Illness Course in Women with Bipolar Disorder

Up to two thirds of women with affective disorders have reported premenstrual exacerbation of mood, but premenstrual mood worsening has not been detected in small studies of bipolar disorder. Using data on menstruating women with bipolar disorder (age range, 18–40) from the STEP-BD study, investigators examined the potential impact of premenstrual mood exacerbation on illness course. Analyses adjusted for psychotropic medications, hormonal contraceptives, comorbidities, number of mood episodes in the previous year, and irregular menstrual cycles.

Of 293 women, 65% reported premenstrual exacerbation of mood symptoms. At 1-year follow-up, those with self-reported premenstrual exacerbation had more mood episodes (primarily depression) than those without — but not more rapid cycling. The researchers examined time to relapse in a partially overlapping cohort of 129 women who had recovered by study entry; 51% had reported premenstrual exacerbation. When relapse was defined to include subsyndromal episodes, women reporting premenstrual exacerbation had greater risk for relapse and shorter time to relapse (4.5 months vs. 8.5 months) than those without, but this difference became nonsignificant after adjustment for the greater number of mood episodes reported by those with premenstrual exacerbation.