Bipolar and menopause

Researchers are investigating links between menopause and bipolar – which lots of women have been reporting for many years. 

The hormonal ups and downs in the run-up to your last period (perimenopause) and the changes after your last period (menopause and post-menopause), can all affect mood.

• In a Bipolar UK survey about how hormones affect women’s bipolar, over half of those (55%) in the relevant age bracket said perimenopausal or menopausal symptoms had impacted their bipolar. Almost a third (28%) said the impact was significant.
• Other studies have noted that anything between 20% and 77% of women with bipolar disorder are at increased risk of mood episodes during menopause.
  

Hormones, mood changes and menopause

Perimenopause and menopause hormonal changes can lead to symptoms that can be similar to symptoms of bipolar:

• low mood and loss of joy
• poor motivation and low confidence
• anxiety and panic attacks
• mood swings
• anger and irritability
• crying spells
• brain fog and indecisiveness (like depression)
• low self-esteem

In perimenopause,levels of female hormones oestrogen and progesterone go up and down, triggering physical symptoms including period changes, hot flushes, insomnia, vaginal dryness and more. Along with these can come mood and emotional changes, like some women find with PMS.

In menopause (the 12 months without a period) and post-menopause (the rest of your life after that), oestrogen levels drop dramatically and stay low afterwards. This drop and lack of oestrogen can also affect mood – because it affects the feelgood hormone serotonin and the stress hormone cortisol.

In medical menopause oestrogen levels drop dramatically and suddenly. This can happen if you have surgery to remove your ovaries, or treatment for some kind of cancers such as breast or ovarian cancer, or sometimes if you have hormone-blocking treatments to help with conditions including endometriosis or fibroids. This dramatic drop in oestrogen levels is more like the kind you might experience after childbirth.

Tracking menopause and bipolar symptoms

‘One of the most useful things you can do is track your symptoms. If you notice changes that might be related to perimenopause – not necessarily bipolar mood changes – that could help you and your doctor identify that you are in a new hormonal phase,’ says Dr Clare Dolman.

Key symptoms to look out for include:

• Period changes such as irregular, heavier, lighter, shorter or longer periods.
• Physical symptoms such as hot flushes and night sweats, heart palpitations, sleeplessness, uncomfortable sex, drier vagina, more urgent or frequent need to pee, joint stiffness, skin changes such as itching or adult acne, changed body shape and weight gain, headaches or migraine attacks, increase in facial hair, tinnitus, hair loss, reduced sex drive, increased number of urinary tract infections (UTIs), sensitive teeth and gums or other mouth problems.
• Mental symptoms such as problems with memory, concentration and brain fog, a loss of your sense of self, loss of self-confidence, anxiety, irritability and anger, low mood.

Can menopause bring on bipolar disorder?

The latest research shows there are four ways perimenopause and menopause can act as a trigger for bipolar.

1. First onset of bipolar due to perimenopause. Perimenopause and menopause can trigger bipolar and major depressive disorder to appear for the first time – a late-onset bipolar due to menopause. One four-year study from 2024 found a 112% increase in first-onset experiences of bipolar at perimenopause. The first onset of major depressive disorder increased by 30%.

2. Repeat bipolar episodes due to menopause hormonal changes. Women whose bipolar symptoms have already been triggered or made worse by PMS, or after giving birth, can find perimenopause and menopause bring on their symptoms again. One study from 2025 revealed:

• Having bipolar and a history of premenstrual symptoms was linked to experiencing any type of mood episode, and depression specifically, during the perimenopause.
• Women with bipolar and a history of postpartum depression within six weeks of delivery were more likely to have depressive episodes during the perimenopause.

3. Hormonal changes affecting your bipolar medications
There is some evidence that hormonal changes may make your bipolar medicines such as mood stabilisers and anti-psychotics less effective. You might need to talk to your psychiatrist about adjusting your dose.

4. Menopause symptoms that can be bipolar triggers.
Although everyone is different in their experience of perimenopause and menopause phases, there are some common symptoms that can affect bipolar.

• Sleep problems are a common symptom of perimenopause and menopause, and can also be a trigger for bipolar episodes.
  • Lack of sleep due to hormonal changes can also make people more likely to drink caffeine – a potential bipolar mood episode trigger.
  • Feeling tired is also more likely to increase your appetite, encouraging you to eat sugary foods – which can also lead to sugar highs and crashes, affecting your mood. Some research even suggests that women are more likely than men to choose unhealthy foods when they are tired. The latest research is looking at the way bipolar bodies and brains process sugar as a key element in shifts between depression and mania.

What happens in bipolar after menopause?

There is very little research on what happens in the post-menopause phase for women with bipolar – and every woman’s post-menopause is individual. This is the time when oestrogen, progesterone and testosterone levels are very low and stay low.

One study in 2025 has started to try and fill in this gap by investigating bipolar depression in a group of 364 women split by whether they were pre- or post-menopause. It suggested that:

• women in post-menopause did not respond as well to treatment for depressive episodes, and had lower remission rates, despite the use of more complex treatment approaches.
• being in post-menopause is an independent risk factor.
• developing tailored treatment protocols could be beneficial. One small study from 2014 with 56 women with bipolar between the ages of 40 and 60 years showed that those in the late menopausal transition period and early post-menopause had significantly higher depression and mood elevation scores than women in the early stages of the menopausal transition.

Self-care for menopause with bipolar

These self-care actions have three key benefits. They:

1. help ease perimenopause and menopause symptoms
2. protect your heart and bones from an increased risk of osteoporosis and heart disease that happens once your oestrogen is low
3. can also help manage your bipolar

Quit smoking

Giving up smoking or vaping can cut your likelihood of severe hot flushes and night sweats, help ease vaginal dryness, and could protect your bones and heart.

Stopping smoking can also help some bipolar treatments work more effectively, plus potentially reducing the risk of mixed and more severe bipolar episodes.

Manage stress well

Keeping stress levels low may help to ease hot flushes and tackle hormonal sleeplessness, as well as helping your heart health. It may also reduce the risk of a bipolar episode.

Eat a healthy balanced diet

Hormonal changes can make it easier to store fat in your belly where it increases the risk of heart disease. Eating well can help you stay at a healthy weight, or lose weight if you need to. Shedding any excess pounds can help reduce hot flushes.

Get active

Regular exercise is great for easing hormonal mood shifts, protecting heart and bones, and helping to tackle sleeplessness.

Prioritise quality sleep

A good sleep routine can help to tackle brain fog, mood regulation and balance blood sugar (which changing hormones can affect).

Treatment from your doctor for perimenopause and menopause in bipolar

Almost a third (32%) of women with bipolar who have perimenopause or menopause symptoms don’t see their doctor about them, according to a Bipolar UK survey. ‘This is a missed opportunity at a time when women can find their health and wellbeing is very much affected,’ says Dr Clare Dolman. ‘There are a range of treatments your doctor can offer you, that could help a lot. Please do go and see them.’

HRT for bipolar menopause

The medically recognised treatment for menopausal symptoms is hormone replacement therapy (HRT). It also helps to protect heart and bones. In the Bipolar UK survey, only 31% of women had been offered HRT, yet 64% of the women using it said it had helped them, with 21% saying it was ‘extremely effective’.

• Evidence and personal stories show a mixed picture. One study showed women with bipolar who were not using HRT were much more likely than those who were using HRT to report the worsening of symptoms during perimenopause/menopause. Anecdotal reports show some women find HRT doesn’t help or makes their bipolar worse.
• It is key to talk to your doctor about whether HRT might be suitable for you, and which type – there are lots of different medicines and approaches that can be tailored to you and your health needs, even if you’re still having periods.
• If your bipolar symptoms have worsened during this time, there is some evidence that getting hormone levels stable means a better response to medicines for mental health conditions.
• If you have your first experience of bipolar due to menopause, be aware that while HRT may help your hormones and possibly your bipolar mood changes, your bipolar is unlikely to resolve without treatment to manage it alongside the HRT.

Testosterone in HRT when you have bipolar

There is growing evidence that, for some women, adding testosterone therapy into HRT may help with symptoms including anxiety, irritability, depression, insomnia, brain fog, low sex drive, fatigue and joint pain.

• One study showed women with bipolar had significantly higher testosterone levels than female controls and suggested this should be investigated as part of the cause of bipolar.
• Some research suggests high levels of testosterone are linked with higher rates of depression, and of hypomania. Low levels of testosterone are linked to mood symptoms in some groups of depressed individuals.
• A significant number of studies suggest that both high and low levels of testosterone may be related to suicide risk.
• One study suggested higher levels of testosterone in the blood of women with bipolar who had a history of suicide attempts was linked to a significantly higher risk of further suicide attempts over the two-and-a-half years of the study.

Testosterone is available on private prescription, but not yet on the NHS. There is very little evidence on its effects in women with bipolar, so always talk things through with your psychiatrist before taking any new medications.

Non-hormonal treatments for menopause in bipolar

Your doctor has other options aside from HRT to support you through perimenopause and menopause. If you try HRT and it doesn’t suit you, you don’t want to use it, or you are not able to take it due to your health history, you can ask about:

• Menopause CBT, which is recommended by the NHS specifically to tackle low mood, anxiety, insomnia and hot flushes and night sweats caused by hormonal shifts in this life stage.
• Non-hormonal medicines on the NHS include treatments to reduce hot flushes and night sweats such as Gabapentin, Clonidine and Oxybutynin (originally for overactive bladder so if that is a menopause issue for you it could help with both).
• Note that SSRI anti-depressants may sometimes be offered to women going through perimenopause and menopause for hot flushes, low mood and anxiety, even though NICE now recommends hormone treatment as the first-line therapy. Remember that SSRIs may affect or trigger mania in some people with bipolar, so always talk things through with your doctor before changing your prescription.