Bipolar and premenstrual syndrome

Premenstrual syndrome (PMS) is the name for the symptoms women can experience in the days before their period arrives – including mood swings, breast tenderness, bloating, headaches, irritability and food cravings.

Is there a link between PMS and bipolar?

In one Bipolar UK survey of 1,000 women, 75% told us that their periods affected their bipolar symptoms.

And research has shown that PMS can linked to depressive, hypomanic and manic episodes in some women with bipolar.

Is there a link between premenstrual dysphoric disorder and bipolar?

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Common symptoms include severe mood swings, depression, intense irritability, anxiety, breast tenderness, headaches, joint or muscle pain and bloating.

• A large study found women with PMDD were eight times more likely to have a diagnosis of bipolar as well.
• Two studies found higher rates of PMDD among women with bipolar.

Self-care for PMS in bipolar

You can help ease PMS with some lifestyle approaches that are also good for your general health and for managing bipolar. These include:

• keeping active
• eating a varied diet
• getting into a good sleep routine
• quitting smoking
• not drinking too much alcohol
• managing stress with yoga, breathing exercises or meditation

Treatments from your doctor for PMS with bipolar

Your healthcare team may be able to recommend treatments to help manage the symptoms you experience due to PMS, and any effect they have on your bipolar symptoms, too.

1. Hormonal treatments such as the oral contraceptive pill may help by reducing the changes in hormones during your cycle.
   • ‘Just be aware that more research is needed on the use of the contraceptive pill if you have bipolar,’ says Dr Clare Dolman, who is a lead researcher in bipolar and women’s health. ‘An Australian study done in 2017 found that about a third of women with bipolar reported mood worsening as a result of contraceptives, with a large percentage reporting mixed and depressive symptoms. This study relied on women recalling their symptoms from the past. So we definitely need more research.’
   • One small review of evidence in 2016 said there was no evidence of worse outcomes for women with bipolar using the pill, levonorgestrel-releasing IUD or a progestogen-only injection.
   • Different types of hormonal treatment can have a different impact on mood for individuals – so working closely with your healthcare team is key.
2. Cognitive behavioural therapy (CBT) is a type of psychotherapy (talk therapy) that some women use to manage PMS by changing unhelpful thinking and behaviour patterns. They then feel more in control and less stressed about hormonal changes.
   
   
3. Antidepressants. Many GPs are used to prescribing antidepressants called SSRIs for the mood effects of PMS and PMDD, but these may trigger manic episodes or rapid cycling in some women with bipolar. Always talk to your healthcare team about your condition and history before trying any new medicines.

Bipolar and the menstrual cycle

Some women find their bipolar symptoms change or get worse at other times in the menstrual cycle, not just in the days just before their periods arrive. For example, you might notice changes when you’re on your period, or around ovulation time.

Keeping a hormone diary alongside a mood diary could help you and your doctor work out if there’s a link.