premenstrual exacerbation and bipolarFebruary’s online edition of The American Journal of Psychiatry contains an article entitled “Longitudinal Follow-Up of Bipolar Disorder in Women with Premenstrual Exacerbation: Findings from STEP-BD,” by Dr. Rodrigo Dias and colleagues. The objective of their research was to shed light upon “the impact of hormonal fluctuation during the menstrual cycle on the course of bipolar disorder,” frequency of relapse, and severity of symptoms.

The study followed 293 pre-menopausal-age women with bipolar disorder for one entire year as part of the Systematic Treatment Enhancement Program for Bipolar Disorder, commonly known as STEP-BD, and compared mood episode frequency and severity between 191 (65.2%) of the participants with premenstrual exacerbation (significant mood changes around their menstrual cycle) and 102 without.

The study examined the baseline hormone/mood relationship during each woman’s regular monthly cycle and whether that relationship could be related to the severity of her mood disorder.

Through the study, researchers concluded that women with premenstrual exacerbation tend to have

  • a worse course of illness,
  • more frequent mood episodes, and
  • more severe mood symptoms

than women without premenstrual exacerbation. The authors suggest that premenstrual mood symptoms may be some type of marker for a more severe subtype of bipolar disorder in women of reproductive age.

Hormones are mood modulators. We know that periods of rapidly changing hormones, such as the onset of puberty and childbirth/post-partum periods, are associated with higher risks of mood episodes. But the study doesn’t claim that hormones cause more severe mood disorder or that these women have any more severe hormonal shifts. It simply suggests a relationship between pre-menstrual mood changes and more severe and frequent mood symptoms of bipolar disorder.

While the outcomes are not specifically helpful in terms of treating bipolar disorder in any individual, it reinforces the concept that carefully monitoring mood cycles over time and connecting them to other life patterns, including sleep, menstrual cycle, and physical health, can help identify patterns that may be very valuable in terms of managing bipolar disorder.

Photo by Anna Hirsch, available under a Creative Commons attribution license.



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    Last reviewed: 1 Mar 2011

APA Reference
Fink, C. (2011). Premenstrual Exacerbation May Be Linked to More Severe Form of Bipolar Disorder. Psych Central. Retrieved on March 3, 2015, from


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Candida Fink, M.D. and Joe Kraynak are authors of
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