Before and during my menstrual periods, I experienced symptoms of depression and irritability. I was instructed to take a slightly stronger dose of my medication during this time of month.
A foreshadowing of my future diagnosis? Perhaps.
A reason to make PMS jokes and references? Unfortunately, always.
According to a Psychiatric Times report, it’s more than just opinion. In a retrospective study of 2,524 women, 65.1% of women with bipolar I and 70.5% of bipolar II reported increased premenstrual mood symptoms.
The contrast? Only about 34% of women without bipolar disorder experienced increased premenstrual mood symptoms.
In women with bipolar disorder, hormonal changes associated with the menstrual cycle can complicate treatment.
Not only is mood affected, but the effectiveness of medication may be as well.
Effects on Medication
Laura Miller, MD, a professor at Harvard Medical School, said there have been case reports of dramatic changes in lithium’s potency across the menstrual cycle. She witnessed this in one of her patients that was vigilant in taking her medication.
The woman reported mild psychotic symptoms and mania several days prior to menstruation, so Miller investigated the woman’s lithium levels through a blood test.
Her lithium level was 0.6 before menstruation, and 1.1 afterward, further demonstrating the menstrual cycle’s impact on medication and treatment.
Many women also report menstrual cycle irregularities. While many women can predict their periods like clockwork, the timeframe may be a little hazier for women with bipolar disorder.
The reasoning for this could be, in part, to medications, although it is not completely clear. Miller suggests chatting with your doctor prior to starting a new medication to get a baseline status.
Long Term Effects on Mood
According to Medical News Today, a study of nearly 300 women with bipolar disorder showed that those reporting an increase in mood symptoms before menstruation had more depressive episodes and more severe symptoms during the following year, compared with women without the increase in mood symptoms.
This study was conducted by Rodrigo Dias, MD, and his colleagues at Boston’s Massachusetts General Hospital. The study results give evidence that premenstrual mood exacerbation may be reliable clinical marker in predicting a worse presentation and course of BP in reproductive-age women.
Women with premenstrual exacerbation symptoms were no more likely to be rapid cycling; however, they showed shorter gaps between symptom periods.
New considerations continue. With new birth control medications like the Depo Provera shot, some women do not get their menstrual period.
It seems as if working with one’s doctor to identify treatment during the different stages of the menstrual cycle are complicated by new methods as this; however, they are extremely effective and convenient.
Do you experience mood symptoms before or during your menstrual period? Do you think they are more intense than a friend’s PMS symptoms (sans bipolar?) Be sure to comment if you have bipolar disorder and you are not particularly affected before or during your period, either.
Have you talked with your psychiatrist, OB-GYN, or general practitioner about your menstrual cycle? What have your experts suggested? What have you found works for you?
Duerr, H. A. (2012, November 09). Treatment issues for bipolar disorder in women. Retrieved from http://www.psychiatrictimes.com/bipolar-disorder/treatment-issues-bipolar-disorder-women
Medical News Today. (2011, February 16). Study: premenstrual mood changes predictive of greater bipolar disorder severity. Retrieved from http://www.medicalnewstoday.com/articles/216545.php
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Last reviewed: 11 Oct 2013