What If Your Perimenopause Symptoms Are Actually Bipolar Disorder?

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TL;DR

• The latest research shows that perimenopause may double the risk of mania.

• Perimenopause may also significantly worsen existing bipolar symptoms.

• 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. 

1. Track Your Symptoms: Use an app like eMoods to track mental health symptoms. 

2. 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.

3. Collaborate With Your Care Team: Let your OB/GYN, therapist, and psychiatrist know about your symptoms. 

4. Prioritize Lifestyle Changes: Focus on things like movement, nutrition, and sleep hygiene. 

5. Maintain a consistent daily routine: Changes in routine can trigger biopolar mood episodes. Therefore, try to stick to the same daily routine for things like bedtimes and meal times.

6. Talk About It: Therapy can help you cope with mental heath symptoms during perimenopause. 

When hormones are shifting and mental health feels harder to manage, even simple decisions like “What’s for dinner?” can feel overwhelming. Having quick, budget-friendly meals ready to go has helped me protect my routines and keep my energy for what actually matters.

Dinnerly can help reduce decision fatigue on the tough days

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. 

FAQS

Can perimenopause trigger bipolar disorder?

Studies have shown that there is an increased risk for first-onset mania during perimenopause.

Can you develop bipolar disorder in your 40s?

Yes, some people do develop bipolar disorder in their 40s, although this is not the common age of onset. Bipolar disorder typically shows up in the late teens to twenties

Can perimenopause cause psychosis?

Research has shown that perimenopause can be a trigger for psychosis.

Sources

1. Shitomi-Jones, L. M., Dolman, C., Jones, I., Kirov, G., Escott-Price, V., Legge, S. E., & Di Florio, A. (2024). Exploration of first onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause. Nature Mental Health, 2, 1161–1168. https://doi.org/10.1038/s44220-024-00292-4

2. Radosavljevic, J., Bengi, D., & Frey, B. N. (2024, September). P101. Bipolar disorder and perimenopause: A comprehensive update [Conference poster]. The 26th Annual Conference of the International Society for Bipolar Disorders. https://www.researchgate.net/publication/392011997_P101_Bipolar_disorder_and_perimenopause_A_comprehensive_update

3. Culbert, K. M., Thakkar, K. N., & Klump, K. L. (2022). Risk for midlife psychosis in women: critical gaps and opportunities in exploring perimenopause and ovarian hormones as mechanisms of risk. Psychological medicine, 52(9), 1612–1620. https://doi.org/10.1017/S0033291722001143