Bipolar disorder occurs with similar frequency in men and women. But there are some differences between the sexes in the way the condition is experienced.

For example, a woman is likely to have more symptoms of depression than mania. And female hormones and reproductive factors may influence the condition and its treatment.

Research suggests that in women, hormones may play a role in the development and severity of bipolar disorder. One study suggests that late-onset bipolar disorder may be associated with menopause. Among women who have the disorder, almost one in five reported severe emotional disturbances during the transition into menopause.

Studies have looked at the association between bipolar disorder and premenstrual symptoms. These studies suggest that women with mood disorders, including bipolar disorder, experience more severe symptoms of premenstrual syndrome (PMS).

Other research has shown that women whose disorders are treated appropriately actually have less fluctuation in mood over the course of the menstrual cycle.

The greatest evidence of a hormonal association with bipolar disorder is found during pregnancy and the postpartum period. Women with bipolar disorder who are pregnant or have recently given birth are seven times more likely than other women to be admitted to the hospital for their bipolar disorder. And they are twice as likely to have a recurrence of symptoms.

Bipolar Disorder Treatment

Treatment for bipolar disorder is targeted at stabilizing mood to avoid the consequences of both the manic and depressive states. In most cases, long-term treatment is required to relieve and prevent bipolar disorder symptoms.

Treatment often involves medication and talk therapy. Drug treatments include:

• Aripiprazole (Abilify)
• Asenapine (Saphris)
• Carbamazepine (Carbatrol, Equetro, Tegretol)
• Cariprazine (Vraylar)
• Divalproex sodium) (Depakote)
• Lamotrigine (Lamictal)
• Lithium (Lithobid)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Symbyax (olanzapine-fluoxetine combination)
• Valproic acid (Depakene, Stavzor)
• Ziprasidone (Geodon)

Some of these drugs carry a warning that their use may rarely increase the risk of suicidal behavior and thoughts in children and young adults. New or worsening symptoms, unusual changes in mood or behavior, or suicidal thoughts or behavior need to be monitored.

Treatment for bipolar disorder is generally the same for men and women. But special treatment considerations are necessary for some women, particularly during pregnancy.

While it is crucial that women continue treatment during pregnancy, risks to the baby are also considered. So treatment regimens may change to minimize risk.

In general, doctors prefer lithium and older drugs such as haloperidol (Haldol), as well as many available antidepressants, during pregnancy. That’s because these drugs have a proven track record and more safety data than the newer drugs,

If women choose to try stopping treatment during pregnancy, doctors often use these drugs if treatment must be resumed. A number of newer atypical antipsychotic medications have been studied during pregnancy and, to date, have demonstrated no known risks for birth defects or developmental abnormalities.

Some drugs, such as valproic acid and carbamazepine, have been shown to be harmful to babies and contribute to birth defects. If a woman taking valproic acid discovers she is pregnant, her doctor may change her medication or adjust the dosage and prescribe folic acid to help prevent birth defects affecting the development of baby’s brain and spinal cord.

Most experts avoid carbamazepine during pregnancy unless there are no other options. Carbamazepine not only poses risks to the unborn baby, but can also cause complications such as a rare blood disorder and liver failure in the mother, particularly if begun after conception.

Some drugs taken in late pregnancy may cause the baby to experience abnormal muscle movements, called extrapyramidal signs (EPS), or withdrawal symptoms at birth. The drugs include antipsychotics such as aripiprazole (Abilify), haloperidol (Haldol), risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa).