Treatment Issues for Bipolar Disorder in Women
Treatment for Women with Bipolar Disorder
Women with bipolar disorder (BD) often require special considerations and closer monitoring compared to men who suffer the disorder, as it is common for menstruation, sexuality, and menopause to cause certain complications. Professor at Harvard Medical School and Director of the Women’s Mental Health Division within the Department of Psychiatry at Brigham and Women’s Hospital, Laura Miller, M.D. discussed these considerations with the attendees at the 2012 US Psychiatric & Mental Health Congress in San Diego.1
Bipolar Disorder and Hormones
First of all, it is not uncommon for a women’s hormonal changes, due to her menstrual cycle, to interfere with the course of her BD, ultimately complicating treatment.1 A study of 2,524 women found that 65.1 percent with bipolar type I, and 70.5 percent with bipolar type II reported an increase in premenstrual mood symptoms. However, while hormonal changes may impact mood, they can also impact the pharmacokinetics of mood stabilizing medicine. According to Miller, there have been several case reports of changes in lithium’s potency during menstruation.1 In fact, one of Miller’s patients, who strictly adheres to her medication, reported experiencing mild psychotic symptoms and mania for several days before her menstrual cycle.1 After an investigation of her lithium levels, it was found that prior to her menstrual cycle, her levels were 0.6, while after, they were 1.1.1 On the other hand, Miller also states that it is also common for BD to impact a woman’s menstrual cycle.1 Often, women with BD report irregular cycles, some of which are attributed to certain medicines, such as valproate, risperidone, and haloperidol.1
According to Miller, perimenopause and menopause are also difficult times for women with BD, as research states that there is often an increase in symptoms during this period.1 A STEP-BD study of perimenopausal women aged 45 to 55 years found that there was an increase in depressive symptoms in many. Hormonal fluctuations, changes in sleep, changes in midlife roles, and losses experienced may be reason for this increase. However, a second study reported that more information was needed to understand the link between increased mood episodes and perimenopause/menopause.1
Bipolar Disorder and Sexuality
Miller states that BD also impacts a woman’s sexuality.1 Unlike many other psychiatric disorders, women with BD often report an increased interest in sex. Unfortunately, this can lead to an increased risk for sexually transmitted diseases and unwanted pregnancy. However, according to Miller, contraception and mood stabilizers may not always work well together.1 The World Health Organization recommends women with BD to consider the depot shot, the implant, or IUDs rather than oral pills, patches, and the ring.1 On the other hand, it is also common for contraception to decrease the level of the mood stabilizer and alter its effectiveness.1 Lamotrogine and valproate may be impacted by contraception, especially during the period of tapering the patient on the medicine.1
 Duerr, HA. (2012, Nov. 9). Treatment Issues for Bipolar Disorder in Women. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/conference-reports/uspc2012/content/article/10168/2113916.
 Payne JL, Roy PS, Murphy-Eberenz K, Weismann MM, Swartz KL, et al. Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. J Affect Disord. 2007;99(1-3):221-9.
 Marsh WK, Ketter TA, Rasgon NL. Increased depressive symptoms in menopausal age women with bipolar disorder: age and gender comparison. J Psychiatr Res. 2009;43(8):798-802. Bipolar.