Premenstrual worsening of mood is common among women with depression, but little is known about how often women with bipolar disorder experience worsening of their mood premenstrually. In a study by Payne et al. (2007), premenstrual symptoms were reported by twice as many women diagnosed with mood disorders (mixture of Bipolar Disorder and Major Depressive Disorder) than by women who did not have a psychiatric diagnosis (67.7% vs. 33.7%). These results suggest that PMS symptoms are particularly common in women with bipolar disorder and major depressive disorder. However, this study involved women reporting prior experiences with PMS, which is not always as accurate as studies that involve prospective monitoring to obtain real-time reporting of PMS symptoms. Such prospective studies of PMS in women with bipolar disorder are sparse and have inconsistent conclusions.
In a study involving prospective daily monitoring of mood symptoms across two menstrual cycles, Karadag et al. (2004) compared premenstrual symptoms in women with bipolar disorder who were treated with lithium and/or valproate to premenstrual symptoms in healthy women. Relative to the non-premenstrual time, the healthy women experienced more mood symptoms premenstrually than did the women with bipolar disorder. Results of this study suggest that mood and behavior fluctuate less across the menstrual cycle in women whose bipolar disorder is well treated than in a comparison group of women without psychiatric illness. Another study by Shivakumar et al. (2008) examined the relationship between bipolar disorder and premenstrual symptoms using prospective daily monitoring for three months. They found that depression and mania symptoms did not significantly increase premenstrually.
A study involving prospective monitoring of PMS symptoms in women with bipolar disorder treated with mood-stabilizers (Viguera et al, 2005) sought to determine how often women with bipolar disorder who seek treatment for premenstrual symptoms are confirmed to have premenstrual exacerbation of bipolar disorder when they complete a daily mood diary across one menstrual cycle. Results of this study show that approximately 50% of 15 women had a substantial deterioration in their mood during the premenstrual week relative to their postmenstrual time. The remaining 50% of these women were shown to have ongoing mood problems throughout their menstrual cycle, not just premenstrually. Those bipolar women with PMS then went on to be treated with quetiapine (Seroquel) in addition to the other bipolar medications that they were already taking. The addition of quetiapine improved premenstrual symptoms overall, with the greatest improvement seen in mood swings specifically, suggesting that optimization of treatment with additional medications may be helpful. Findings from this study also suggests that prospective monitoring of mood across the menstrual cycle is a helpful tool to determine if premenstrual worsening is present or if mood disturbance is persistent across the menstrual cycle.
Hadine Joffe, MD, MSc
Rachel VanderKruik, BA
Payne JL, Roy PS, Murphy-Eberenz K, Weismann MM, Swartz KL, McInnis MG, Nwulia E, Mondimore FM, MacKinnon DF, Miller EB, Nurnberger JI, Levinson DF, DePaulo JR Jr, Potash JB. Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. J Affect Disord. 2007 Apr; 99(1-3):221-9.
Karadag F, Akdeniz F, Erten E, Pirildar S, Yucel B, Polat A, Atmaca M. Menstrually related symptom changes in women with treatment-responsive bipolar disorder. Bipolar Disord. 2004 Jun;6(3):253-9.
Shivakumar G, Bernstein IH, SuppesT; Stanley Foundation Bipolar Netweork, Keck PE, McElroy SL, Altshuler LL, Frye MA, Nolen WA, Kupka RW, Grunze H, Leverich GS, Mintz J, Post RM. Are bipolar mood syptoms affected by the phase of the menstrual cycle? J Womens Health (Larchmt). 2008 Apr; 17(3):373-8.
Viguera A, Soares C, Joffe H, Coleman J, Petrillo L, Gottschall H, Whitfield T, Cohen S. Open Label Quetiapine for Premenstrual Worsening of Bipolar Disorder: From Screening to Treatment. In: American Psychiatry Association 2005, May 21-26; Atlanta, GA; 2005.
PMS and bipolar disorder. I go through it every month. For a few days I experience anger that does not go away without help from medication. It has gotton so bad that it is uncontrolled and I cannot calm down. Pms is worse with bipolar disorder. This is my uneducated opinion.
In women with bipolar disorder, PMS symptoms can be quite severe. However, effective treatment of the mood disorder can significantly improve PMS. Sometimes women need higher doses of medication during the premenstrual phase of their cycle.
@Jenny Bridal, I agree with you wholeheartedly. I get the anger that won’t go away, impulsive actions, sometimes it feels like I’m not even on anything even when I am. So, I, too, think it worsens during pms. I don’t care what the docs and controlled studies say. that’s the issue, they are controled.
Just another person who is bipolar and in the last year or so has really noticed a link between my periods and my moods. For the 2-3 days before my periods starts I feel awful! Not just a little moody but down right suicidal. I am taking with my doctor and seeing if there is something that can be done…it’s awful. During those 2-3 days I just feel so hopeless like life just isn’t worth living. Like I am losing what is left of my mind.
Anna, I identify with you 100%. I am just realizing that my PMDD exacerbates my bipolar disorder. It happens a week before my period begins. I was downright suicidal on Monday. It scared me out of my wits this extreme reaction. I will be meeting with my psych for help. It is damaging to me on a mental and spiritual level. The spiraling out of control is unbelievable.
@Anna, I also suffered major depressive episodes right before my period. It got to the point where I would be thinking “I just want to die… Oh, my period must be due!” and sure enough it would start the next day. I actually thought this was fairly normal until last year when I saw a specialist and she told me it didn’t have to be that way and that estrogen supplementation would change my life. She was right: I’ve been on hormone therapy for 18 months and stopped taking ALL my bipolar meds (lithium, lamotrigine & zyprexa) 12 months ago with no relapses! The only issue is that I still have the occasional bad bout of pms, which I have just been prescribed seroquel to take as needed. Hopefully it will help!
I was recently, within the last 6 months, diagnosed with bi-polar disorder and slight paranoid schizophrenia. Im finding that 3 to 4 days before my period starts I begin to become extremely depressed and confused about emotions I am having. Once my period begins I begin to have suicidal thoughts, actually visualizing myself carrying through the suicide. I take out anger on others around me and begin feeling complete alone. Im wondering if I have been miss diagnosed or if the is something more that can be done…
I was diagnosed with bipolar disorder 2 years ago and have been on Mirtazapine since then. I recently realized that maybe what the doctor thought was bipolar disorder might actually be a severe PMS… I do experience very bad mood swings a week before my period and the hopelessness mentioned above, anger, insomnia and extreme nervousness:( It’s unbearable, up to the moment when I get my period finally and then the world seems bright and optimistic. Is it possible to actually confuse bipolar disorder with PMS? Or are these completely separate conditions?
I think PMS & Bi-Polar disorder have similar symptoms. Both affect moods,thoughts, feelings & emotions. I think separately they each are bad enough. But, mix the two, and those symptoms together & at the same time become much more intensified. This is my experience & my opinion. Bi-Polar disorder on a “regular”day, can be so trying,exhausting & frustrating. So,when it’s about to be my period,I really want to just disappear!!!!! I feel “ALL” the symptoms I read above,”PLUS!!!” Increased appetite,by “alot” and extremely tired, no energy. Just, really tired for NO reason. Much more impatient with myself & others. Feeling “EXTREMELY ALONE,” sad & depression “MUCH Worse,” I don’t want to get out of bed,just want to sleep. I “MAKE” myself get up,but feel NO BETTER!!!! I feel,no one understands me. I feel so alone.
My 31 year old daughter, diagnosed with bipolar disorder when she was 15, has always struggled with PMS sx between ovulation and getting her period. After a miscarriage and an emergency ectopic pregnancy within the last year. she made the difficult decision to have a tubal ligation. She’s unable to use any kind of BCP’s (they usually make her plummet into a deep depression) and she expelled an IUD several years ago. The risks to her own health and that of the baby’s during a pregnancy and post-partum were too great and so she had the procedure done on Jan 30 of this year. She’s been dealing quite well with the physical and emotional healing.
She’s approaching her first period since the surgery and she probably ovulated about a week ago. She’s been in post-tubal ligation hormone hell ever since. She’s been experiencing severe PMS-like symptoms –>anxiety, insomnia, extreme irritability and major suicidal ideation. I hadn’t seen her this “out of control” in a very long time and she says this is NOT rapid cycling bipolar disorder or depression. It’s like PMS on steroids and said that she has never felt like this before. Of course, having bipolar disorder and being uber-sensitive to everything makes all this super amplified.
Alas, I’m not sure that there is any real “fix”, short term or long term since treatment is usually with synthetic hormones, which she can not take/tolerate. She finally got a call back from her psychiatrist, who didn’t blow her off. He doubled her Abilify and told her to eat foods rich in phytoestrogens (but not soy-based) and to talk to her gynecologist, who was not available last Friday.
This may be due to something called post tubal ligation syndrome. http://tubal.org/symptoms_of_pts.htm We had both heard/read about PTLS when my daughter was considering a tubal back in her twenties. She brought this up with her current MD, who told her that the most of the evidence is anecdotal. I purposely decided not to research PTLS before this recent surgery because I didn’t want to be alarmist and because she really didn’t have any other choices re: contraception.
She’s terrified that these might be permanent side effects….and if this continues, I really think she might kill herself.
To top it off, the nurse/receptionist at her gynecologist’s office had the audacity to say that PTLS was a myth and that she should take a Midol!!! This is what she is often up against….even within the medical profession. Having these rare (I’m not convinced that PTLS is really that rare based on what I’ve read) and unusual/weird side effects make her feel even more “crazy” and that others, knowing she has a mental illness, probably think she’s just being hysterical, manic, over-reactive, CRAZY….like she’s reinforcing the stereotype. I still am in awe of what’s she had to handle in her life and never, ever take forgranted that she’s still alive.
I’m wondering if anyone from MGH Center for Women’s Mental Health Perinatal and Reproductive Psychiatry Program could shed some light on post tubal ligation syndrome, esp as it relates to women with mood disorders. Also, if anyone else has experienced this, I’d very much appreciate your comments. My dear daughter made a difficult but very mature decision to have this tubal ligation and to now see her suffer such serious and life threatening side effects makes me extremely concerned for her health and stability.
Thank you in advance for any information you can share.
Nancy, check out Facebook and “The new PTLS private support group”.
I have bipolar disorder and my PMS is severe. Every 3-7 days before my period I get suicidal thoughts and impulse to take action. It is very bad for me I feel if I commuted suicide it would be my time on PMS not knowing or having the rational to know it’s the PMS . I take this very seriously and care about my health.
So far I have taken birth control and that hasn’t helped.
I like the idea of seriqual , as I used to use it for sleep and now I realize my PMS was better at those times.
I believe the higher dose will help I’m going to discuss this with my psychiatrist next visit.
PMS is serious everybody gets that people get moody on their period. And often not diagnosed but suicidal ideation a once a month is PMS and serious