What is bipolar disorder?
Bipolar disorder, also known as ‘manic-depression’, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder can be severe.
Many people with bipolar disorder experience mixtures of ‘highs’ and ‘lows’ known as states of ‘mania’ and ‘depression’. Although the disorder occurs equally between males and females, women are especially prone to more frequent changes in mood state, known as ‘rapid cycling’.
It is a common condition, affecting around four in every 100 people worldwide, and typically develops in late adolescence. Once diagnosed, bipolar disorder can be treated effectively and people with the condition can lead full and productive lives.
Life changes and bipolar disorder
Bipolar disorder is a long-term illness that must be carefully managed throughout a person's life. It can be adequately managed, but factors such as age and hormonal fluctuations can worsen its symptoms.
The menopause is a normal part of life. It is the culmination of a long, slow process of reproductive aging known medically as perimenopause or menopause transition. For most women, this begins silently somewhere around age 40 when periods may become less regular and the ovaries gradually start to produce less estrogen and progesterone. The term is commonly used to describe any changes a woman experiences either just before or after she stops menstruating.
Worsening of symptoms in perimenopause
The average length of perimenopause is four years and in the last one to two years, hormone loss accelerates. At this stage many women, whether or not they are living with bipolar disorder, may experience menopausal symptoms such as mood swings.
It is thought that these mood swings are strongly related to decreasing levels of estrogen, which is known to dramatically affect mood in women. furthermore, those that experienced severe pre-menstrual syndrome in their younger years are likely to have more severe mood swings during perimenopause.
Most experts agree that bipolar symptoms themselves can also worsen during the perimenopause phase. Medications that have previously been effective in controlling bipolar symptoms may not work so well anymore.
Additional life stresses can make bipolar disorder worse, for example, concerns about body image, sexuality, aging, or the ‘empty nest’ syndrome caused by children leaving home. Thus, in order to manage symptoms successfully, it is important to know what signs to look out for and to understand the underlying causes.
What are the signs of perimenopause?
You will know you are entering the menopause when you begin to experience some or all of the following symptoms.
- Hot flashes
- Sweats
- Breast tenderness
- Worsening of premenstrual syndrome
- Decreased sex drive
- Fatigue
- Irregular periods
- Vaginal dryness or discomfort during sex
- Urine leakage when coughing or sneezing
- Urinary urgency (a pressing need to urinate more frequently)
- Difficulty sleeping.
Other symptoms may develop, such as: headaches; palpitations; aches and pains; irritability; or having feelings of not coping as well as before.
Managing menopause symptoms
It may be hard to distinguish between some of these menopausal symptoms and the signs of worsening bipolar disorder. Often your doctor can make the diagnosis based on symptoms alone but blood tests to check hormone levels may also be beneficial.
For perimenopausal mood swings, some experts recommend a low-dose oral contraceptive - even if contraception is not desired. These pills provide continuously stable hormone levels and may control mood swings.
Some antidepressant medications can also be helpful in controlling hormonal mood swings and may reduce hot flashes. This is especially true of the class of antidepressants known as SSRIs, which have a marked ‘mood-lifting’ effect and are commonly used to treat female hormone disorders, such as post-natal depression and pre-menstrual syndrome, as well as the menopause itself. However, antidepressants may not be helpful beyond the acute depressed phase and may actually induce rapid cycling in people with bipolar disorder.
Knowing the pros and cons of treatment, and the different choices available, is key to successful therapy for any woman considering HRT. It is very important that your doctor goes through all the options, side-effects and advantages or disadvantages of each treatment.
Coping with worsening bipolar symptoms
Even people who always take their medication and are careful with their health can still have mood swings from time to time. So that's why it's important to catch changes in your mood early before they develop into something serious.
Mood swings may take you by surprise during the menopause, especially if such mood changes have always been well managed by regular medication. You should be able to recognize patterns or signs of worsening symptoms and may be entering a period of mania or depression. Aside from a shift in your mood, look for changes in the following:
- Sleep patterns
- Energy levels
- Alcohol or drug use
- Sex drive
- Self-esteem
- Concentration.
If you detect any sign that your symptoms may be worsening, don't wait for the mood swing to pass on its own, get help from your doctor. With quick intervention, such as additional mood stabilizers, it is possible to stop a very minor mood swing from becoming a serious problem.
Communicate with your doctor
At least once a year, and whenever your symptoms worsen or change, you should have a complete physical examination. This will determine whether a medical problem is causing or increasing your symptoms. When you see your doctor, take a written list of any new, unusual, uncomfortable or painful symptoms, and discuss any concerns you have with your doctor.
Simple modifications to your lifestyle, such as watching your diet and taking regular exercise can positively impact on menopause symptoms, as well as being generally important to your health.
Managing your therapy carefully will ensure that you continue to take all your regular medications; and psychotherapy or talking therapy can also help at times of increased stress. Support from family and friends is also important for anyone going through the debilitating effects of the menopause and you should talk openly about your experiences where possible.
Establishing a good and comfortable relationship with your doctor, and keeping regular appointments, is a key factor for success - so that together you can find a treatment plan that helps you to manage both bipolar disorder and the menopause and take control of your symptoms and your life.
Next month on PatientHealthInternational.com
Anxiety and its management will be discussed in a feature article that examines the importance of treatment availability.
Additional reading list