Progression of female reproductive stages associated with bipolar illness exacerbation
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Marsh WK, Ketter TA, Crawford SL, Johnson JV, Kroll‐Desrosiers AR, Rothschild AJ. Progression of female reproductive stages associated with bipolar illness exacerbation. Bipolar Disord 2012: 14: 515–526. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objectives: Late perimenopause and early postmenopause confer an increased risk of depression in the population, yet bipolar disorder mood course during these times remains unclear. Methods: Clinic visits in 519 premenopausal, 116 perimenopausal (including 13 women transitioning from perimenopause to postmenopause), and 133 postmenopausal women with bipolar disorder who received naturalistic treatment in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP‐BD) study over 19.8 ± 15.5 months were analyzed for mood state. History of postpartum and perimenstrual mood exacerbation and current hormone therapy were evaluated as potential mood predictors. Results: A progression in female reproductive stage (premenopause, perimenopause, and postmenopause) was significantly associated with percent of visits decreasing in euthymia (29.3%, 27.0%, 25.0%, respectively, p < 0.05), decreasing in syndromal mood elevation (5.3%, 4.1%, and 3.0%, respectively, p < 0.001), and increasing in subsyndromal symptoms (47.3%, 50.7%, and 52.7%, respectively, p = 0.05). Thirteen women transitioning from peri‐ to postmenopause had a significantly greater proportion of visits in syndromal depression (24.4%, p < 0.0005) compared to premenopausal, perimenopausal, and postmenopausal women, while depression in the latter three groups (18.1%, 18.1%, and 19.3%, respectively) did not differ. Perimenstrual and/or postpartum mood exacerbation, or hormone therapy did not significantly alter depression during perimenopause. Conclusions: A progression in female reproductive stages was associated with bipolar illness exacerbation. A small number of women transitioning from perimenopause to postmenopause had significantly greater depression than other female reproductive groups. Euthymia and mood elevation decreased with progressing female reproductive stage. Menstrual cycle or postpartum mood exacerbation, or current hormone therapy use, was not associated with perimenopausal depression. Future studies, which include hormonal assessments, are needed to confirm these preliminary findings.
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For many women, stress and hormonal changes associated with the transition to menopause may increase or trigger mood symptoms.
“For many women, stress and hormonal changes associated with the transition to menopause may increase or trigger mood symptoms.550, 551, 552”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [552]
The Introduction (page unavailable) describes frequent psychological symptoms during the menopausal transition, an increased risk of depressed mood, and a possible relationship between hormonal fluctuation and mood. The Results (page unavailable) find more visits with depression among women with bipolar disorder transitioning from perimenopause to postmenopause. The paper does not establish stress as a trigger, and its own findings concern women with bipolar disorder rather than women generally. (LLM, conf=0.85)
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Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., et al. (2018) · Bipolar Disorders · doi:10.1111/bdi.12609 · Cited by 1,852 · see citing works
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- Authors
- Marsh, W. K., Ketter, T. A., Crawford, S. L., Johnson, J. V., Kroll‐Desrosiers, A. R., & Rothschild, A. J.
- Affiliations
- UMass Memorial Health Care (US)
- Stanford Medicine (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Marsh, Wendy K
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2012-05-31
- Volume
- 14
- Issue
- 5
- Pages
- 515-526
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- PMC
- PMC3407285
- OpenAlex
- W2160100584
- Cited by
- 27
- References
- 55
- Citations by year
- 2025: 4 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 3
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship@UMassChan (submittedVersion)
- Funders
- American Psychiatric Publishing
- AstraZeneca
- National Institutes of Health (n01mh80001-12-0-0)
- National Institute of Mental Health (01MH80001, N01 MH080001)
- National Center for Research Resources (KL2RR031981)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- bipolar disorder, perimenopause, postmenopause, depression, euthymia, mood improvement, subsyndromal symptoms, postpartum mood, hormone therapy, menstrual cycle
- MeSH terms
- Adult, Affect, Aged, Aged, 80 and over, Aging, Bipolar Disorder, Depressive Disorder, Female, Humans, Longitudinal Studies, Middle Aged, Premenstrual Syndrome, Prospective Studies, Estrogen Replacement Therapy, Premenopause, Postmenopause, Disease Progression, Perimenopause
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