Menopause and Bipolar Disorder

Most of the mood experts I've read seem to agree:  bipolar symptoms can worsen in the 5 (some would say as many as 10) years prior to the end of menstrual cycling, a period generally referred to as perimenopause.  I've certainly been struck by that in my practice of psychiatry.  For a while there, it seemed as though at least every other new patient I saw was a woman in her mid-forties.  She would report that her symptoms were present in her thirties (often starting after the second child was born; a hunch to be pursued); but that things had recently worsened to the point where she was not functioning very well in some respect.  She might describe anxiety, or irritability, and almost always difficulty sleeping -- as well as substantial problems with depression. 

Now, you surely know that these symptoms have been associated with menopause alone (for basics on that topic, read Menopause and Mood).  How might one know if she had "bipolar disorder" also?  Ah, good question.  That can get pretty tricky.  Anyone wondering this should probably read about the diagnosis of Bipolar II

Suppose the diagnosis of Bipolar disorder is relatively confirmed, prior to a woman's early forties.  And now she's having increased difficulty controlling her prior symptoms.  Her medications had been working pretty well, but not anymore.  Now it could just be that she's facing additional life stresses, which can also make bipolar disorder worse.  And several big new life stressors often show up around this age range.  The most famous one on this list, for many women, is a possible "empty nest" situation:  her children may now be old enough to be leaving the home, and she may find herself with much less self-definition as a "mother" every day.  She may not have other activities and responsibilities that keep her active and in a position to receive "validation", some sense of positive feedback, for how she's spending her time. 

For some women this "empty nest" syndrome, or other social explanations, may be very important.  Such women might benefit from connecting with a good therapist.  It would certainly be worth considering before taking on strategies that carry risk, such as hormones or antidepressants or other medication approaches.  And one must remember the central role of exercise in this situation: a known antidepressant with multiple other health benefits and (especially for women like this) nearly zero risk. 

AND... it is also important to recognize that some of the symptom increase a woman may experience at this time could have a strong "chemical" basis.  I've seen quite a few very motivated patients who still seem to need some help with their chemistry in order to be able to use good therapy and stay with an exercise program.  Until very recently I didn't really know how to help them.  I'm still not certain; but at least one psychiatrist who's been working on hormone interventions in the perimenopause feels she knows how:  Dr. Marjorie Shuer.  She offered her advice at a recent conference.Shuer  

Update 12/2003:  Finally another psychiatric clinic that claims, at least, to know how to interpret women's mental health symptoms in light of their hormonal status:  the UCSF Womens' Mood and Hormone Clinic, led by Louanne Brizendine, M.D.  This program, and the Women's Mental Health clinic at Harvard, are the two main programs you could expect to offer expert opinion in this area.  I have much less direct experience nor the multidisciplinary contact of these clinics.  

However, I will continue to collect material of interest on these pages.  Here are some basics that have emerged so far (under construction, but the links are there with a note for each).  

And some initial thoughts on Hormones and Risk