Signs of Bipolar Disorder in Women: Warning Signs and What to Know
Key Takeaways (TL;DR):
Bipolar disorder can look different in women than in men. This is due to different life experiences (like pregnancy and menopause). Social expectations can also play a role. Common signs of bipolar disorder in women include intense mood swings, marked by periods of intense highs or mania (or hypomania) and depression. Women also experience disrupted sleep, anxiety, and changes in self-esteem.
Bipolar disorder is often misdiagnosed or underdiagnosed in women. That’s because the symptoms can overlap with other mental health conditions like depression, as well as physical health conditions like PMDD.
Understanding Bipolar Disorder in Women
Bipolar disorder involves big changes in mood, energy, and activity levels. A person with bipolar disorder experiences manic or hypomanic episodes. These are periods of elevated mood that are marked by increased activity, rapid speech, and a decreased need for sleep.
Manic episodes typically alternate with periods of depression, although depressive episodes are not required for a diagnosis of bipolar 1. Depressive episodes are characterized by hopelessness, sadness, and a lack of energy.
There are three main types of bipolar disorder, including:
Bipolar I Disorder: This type is characterized by manic episodes (which are more severe than hypomanic episodes). They may or may not be followed by depressive episodes.
Bipolar II Disorder: Involves hypomanic episodes (less intense than mania) and more frequent depressive episodes.
Cyclothymic Disorder: A milder form of bipolar disorder that doesn’t meet full criteria for manic or depressive episodes.
Why Is Bipolar Disorder Misdiagnosed in Women?
Women with bipolar disorder are more likely to be misdiagnosed with major depression, leading to treatment delays, sometimes for years. The most common reasons include:
Gendered expectations: Emotional changes may be dismissed as drama, stress, or hormones.
Overlap with other conditions. The symptoms of bipolar disorder overlap with depression, anxiety, and hormonal mood changes (PMDD). This can make it difficult to diagnose.
Hypomania is overlooked: In Bipolar II, the “high” phases may not be severe enough to trigger clinical attention. The person may appear to be “high functioning.”
Bipolar disorder is treatable with therapy, medication, and lifestyle support—but the treatment is significantly different from unipolar depression. For example, selective serotonin reuptake inhibitors (SSRIs) are a mainstay medication for depression. But these medications can trigger mania in people with bipolar disorder. This is why the correct diagnosis is important.
What Are the Signs of Bipolar Disorder in Women?
Every woman’s experience with bipolar disorder is unique. However, there are some common patterns:
1. Intense Mood Swings
In women, bipolar disorder mood swings may seem to be connected to hormonal cycles, such as during the premenstrual period or perimenopause.
However, bipolar mood changes often:
Last for weeks (rather than hours or days)
Occur even outside hormonal cycles
Are very severe
Significantly interfere with relationships, work, and life
2. Periods of High Energy or Irritability
During manic or hypomanic phases, women might:
Experience more irritability than normal.
Sleep much less than usual.
Take on multiple projects at once.
Feel unusually confident or “on top of the world.”
Make impulsive decisions like spending a lot of money.
Talk more than normal or feel like their thoughts are racing.
3. Deep Depressive Episodes
According to research in the American Journal of Psychiatry, depression is often more prominent in women with bipolar disorder than mania. This is why depression is often diagnosed in women instead of bipolar disorder. Signs of bipolar depression include:
Persistent hopelessness, sadness, or emptiness.
Difficulty concentrating or focusing.
Weight or appetite changes.
Withdrawal from friends or activities.
Feelings of worthlessness or guilt.
Feeling physically drained or fatigued often.
Oversleeping or sleeping much more than usual.
Physical symptoms that aren’t due to a medical condition.
4. Sleep Changes
Sleep disturbances are one of the core bipolar disorder symptoms. That’s because bipolar disorder is linked to disruptions in the body’s circadian rhythm, which regulates our internal “biological clock.”
During mania: A person may need much less sleep than normal (like one or two hours a night), but still feels energized. This isn’t just insomnia. In bipolar disorder, the body doesn’t register fatigue correctly.
During depression: Oversleeping, insomnia, and restless nights are common. Even if a person gets 12+ hours of sleep, they may still feel tired the next day.
Because sleep changes are so closely tied to bipolar disorder, tracking sleep is very helpful for monitoring symptoms.
5. Hormonal Triggers and Life Stages
Hormones don’t cause bipolar disorder, but they can amplify symptoms and even increase the risk of developing bipolar disorder. Many women notice mood changes intensify during:
Pregnancy or postpartum: Pregnancy and the postpartum period are especially high-risk times for women with bipolar disorder. Women are much more likely to experience mania and/or psychosis during these periods.
Perimenopause or menopause: Recent research has found that perimenopause can be a trigger for first-onset bipolar disorder. There is a significant increase in new diagnoses during this time. Bipolar disorder symptoms can also worsen during this time for women already diagnosed.
Menstrual cycles: Many women find that bipolar symptoms increase during the premenstrual phase. Sometimes these can look like premenstrual dysphoric disorder (PMDD), a severe form of PMS.
6. Irritability and Emotional Reactivity
Many women experience moodiness and emotional reactivity with bipolar mania and hypomania, rather than the stereotypical “highs.” This can cause bipolar disorder to be mislabeled as
Not all mania looks like euphoria. In women, irritability, agitation, or emotional outbursts can be more common than stereotypical “highs.” This can lead to mood episodes being brushed off as simply being “overly dramatic.”
When to Seek Professional Help
Wondering if you have bipolar? If you or someone you love has symptoms of bipolar disorder, it’s important to seek help — especially if these interfere with relationships or work.
A mental health professional can perform a thorough evaluation, which can help clarify what’s going on and lead to effective treatment.
FAQs: Bipolar Disorder in Women
1. Is bipolar disorder more common in women?
No, according to the World Health Organization (WHO), bipolar disorder occurs equally in men and women.
2. Can bipolar disorder start later in life for women?
Yes. The symptoms of bipolar disorder most often start in the late teen years to early twenties. However, for women, symptoms may emerge during postpartum or perimenopause due to hormone shifts.
3. What’s the difference between PMS/PMDD and bipolar disorder?
PMS and PMDD symptoms are usually tied to the menstrual cycle (luteal phase) and resolve with menstruation. Bipolar episodes, however, last longer and aren’t confined to specific cycle days. They occur anytime during the cycle.
4. Are women more likely to have a certain type of bipolar disorder?
Yes, women are more often diagnosed with Bipolar II. In clinical samples, women are much more likely to be diagnosed with bipolar II compared to men.
Final Thoughts
Recognizing the signs of bipolar disorder in women is important. It can lead to earlier treatment, which can lead to better outcomes. If you notice the signs above, reach out to a licensed therapist or psychiatrist.
References
Dell’Osso, B. et al. (2021). Has Bipolar Disorder Become a Predominantly Female Gender-Related Condition? Analysis of Recently Published Large Sample Studies. International Journal of Bipolar Disorders.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
Oliva, V., Prisco, M. D., Spina, E. L., Paolucci, S., Fico, G., Anmella, G., Hidalgo-Mazzei, D., Murru, A., Pompili, M., Fornaro, M., Solmi, M., Yildiz, A., Leucht, S., Vieta, E., & Joaquim Radua. (2025). Switch to mania after acute antidepressant treatment for bipolar depression: a systematic review and network meta-analysis of randomised controlled trials. EClinicalMedicine, 87, 103413–103413.
Altshuler, L. L., Kupka, R. W., Hellemann, G., Frye, M. A., Sugar, C. A., McElroy, S. L., Nolen, W. A., Grunze, H., Leverich, G. S., Keck, P. E., Zermeno, M., Post, R. M., & Suppes, T. (2010). Gender and Depressive Symptoms in 711 Patients With Bipolar Disorder Evaluated Prospectively in the Stanley Foundation Bipolar Treatment Outcome Network. American Journal of Psychiatry, 167(6), 708–715.
Yan, X., Xu, P., & Sun, X. (2023). Circadian rhythm disruptions: A possible link of bipolar disorder and endocrine comorbidities. Frontiers in Psychiatry, 13.
Shitomi-Jones, L. M., Dolman, C., Jones, I., Kirov, G., Escott-Price, V., Legge, S. E., & Arianna Di Florio. (2024). Exploration of first onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause. Nature Mental Health.
Musial, N., Ali, Z., Grbevski, J., Veerakumar, A., & Sharma, P. (2021). Perimenopause and First-Onset Mood Disorders: A Closer Look. FOCUS, 19(3), 330–337.
World Health Organization. (2024, July 8). Bipolar disorder. Who.int; World Health Organization: WHO.
Parial, S. (2015). Bipolar disorder in women. Indian Journal of Psychiatry, 57(Suppl 2), S252–S263.
