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As a woman menstrual cycle and PMS are things we women do not like speaking about. For me its my least favorite topic. From cramps, mood swings, sugary cravings among other symptoms. When that dreadful week is over everything is back to normal. However, this is not so for women who have bipolar disorder, the menstrual cycle can make their bipolar disorder symptoms worse. Below I have outlined possible reasons why this is so.
Bipolar disorder is considered a mood spectrum disorder, a condition that shifts moods from on extreme to the other. Hormone levels may also cause rapid or extreme mood changes. This is very important especially for women who have been diagnosed with bipolar disorder as unbalanced hormones can trigger a bipolar episode.
Why does PMS make Bipolar Disorder Worst?
For some women bipolar disorder symptoms seem to get worse around their period. I thought it would be important to include it here in my blog. Recently, someone asked me “Why does my bipolar symptoms seem to get worse around my period”? The answer is possibly fluctuating hormones which are very common around a woman’s menstrual cycle.
Research on the issue has indicated that Estrogen and progesterone are female hormones that regulate the menstrual cycle and likely serve an important role in the regulation of mood. Premenstrual Syndrome (PMS) which affects 75% of healthy women is a cyclic pattern of mild dysphoria and physical discomfort that begin 1-2 weeks pre-menses, and resolve by 2-3 days post-onset of menses.
Up to 66% of women with bipolar disorder (BD) describe premenstrual mood changes that range from mild symptoms to severe worsening that require hospitalization. Therefore, the hormonal shifts of the menstrual cycle likely influence bipolar symptoms, but confirmatory research is lacking.
Increased symptoms around the menstrual cycle
Women with bipolar disorder experience:
- More episodes related to their bipolar disorder, most commonly depressive episodes
- less time between episodes
- More severe symptoms (including depressive, manic and hypomanic episodes)
Women who have premenstrual symptoms which exacerbate their symptoms of bipolar disorder have a worse course of illness, a shorter time to relapse, and more severe bipolar symptoms. In a retrospective study of 2,524 women, 65.1% of women with bipolar I and 70.5% of bipolar II reported increased premenstrual mood symptoms. Not only is mood affected, but also the effectiveness of medication.
Effects on Medication
Laura Miller, MD, a professor at Harvard Medical School, said there have been case reports of dramatic changes in lithium’s potency across the menstrual cycle. She witnessed this in one of her patients that was vigilant in taking her medication. The woman reported mild psychotic symptoms and mania several days prior to menstruation. Miller investigated the woman’s lithium levels through a blood test. Her lithium level was 0.6 before menstruation, and 1.1 afterward, further demonstrating the menstrual cycle’s impact on medication and treatment.
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