How does PMS affect bipolar disorder?

Bipolar disorder (BD)is a mental health condition causing extreme mood shifts. During a person’s menstrual cycle, they may experience a worsening of their BD symptoms.

This makes the premenstrual period, or time before menstruation, particularly difficult for some people. Hormonal fluctuationsTrusted Source during the menstrual cycle may be responsible for this.

What is bipolar disorder?

BD is a mental health condition characterized by shifts in mood, concentration, and energy levels. These changes affect a person’s ability to perform day-to-day tasks.

According to the National Alliance on Mental Illness (NAMI), about 2.8% of adults in the United States live with BD.

BD is usually diagnosedTrusted Source by a doctor, psychologist, or psychotherapist in the later teen years or early adulthood. However, it can also appear during pregnancy or after childbirth.

Although symptoms can be managed with a treatment plan, lifelong treatment is usually needed.

Bipolar disorder in females

NAMI reports that rates of bipolar disorder in males and females is similarTrusted Source. In the past year, 2.9% of adult males experienced bipolar disorder, compared to 2.8% of adult females.

One 2021 review claims that studies are skewed by a recent increase in the diagnosis of BD in females. This does not necessarily mean that BD is becoming more common in females — it indicates that healthcare professionals are getting better at recognizing their symptoms.

Researchers theorize that fluctuations in reproductive hormones exacerbate BD symptoms during the menstrual cycle, during pregnancy, and after childbirth.

PMS and PMDD

A person’s menstrual cycle lasts approximately 28 days. It is broken down into two parts: the follicular phase and the luteal phase.

The first half of the cycle is the follicular phase. It is marked by low levels of progesterone, a pro-gestational hormone. Levels of estradiol, a type of estrogen, increase. This results in the release of an egg from the ovaries.

The second half of the cycle is the luteal phase. During this time, progesterone increases, and estradiol spikes again. If fertilization of the egg does not occur, hormone levels fall, and menstruation begins. The cycle then repeats.

PMS and premenstrual dysphoric disorder (PMDD) are caused by these hormone fluctuations. They cause both emotional and physical symptomsTrusted Source.

Mental and emotional symptoms include:

• irritability
• tiredness
• sleep pattern changes
• appetite changes
• trouble with concentration
• tension or anxiety
• depression or sadness
• changes in mood
• decreased libido

Physical symptoms include:

• swollen or tender breasts
• bowel changes
• bloating
• cramping
• headache
• clumsiness
• lower tolerance of noises or lights

Because the symptoms of PMS and PMDD overlap, it can be hard to tell the difference between the two. A person’s individual symptoms may also vary month-to-month.

PMDD is more severeTrusted Source than PMS. It can significantly affect a person’s quality of life and relationships. People with PMDD may miss days from work or school due to their symptoms.

PMS and bipolar disorder

Even with adequate BD treatment, some people experience a worsening of symptoms around their menstrual cycle.

This is because the hormone changes causing PMS also affect BD symptoms. A 2019 literature reviewTrusted Source described how these hormone fluctuations can affect a person’s BD symptoms.

They can cause:

• more depressive episode
• less manic episodes
• shorter time between episodes
• more severe episodes

These changes are relatively common.

One 2014 meta-analysisTrusted Source examined how many women with BD were affected by premenstrual symptoms. Results suggest:

• 25-77% experience PMS
• 15-27% experience PMDD
• 44-68% experience premenstrual-related mood changes

Treatment and Management

Since premenstrual symptoms and PMDD can significantly worsen bipolar disorder, it’s important to control PMDD symptoms as well as possible. Treatment options for PMS/PMDD include:

• Lifestyle changes: Avoiding alcohol and caffeine can be helpful, and exercise is critical. Dietary changes can make a difference and include eliminating high glycemic index carbohydrates as much as possible. A glycemic index chart can be helpful to figure out which foods this includes.
• Alternative treatments: It is important to talk to your psychiatrist before trying any alternative therapies, though nutritional supplements such as chasteberry and calcium carbonate may help some people.
• Relaxation therapy: Including activities such as meditation and yoga may help some people and have a low risk of side effects.
• Birth control pills: Taking birth control may help some people, though this approach is most effective for those with mild symptoms and can sometimes worsen symptoms. Estrogen patches, oral progesterone, and gonadotropin-releasing hormones are second-line treatments that may offer some relief.

Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) are often used for women without bipolar disorder but should be avoided for those with bipolar disorder (due to the risk of precipitating a manic episode). If these medications are used they should most often be used along with a mood stabilizer or antipsychotic medications, and then only with extreme caution. Because SSRIs are used very commonly for people with PMS/PMDD, this is an important reason why it’s important to distinguish between PMDD and bipolar disorder.

Summary

The hormone fluctuations of the menstrual cycle can cause PMS and PMDD. However, people with bipolar disorder may be more affected than others. These changes can worsen their bipolar symptoms.

A person who notices significant mood changes around their menstrual cycle can seek treatment for their symptoms. Adjusting their treatment plan accordingly will help stabilize their mood.