Bipolar Disorder: The Impact on Women

Woman in therapy

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The course of bipolar disorder differs between men and women. Women experience more depressive mixed or rapid cycling, so that means their manic episodes tend to be less severe and their depressive episodes are longer. Stress brings on episodes, and during these pandemic times, women are more likely to be less stable.

Patients with severe mental illness may be among the most vulnerable populations affected by the COVID-19 pandemic.² Among other factors that disproportionately disadvantage patients with severe mental illness are stigmatization,³ less provision of physical health care, low household income, worse lifestyle factors, residential instability, and small social networks.² Sanctions, such as lockdown, no-contact provision, and quarantine, may further increase stress/mental illness in this population.”¹ Studies show that women with bipolar disorder are also more likely to be at risk of substance abuse, thyroid disorder, medication-induced weight gain, diabetes, and suicidal tendencies. Women also tend to have their first episodes of bipolar disorder at an older age than men: 27 versus 22 years of age.

Studies have shown that the female hormonal cycle can also impact bipolar disorder symptoms. It seems that women who have very bad PMS are more likely to have exacerbations of their bipolar disorder symptoms. Also, women who have very bad PMS and develop premenstrual dysphoric disorder are at higher risk of ultimately developing bipolar disorder.

Pregnancy can also cause complications. Many bipolar disorder treatments, such as Lithium or Depakote, are very teratogenic and could cause developmental issues for the fetus during pregnancy. There are really no safe medications to be used during pregnancy, meaning women often have to come off their medication. There are some medications that are safer, such as some of the older antipsychotic medications such as Haldol or Risperdal, but none are without risk entirely.

While many women can do well during their pregnancy, bipolar disorder patients can struggle during postpartum, as they are increasingly susceptible to postpartum depression that can be very severe and unmanageable. This is why you must think very long and hard about whether it makes sense to have a baby if you have serious bipolar disorder, both due to concerns of coming off medication, and having a serious relapse of your symptoms during or after pregnancy.

Another concern is that bipolar disorder is highly inheritable. If one parent has it, such as a mother, there's a 15 to 30% chance they will give it to their child (about 25% of the time). If both parents have it, the risk goes up to 50% and presents serious ethical concerns about whether it makes sense to have a child if you have a serious bipolar illness (versus adoption or other ways of having a child). I talk about this more in this interview. I highly recommend any patient of childbearing years who is taking serious bipolar medication consider the use of IUDs to prevent pregnancy and to consider alternative options for pregnancy, such as egg donation or adoption.

It is really important to focus on sleep because sleep is a huge predictor of issues. I really like using the Oura Ring to monitor sleep and have even asked patients to send me the data in order to monitor and track their sleep patterns. Sleep patterns often shift before a new episode develops, so this allows me as a practitioner to have the time to adjust the medication to prevent a full-blown episode.

However, many women can live happy and healthy lives with bipolar disorder if they are in close contact with their treatment provider and take their medications seriously to prevent relapse. Developing good sleeping habits, following up with your medical practitioner, taking your medication on time, following up with your medical check-ups, and doing regular lab work are all ways you can help keep bipolar disorder in check and allow you to be a strong independent woman.