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Bipolar Disorder in Women Vol. 2: What I Wish I Knew Before

Ginger in the wind This is the second article in a series about bipolar women. As I discussed in the first article on hormones, pregnancy, and medication, this series will explore issues specific to females with bipolar.

The following information, taken from a National Institute of Health manuscript on women and  bipolar across the lifespan, was compiled to inform you about all of the things you might not have known.

Share this information with your friends. Being a woman with bipolar disorder is both unique and challenging. A part of understanding this illness is being armed with information.


Men vs. Women

In case you were wondering, bipolar I disorder affects men and women equally.  More women have bipolar II disorder than men.


Onset of Illness

Women also develop bipolar depression, mixed mania, and rapid cycling more commonly than men.

While the average onset for both sexes for bipolar disorder is 21 years of age, women are actually over-represented in later-onset illness (45-49 years).



Because women often have co-morbid or co-occurring conditions (see section “Co-morbid Conditions”), a complete assessment includes medical, psychiatric, alcohol/substance use, and family histories as well as inquiry about stressors and screening for unusual beliefs and risk of harm to self or others.


Medications and Treatment

Women face delays in treatment, up to 11 years from onset, because of failure to diagnose. This is compared with seven years on average for men.


  • If you’re considering lithium, renal, thyroid, and pregnancy status must be checked before starting.
  • Medication choices differ between women and men. Fat-soluble medications have a greater volume of distribution and longer half-life in women that lead to higher drug serum levels and prolonged clinical and adverse effects. Women may benefit from a lower initial dose, then customized according to side-effect tolerance and therapeutic effect.
  • Electroconvulsive therapy (ECT) remains an option for bipolar psychosis, treatment resistance, severe mixed episode, or pregnancy, to induce rapid mood stabilization.


Co-morbid Conditions

Women are at a greater risk of co-morbid conditions like alcohol abuse, thyroid disease, medication-induced obesity, and migraine headaches than men.

Pain disorders occur more in bipolar women, and hypothyroidism more in common with women than men in bipolar.


  • Medical issues of bipolar women may related to co-morbid psychiatric or medical illnesses, medication toxicity, side effects, or lifestyle factors.



Reported atypical symptoms for women include: Weight gain, hypersomnia, and extremely low energy .

Extrapyramidal side effects (tremor, rigidity, akathesia, bradykinesia, tardive dyskinesia, dystonia) remain elevated in women and the elderly (I happen to have some tardive dyskinesia myself).


History of Abuse

A past history of sexual abuse is reported twice is often in women with bipolar as men.



And despite what many may think, risk of suicide is unrelated to gender.


Pregnancy, Breastfeeding, and Postpartum

Pregnancy does come at a price when you have bipolar disorder.

Bipolar recurrences occur in 45% to 50% of pregnancies, but with lithium the recurrence rate falls to 21%.

Abrupt discontinuation of anti-manic agents and a past history of four or more episodes are significantly associated with increased risk of recurrence.

Ideally, women with bipolar will work with their health care providers when planning their families and develop a comfortable approach before conception.

Factors that need to be considered include risks to the patient, family, and fetus of an untreated illness; and the substantial risk for relapse with discontinuation of treatment.

Birth defects and intrauterine death should be considered in choosing medications. The lowest effective dose will likely be used to minimize any risk.

For women that take lithium, the risk of Ebstein’s anomaly is at a 10 to 20 times increased risk.

Lithium levels should be checked at each trimester and doses adjusted accordingly.

Vomiting, dehydration, and volume shifts during delivery can alter serum drug levels.

Because of risk of birth defects and complications, it is advisable to follow the pregnancy with level II/III ultrasounds in the second and third trimesters.

And actually, ECT appears to be an effective and safe alternative treatment for bipolar episodes in pregnancy.

Omega-3 fatty acids continue to be studied for their mood-stabilizing effects and may be a potential treatment option in pregnancy.


Postpartum Depression

Postpartum psychosis affects 1 to 2 women per thousand after delivery and seems more closely linked to bipolar.

It begins within two weeks of childbirth with symptoms of mood disturbance, confusion, delusional thinking, hallucinations, poor concentration, and impaired judgment/insight.

The failure to treat postpartum psychiatric conditions may result in worsening symptoms, more treatment-resistant illness, and impaired maternal function, with adverse consequences for the baby.

The situation requires complete screening for thoughts of harming self or others, and necessitates immediate treatment in a hospital setting with an anti-manic agent, antipsychotic agent or ECT.


Thank you for reading Volume 2 of  my series on women with bipolar. Did you know all of these facts above? If not, what surprised you or helped you the most? If you did, please share with us a fact of your own!

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Bipolar Disorder in Women Vol. 2: What I Wish I Knew Before

Kat Dawkins

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APA Reference
Dawkins, K. (2013). Bipolar Disorder in Women Vol. 2: What I Wish I Knew Before. Psych Central. Retrieved on February 27, 2020, from


Last updated: 14 Apr 2013
Statement of review: Psych Central does not review the content that appears in our blog network ( prior to publication. All opinions expressed herein are exclusively those of the author alone, and do not reflect the views of the editorial staff or management of Psych Central. Published on All rights reserved.