend money foolishly, make bad investments with your money, or behave in other reckless ways.

Manic episodes can last for a week or longer. If you experience either visual or auditory hallucinations or delusions, these are referred to as “psychotic features.”

Hypomania

Hypomania is a less severe form of mania. During hypomanic episodes, you may feel elevated moods similar to those that occur with mania. These elevated moods are less intense than manic moods, though, and have less impact on your ability to function. Women are more likely to develop hypomania than men.

Depression

Depression is a state of extremely low mood. During depressive episodes, you may feel intense sadness with a significant loss of energy. These episodes last at least two weeks. Because of this, depressive episodes can cause severe impairment. Women are more likely to experience depressive symptoms than men.

Mixed mania

In addition to separate manic and depressive episodes, people with bipolar disorder may also experience mixed mania. This is also known as a mixed episode. With a mixed episode, you may experience both manic and depressive symptoms daily for a week or longer. Women are more likely to experience mixed episodes than men.

Rapid cycling

Bipolar episodes can also be characterized by how quickly the episodes alternate. Rapid cycling is a pattern of bipolar disorder that occurs when you have at least four manic or depressive episodes within one year. Rapid cycling is linked to increased rates of:

• depression
• suicide
• substance abuse
• anxiety
• hypothyroidism

Women are more likely to experience rapid cycling than men.

Several known risk factors can increase the likelihood of bipolar onset or relapse in both men and women. Those risk factors include:

• having a parent or sibling with bipolar disorder
• drug abuse
• alcohol abuse
• major life events, such as the loss of a loved one or exposure to a traumatic experience

Women with bipolar disorder are thought to be at an increased risk of onset or relapse due to hormone fluctuations. These fluctuations can be caused by:

• menstruation
• premenstrual syndrome and premenstrual dysphoric disorder
• pregnancy
• menopause

Women with bipolar disorder also have a greater likelihood of having certain other health problems along with bipolar. These problems can include:

• alcoholism
• eating disorders
• medication-induced obesity
• migraine headaches
• thyroid disease

Diagnosing bipolar disorder can be very difficult, as many of its symptoms also occur with other conditions. These conditions can include attention deficit hyperactivity disorder (ADHD). They can also include schizophrenia, especially if you have symptoms of psychosis. Diagnosis in women can also be complicated by reproductive hormones.

A diagnosis typically involves a physical exam. Your doctor will also assess your medical and family history. With your permission, your doctor may also speak with family members and close friends to gather information about any abnormal behaviors. Before confirming the diagnosis, your doctor must also rule out the effects of other medications or conditions.

There isn’t a known cure for bipolar disorder. The symptoms of the condition are highly treatable, though. Treatment is individualized based on your specific symptoms.

Medication

Medications are often used as initial treatment to get bipolar symptoms under control. The drugs used primarily for treatment of bipolar disorder include mood stabilizers, antipsychotics, and anticonvulsants.

While they can be helpful, these medications can cause side effects. These side effects may include:

• drowsiness
• nausea
• vomiting
• weight gain

If you have side effects from your medication, talk to your doctor about ways to reduce them. And be sure to follow your medication plan as directed by your doctor.

Psychotherapy

Psychotherapy, or talk therapy, is another treatment option. Talk therapy is used along with medication. It can help stabilize your mood, and help you adhere to your treatment plan. This form of therapy carries the least amount of risk, although talking about painful life experiences can cause emotional discomfort.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is an additional option for treating bipolar disorder. ECT involves the use of electrical stimulation to induce a seizure in the brain. ECT has been shown to be an effective treatment option for severe depression and manic episodes, although how and why it works is still unclear. The side effects that can be associated with ECT include:

• anxiety
• confusion
• headache
• permanent memory loss

Getting the care and support you need is key to managing bipolar disorder. Don’t be afraid to reach out to others, or to take extra good care of yourself.

Support options

The National Institute of Mental Health provides the following guidance if you, or someone you know, have symptoms of bipolar disorder:

• discuss treatment options with your doctor
• maintain a regular routine
• get adequate sleep
• stay on any medication that has been prescribed for your treatment
• learn about warning signs that may alert you of an impending bipolar episode
• expect gradual improvement in symptoms
• get support from family and friends
• talk with a doctor or therapist about what you may be feeling
• join a local or online support group

If you’re thinking about harming yourself or know someone who is, seek help immediately. You can do one or more of the following:

• call your doctor or therapist
• call 911 or go to an emergency room to receive immediate help
• call the toll-free, 24-hour National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255)
• if you have hearing or speech impairments, call via teletypewriter (TTY) at 800-799-4TTY (4889) to talk to a trained counselor

If possible, ask a friend or family member to help you.

Self-care

Proper self-care is an important part of managing this condition. If you’re a woman with bipolar disorder, you can practice healthy habits to better manage the disorder and improve your overall quality of life. These habits include eating nutritious foods, getting adequate rest, and reducing stress. Your doctor can tell you more.

While men and women can both experience bipolar disorder, the condition affects each differently. A big reason for this is the role of women’s reproductive hormones. Fortunately, with proper medical treatment and symptom management, women with bipolar disorder have a favorable outlook. And doctors continue to make strides in understanding bipolar disorder and its unique characteristics in women.