What If Your Perimenopause Symptoms Are Actually Bipolar Disorder?
The latest research shows that perimenopause may double the risk of mania and significantly worsen existing bipolar symptoms—yet many women’s symptoms are overlooked.
For me, the transition into menopause wasn’t just marked by irregular periods and hot flashes; it also came with brain fog, sleep disturbances, and mood changes. These things can be due to hormonal changes, so I (and my doctor) attributed them to perimenopause (at first).
But, over time, it became apparent that something else was going on when I ended up in the psychiatric hospital for the first time in my life.
The Connection Between Perimenopause and Mood
Perimenopause is the stage leading up to menopause. It typically occurs in the mid to late 40’s, but can occur much earlier. During this period, levels of key hormones, including estrogen and progesterone, begin to fluctuate. This can also impact key brain neurotransmitters, including dopamine, serotonin, and GABA. These neurotransmitters are closely linked to mood regulation.
So, for some women, especially those already living with bipolar disorder or genetically predisposed towards the disorder, these hormonal changes can significantly impact mood stability. But just how significant is this connection?
What Science Says
A large 2024 study published in Nature Mental Health that involved 128,000 women found the following:
The risk of first-onset mania increases by 112%. Women going through perimenopause had a 112% percent increased risk of experiencing mania compared to earlier years.
Depression risk also increased. Women going through perimenopause were 30% more likely to experience major depressive disorder (first onset).
Psychiatric diagnoses increased. The rate of new psychiatric conditions increased by 52 percent.
Another literature review in 2024 also found an increased risk of new-onset bipolar disorder during perimenopause. The studies also indicated that women already diagnosed with perimenopause tend to experience worsening bipolar symptoms during this period with more frequent:
Rapid cycling
Mixed sattes
Depressive episodes
Why This Is Important
This research is so important because it shows that there is a link between perimenopause and developing psychiatric disorders for the first time, especially bipolar disorder.
Symptoms like brain fog and difficulty sleeping may be chalked up to perimenopause by both doctors and the person experiencing the symptoms (they were for me). This can cause a delay in diagnosis or improper treatment, which can have disastrous consequences.
Signs to Watch For
Here are some things to watch out for during perimenopause that may signal that it’s more than hormones:
Frequent or severe mood swings
Increased energy levels
Significant sleep disturbances
Increased anxiety
Frequent irritability or sadness
Thriving Emotionally During the Transition
Here are some things you can do to help manage your mental health during the perimenopause transitions.
Track Your Symptoms: Use an app like eMoods to track mental health symptoms.
Explore Hormonal Options: Although hormone replacement therapy (HRT) won’t treat bipolar disorder or other psychiatric problems, it may help stabilize mood for some women. HRT is not right for everyone, so talk to your doctor about the risks and benefits.
Collaborate With Your Care Team: Let your OB/GYN, therapist, and psychiatrist know about your symptoms.
Prioritize Lifestyle Changes: Focus on things like movement, nutrition, and sleep hygiene.
Talk About It: Therapy can help you cope with mental heath symptoms during perimenopause.
Related: Managing Bipolar Disorder With a Daily Routine
What This All Means
Perimenopause isn’t just about hot flashes and night sweats. It can also significantly influence mental health. For some women, hormonal changes may trigger the first episode of mania. For others, who are already diagnosed, it may worsen symptoms. Understanding that there is a connection may lead to earlier and better treatment options.
