From the Research
Perimenopause can worsen or trigger bipolar disorder symptoms due to hormonal fluctuations that affect mood regulation, and management typically involves close monitoring of mood changes, adjustment of existing mood stabilizers, and sometimes the addition of hormone therapy when appropriate. During perimenopause, estrogen and progesterone levels fluctuate significantly before eventually declining, which can disrupt neurotransmitter systems involved in mood regulation, particularly serotonin and dopamine 1. Women with existing bipolar disorder often experience more frequent mood episodes, increased cycling between states, and greater symptom severity during this transitional phase. For some women without a previous diagnosis, perimenopause can unmask underlying bipolar vulnerability or trigger first-onset bipolar symptoms. Some key points to consider in the management of bipolar disorder during perimenopause include:
- Close monitoring of mood changes to distinguish between normal perimenopausal mood changes and true bipolar symptoms, which can be challenging as both conditions may present with irritability, sleep disturbances, and emotional lability 2
- Adjustment of existing mood stabilizers, such as lithium, valproate, or lamotrigine, to optimize treatment and prevent relapse 3
- Consideration of hormone therapy as an adjunctive treatment to help manage perimenopausal symptoms and stabilize mood 1
- Collaboration between psychiatric and gynecological providers to develop an integrated treatment approach that addresses both hormonal and mood stability needs 2
- Education and support for women experiencing perimenopausal mood changes, including tracking symptoms, maintaining regular sleep patterns, reducing stress, and seeking professional help when needed 1. The most recent and highest quality study on this topic is from 2023, which highlights the importance of personalized pharmacological combinations for the treatment of bipolar disorders, including the use of mood stabilizers such as lithium and valproic acid, and atypical antipsychotics 3.