Women with histories of major depression are vulnerable during the transition to menopause and are at increased risk for relapse; however, we have less information on how this transition affects women with bipolar disorder.

At the American Psychiatric Association’s 2014 Annual Meeting, researchers presented data from an observational study of 56 women between the ages of 40 and 60 years with bipolar disorder (BD).

Women in the late menopausal transition (MT) period and early postmenopause had significantly higher depression and mood elevation scores than women in the early stages of the menopausal transition.

The findings are a bit surprising. Although clinically we do often see destabilization during the menopausal transition, I would have expected to see the highest levels of destabilization during the early part of the transition, when levels of estrogen fluctuate more dramatically. The findings of the present study may suggest that estrogen — even when its levels are fluctuating — has a mood stabilizing effect or may enhance the effects of traditional mood stabilizers.

Future studies will help us to better understand the impact of the menopausal transition on the course of bipolar disorder. The study highlights the importance of monitoring women as they transition into the menopause. This constitutes a period of increased vulnerability, where even women who were previously stable on a medication regimen may be vulnerable to relapse.

Ruta Nonacs, MD PhD

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