Bipolar disorder may look different in women than in men. This mental health condition leads to intense and sudden mood shifts.

Women with bipolar disorder may experience episodes of mania, during which they feel highly motivated and active, and major depressive episodes, in which they lack the energy to continue with their usual routine.

Menstrual cycles, pregnancy, lactation, and menopause may make bipolar symptoms in women more difficult to identify. In the words of the late, great Tammy Wynette: “Sometimes, it’s hard to be a woman.” Bipolar disorder symptoms can make it even more so.

If you get a bipolar disorder diagnosis, you’ll likely need to manage your symptoms for the rest of your life. But the good news is that you can manage the condition, even though diagnosis and treatment both take time.

Here’s what to know.

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Bipolar symptoms in women can vary from person to person and differ from those typically seen in men.

Some symptoms are common in both women and men during episodes of mania or depression:

  • sad or hopeless feelings
  • irritability
  • an inability to feel pleasure or joy, even in things you used to enjoy
  • sleep problems
  • low energy
  • racing thoughts
  • memory problems
  • periods of high energy and activity

Women are more likely to experience more depressive episodes of mania and rapid cycling than men. Rapid cycling won’t win you the Tour de France — it’s when you have four or more depressive episodes within a year.

Some symptoms are more prevalent in women, including:

  • hypomania: a shorter-lived and milder version of mania
  • mixed mania: having symptoms of depression and mania together

Bipolar disorder used to be called “manic depression” because of the intense mood shifts from low depressive states to the extreme highs of mania.

The condition typically starts in early adulthood, with an average onset age of 21. But women often develop it in their late 40s, meaning they may dismiss their symptoms as signs of perimenopause.

Studies suggest that around 5 percent of the population lives with bipolar disorder.

The bipolar I subtype presents equally in men and women, but women are more likely to have bipolar II. Clinical depression, mixed episodes of depression and hypomania, and standalone hypomania define this subtype.

Women with bipolar II often experience rapid cycling.

Because bipolar disorder may appear differently in women, doctors may find it tough to pinpoint, especially during pregnancy and lactation.

Bipolar disorder symptoms often show up later in life for women than for men and appear amid more mixed episodes. Women are also more likely to have other health issues in addition to bipolar disorder, including:

Even though men with bipolar disorder are more likely to misuse alcohol than women, women with the condition may be more likely to have a genetic risk of alcohol use disorder.

Women with bipolar disorder also have an increased rate of eating disorders in their lifetime. In men, substance use disorders are more common.

Depression is a defining feature of bipolar disorder. Depression can make you feel low and often irritable and hopeless. You may feel like you could cry at any moment. You may lose interest in the things you love and lose the desire to take care of yourself.

Women with bipolar disorder are more likely than men to have depressive episodes.

In fact, young women are more than twice as likely as their male counterparts to have depressive symptoms, meaning that doctors may misdiagnose the signs of bipolar disorder as depression.

Bipolar disorder is often different for women than for men. Both women who have bipolar disorder and healthcare professionals may find it hard to recognize the symptoms, often mistaking them for the monthly blues, depression, or perimenopausal symptoms.

If you’re a woman with bipolar disorder, you may notice seasonal changes to your symptoms. You may have bouts of depression that lead to weight gain and feelings of guilt.

Sleep disturbances are also common. You may wake up much earlier than usual or sleep much more than usual but feel extremely tired all the time.

You may feel guilty for no reason, have trouble concentrating and remembering things, or feel like going about daily life is just too difficult. Women with bipolar disorder often experience depression before mania.

Symptoms of mixed mania

Women who have bipolar disorder may also experience mixed mania, in which symptoms of mania and depression happen together. Symptoms can include:

Women, bipolar disorder, and suicide

Research suggests people with bipolar disorder are likely to have a lower-than-average life expectancy, often due to suicide. The rate of suicide among people with bipolar disorder is 10 to 30 times higher than that of people without the condition.

Up to 20 percent of people with bipolar disorder die by suicide, although this occurs mostly in people who have never received treatment.

A 2014 study noted that in men with bipolar disorder, substance use increased the risk of suicide. In women with the condition, suicide was more likely in those who had:

  • early-onset psychiatric problems
  • personality disorders and social problems
  • a pattern of mixed episodes of depression and mania for many years

Fluctuation of hormones during your regular monthly cycle or during pregnancy or menopause can trigger the onset of bipolar disorder or a relapse of symptoms.

Postpartum episodes

For many women with bipolar disorder, the arrival of a new baby may trigger a return of symptoms. You may have an increased risk of new mental health issues, hospital admissions, and psychiatric care in the 3 months after labor and childbirth.

If you’re experiencing “the baby blues,” it’s essential to talk with your doctor and seek treatment.

It’s important to get a diagnosis and appropriate treatment as soon as possible. If left untreated, your “baby blues” could progress to bipolar episodes of hypomania, mania, or rapid cycling and become difficult to treat. This can place both you and your baby at risk.

There hasn’t been much research in this area, but one 2006 study found a significant link between childbirth and severe mental disorders in women. The researchers didn’t see the same association in new dads.

It’s still not clear why birth triggers bipolar disorder in some women. It could be because of hormones, changes in routine, or something else altogether.

Menstruation

As if your menstrual cycle making you feel sh*tty isn’t enough, if you’re living with bipolar disorder, your symptoms of depression, hypomania, and mania may get worse right before your period.

Researchers in one study found that up to 68 percent of women with bipolar disorder had premenstrual-related mood changes. They also had more bipolar disorder-related mood changes, less time between relapses, and more severe symptoms.

You may confuse bipolar disorder symptoms with the irritability and emotional roller coaster of premenstrual syndrome (PMS) or its more severe cousin, premenstrual dysphoric disorder (PMDD). It’s understandable, since the symptoms seem to overlap.

Track your symptoms over a few months to see if PMS or PMDD is making your bipolar disorder symptoms worse. This is the only way to know, since there are no blood or hormonal tests to get you these answers.

If you think your cycle is playing a part in your bipolar disorder symptoms, your doctor can suggest treatments and lifestyle changes to help.

Health professionals usually treat bipolar symptoms in women with a combination of medications, psychotherapy, and lifestyle changes. You may find that you receive different treatment than men with the condition, even if you have the same symptoms.

In a 2015 study of more than 7,000 people with a bipolar disorder diagnosis in Sweden, researchers found significant differences in how doctors routinely treated women and men.

The women in the study received medications, including antidepressants, benzodiazepines, and lamotrigine, and therapies like electroconvulsive therapy and psychotherapy more often than men. In contrast, doctors prescribed lithium to men more frequently than to women.

The authors couldn’t find any substantial reason for this — only bias.

Pregnancy risks of medications

Episodes of mania or depression happen in 25 to 30 percent of women with bipolar disorder during pregnancy.

Treating bipolar disorder during pregnancy can be tricky. It’s a balancing act between protecting your mental health and reducing any risk to your unborn baby.

Mood stabilizers like lithium and sodium valproate may cause fetal development issues. There’s a lot of controversy around sodium valproate, and it’s banned in the U.K. for any women who aren’t participating in a pregnancy prevention program.

If you’re thinking of trying to get pregnant and you have bipolar disorder, talk with your doctor to determine the best treatment for you.

Whatever you do, do not stop your meds suddenly without medical advice.

In a 2007 study of 89 pregnant women with bipolar disorder who stopped taking meds from 6 months before conception to 12 weeks after, the risk of symptoms coming back during pregnancy was 71 percent. Which is, ya know, a big percentage.

Menstruation

Lithium is a medication doctors use to treat bipolar disorder and epilepsy. Some studies have shown that in women with bipolar disorder who are taking lithium, the hormone cycle affects the levels of lithium that circulate in their blood.

Lithium may be slightly less effective at controlling symptoms during your menstrual cycle.

Bipolar disorder symptoms in females and males may look different. Women are more likely to have depressive episodes, and doctors often misdiagnose bipolar disorder as depression.

Women are also more likely to experience other physical and mental health issues, rapid cycling, and mixed mania symptoms.

Hormonal fluctuations during the menstrual cycle and pregnancy can affect bipolar disorder symptoms and treatments.

If you think you’re experiencing symptoms of bipolar disorder, it’s a good idea to keep a diary that tracks how your hormonal cycle affects how you feel.

Armed with this information, you can talk with your doctor to rule out any potential health issues. They can also refer you to a mental health professional for further evaluation and a treatment plan.