Bipolar Disorder and Menopause Symptoms Women Often Miss

Menopause can amplify mood symptoms, disturb sleep, and even mimic bipolar episodes. Hear how some women recognized the early signs — and what helped.

Key Takeaways

• Menopause can cause changes in sleep, mood, energy, and irritability that overlap with bipolar symptoms, making mood episodes harder to recognize.
• Hormonal changes may affect how well bipolar medications work and can sometimes trigger a first mood episode.
• Hormone therapy can help some women during the menopause transition, but certain formulations may also worsen mood, so it’s important to weigh the options carefully with your care team.

The hormonal swings that accompany a woman’s change of life can create challenges that are difficult for anyone to weather. For women with bipolar disorder, however, some menopausal symptoms can make managing their illness a lot harder.

Menopause can bring changes in sleep, mood, energy, concentration, and irritability — all symptoms that can either look similar to, bring about, or amplify mood episodes in bipolar. Depressive episodes may become more severe as menopause sets in. The same goes for anxiety. 

To make matters more complicated, psychiatric medications of proven worth sometimes lose their effectiveness or interact with treatments for menopausal symptoms.

For women living with bipolar, distinguishing between hormonal changes and mood episodes can be especially challenging. Recognizing whether symptoms follow a hormonal pattern, a mood episode pattern, or a combination of both can help you have more informed conversations with your healthcare team and find a treatment plan that works for you.

The Three Stages of Menopausal Transition

The term “menopause” is often used broadly, but the menopausal transition is better understood in the context of three stages that occur as the female body approaches the end of ovulation:

• Perimenopause Levels of female hormones produced by the ovaries (especially estrogen) begin to fluctuate for most women in their forties, triggering changes in the monthly cycle. This transitional stage may last anywhere from four to eight years.
• Menopause After 12 consecutive months without a period, a woman officially reaches menopause. The average age of menopause in the United States is 51, although an individual typically experiences it anywhere between 45 and 55 years old.
• Postmenopause As in, the rest of your life. Estrogen levels usually continue to hopscotch around for a few years, but eventually stabilize at a significantly lower level. Low estrogen may affect sexual pleasure and bone health.

Common Physical and Emotional Signs to Expect

According to Cleveland Clinic, typical symptoms during perimenopause or menopause include:

• Changes in menstrual periods (periods coming closer together or further apart)
• Changes in menstrual flow (becoming lighter or heavier, longer or shorter)
• Hot flashes
• Night sweats 
• Disturbed sleep 
• Increased irritability 
• Vaginal dryness 
• Worsened premenstrual symptoms
• Changes in sex drive
• Urinary problems

These symptoms may persist in the postmenopausal stage, according to the American Medical Association.

Why Menopause Can Make Bipolar Symptoms Harder to Detect

Many women sail through menopause without disturbance. When symptoms arise, the classic complaints are hot flashes and cold sweats. But many women also experience insomnia, irritability, anxiety, depression, fatigue, brain fog, and memory blips, as estrogen plays a role not only in mood but also in cognitive function.

That list will be eerily familiar to anyone living with bipolar. Because these symptoms overlap so heavily, a bipolar episode at menopause is easily misattributed to the transition itself — the underlying connection overlooked. 

And menopause isn’t the only time this happens: The same hormonal ebb and flow can worsen symptoms, or trigger a first manic episode, across a woman’s life — at puberty, pregnancy, the postpartum period, and through the monthly cycle.

Take Diana A. of Hawaii. Despite a decade of successful mood management and a stable treatment plan, the onset of menopause triggered a severe episode of mania and psychosis.

“I went through menopause very quickly when I was 49 years old,” Diana says. “I became irritable, impatient, and eventually hypomanic, and then manic. I hadn’t been under any stress, so it had to have been hormonal.”

How Midlife Hormonal Shifts Can Spark Hypomania and Depression

At 60, Willa G. has reached the relatively calm waters of postmenopause. Hers was a long and bumpy passage, however. Her physical and emotional discomfort grew steadily worse over a number of years, as did the recurrent depression that had plagued her since childhood.

Willa had taken antidepressants in her early thirties for what she now recognizes was postpartum depression. Menopause put her back on the hormonal roller coaster, triggering a severe depressive episode that left her struggling to find an antidepressant she could tolerate.

Rather than stabilizing her mood, the selective serotonin reuptake inhibitors intensified her agitation and made concentrating impossible, eventually shifting her into the overdrive of hypomania. 

“I wrote most of a book in the course of a week. My boss noticed there was something wrong, but I just said, ‘I’m a spurt worker,’” says Willa, who lives with her wife in rural Oregon.

A deeper depressive crash followed. Willa was diagnosed with bipolar 2 with rapid cycling and began another search for effective medications. The blurred line between menopausal and mood disorder symptoms only complicated matters.

Does the Menopausal Transition Worsen Mood Instability?

“The question is, ‘Is the menopause process making this person worse?’ That’s always a possibility,” says Nanette Santoro, MD, a professor of obstetrics and gynecology at the University of Colorado’s School of Medicine and the president of the Endocrine Society. “We need to identify where a woman is in her transition.”

As with so many aspects of bipolar, tracking symptoms and looking for patterns becomes extremely helpful.

For some women, the clue is not a single symptom but its timing. Sleep disruption, irritability, anxiety, depressive symptoms, and periods of unusually high energy may become easier to interpret when they repeatedly appear alongside menstrual changes, hot flashes, night sweats, or other signs of the menopausal transition.

“The best thing is to keep a menstrual calendar and keep a record,” Dr. Santoro says.

‘Menstrual Magnification’ and Medication Interactions

Santoro uses the term “menstrual magnification” to describe the way ping-ponging hormones can affect a preexisting mood disorder such as bipolar. Unfortunately, she says, the field of endocrinology “hasn’t caught up with bipolar” because it’s relatively rare in the general population.

Few practitioners — whether gynecologists or mental health professionals — will have the possible interplay of menopause and bipolar front of mind. Yet it’s vital for women to recognize what’s going on and find the right team to negotiate the complex interactions between fluctuating hormones, therapies for menopause, and treatments for bipolar disorder.

Take Juliann G., for instance, who went on an odyssey to find solutions when she began to have irregular bleeding, night sweats, and other signs of menopause at age 39 and the medications that helped keep her bipolar in balance stopped working.

She sought help from her psychiatrist, a gynecologist with a holistic approach, and a menopause specialist. She tried two kinds of birth control pills, various herbs and supplements, and a drug to suppress ovulation altogether (known as medical menopause). Taken alone, that drug “turned off all the mood stuff,” she says, but it introduced relentless migraine attacks and other side effects.

After a hospitalization, Juliann started treatment with a psychiatrist and a reproductive endocrinologist. Together, the doctors put together a regimen of hormone pills and patches that moderates the downside of her medical menopause and complements her psychiatric medications.

What Clinical Studies Reveal About Risks in Late Perimenopause

Several studies have linked the menopausal transition to an increased risk for depressive symptoms, recurrence of depression, and onset of a depressive disorder. There’s far less scientific literature on how hormonal shifts affect bipolar.

“There’s a lot of reason to believe it’s a time of increased risk, based on research in unipolar depression, increased risk of bipolar mood episodes in the postpartum period when hormone levels also drop, and what we know of overlap of symptoms of mood disorders and menopause,” says Wendy Marsh, MD, a University of Massachusetts researcher who specializes in menopause and mood issues.

A study that Dr. Marsh led analyzed mood states in 768 pre-, peri-, and postmenopausal women with bipolar. The study, published in Bipolar Disorders, found more mood instability as women moved through menopause. A much larger UK Biobank study, including 128,294 women, found that first-episode mania was 112 percent more likely to begin during the four years surrounding the final menstrual period than at other times.

Marsh has also found that during the menopausal transition — especially in the later stages — women with bipolar have a greater proportion of clinic visits with depressive symptoms versus men and younger women with bipolar.

“Late perimenopause to early postmenopause is when the hormones drop the most,” Marsh says.

Tracking Symptom Patterns to Fine-Tune Your Treatment Plan

Learning to read your body’s signals makes navigating menopause with bipolar disorder much less overwhelming. Recognizing what’s behind a specific shift gives you and your care team a clearer, more supportive path forward:

• Pay attention to what’s actually waking you up at night. Waking up drenched in sweat is an exhausting hallmark of perimenopause, per Cleveland Clinic. Because interrupted sleep can quickly destabilize your mood or trigger a bipolar episode, knowing whether physical overheating or racing thoughts woke you helps your doctor decide between menopause symptom relief, gentle sleep support, or an adjustment to your psychiatric medications.
• Notice how your emotional baseline shifts if you try hormone therapy. While steadying estrogen can smooth out mood swings and help you feel more balanced, some formulations — especially those with synthetic progestins — can unintentionally trigger or deepen depression. 
• Watch for signs that your bipolar medications feel less effective. Shifting hormones can speed up how your body processes medication. For instance, estrogen fluctuations can cause blood levels of mood stabilizers like lamotrigine (Lamictal) to dip. If familiar symptoms resurface, tracking their timing helps your doctor fine-tune your dosage, rather than assuming your bipolar is simply worsening on its own.

Collaborating With Your Psychiatrist and Gynecologist

You’ve probably heard the phrase “trial and error” more than once when it comes to managing menopause symptoms. That’s because your hormones and your brain chemistry interact in a way that’s completely your own. Getting to the bottom of your patterns takes patience and a team that works together for you, with your psychiatrist and gynecologist talking to each other and to you.

“Hormones may help,” says Santoro. But she adds, “sometimes hormones are not the answer. A lot of things have to be taken into account. There are a lot of things that can be tried.”

One simple step that makes a real difference: Bring a daily journal to your appointments — in it, jot down your hot flashes, how well you slept, where you are in your cycle, and how your mood has been. It lets your doctors see the whole picture of what you’re experiencing, not just a snapshot from one visit.

“The important thing is to consider treatment,” Santoro says, “and to not shun the endocrinologist out of fear that the only thing they will be offered is hormones.”

RELATED: 5 Treatment Options When Bipolar Symptoms Worsen With Menopause.

Personal Stories: How Women Navigate Both Conditions

According to accounts from women with bipolar who have experienced menopause, several recurring patterns stand out. For some, disturbed sleep is the first symptom. For others, the telltale signs of menopause are cycle-linked irritability, changes in concentration, worsening depression, hypomania, and a noticeable shift in how they behave or function. 

Below, the women themselves detail their lived experiences of going through menopausal changes while having bipolar. 

Broken Sleep, Night Sweats, and Insomnia

“Hot flashes, hot flashes, and did I mention, hot flashes! Those fiery flushes woke me up several times a night, and protecting my sleep routine is essential to managing my bipolar 2. Once my psychiatrist and I addressed the insomnia directly so I could stay asleep, it made all the difference.”
— L.W., Florida

“I didn’t know I had bipolar when I was going through menopause, which only exacerbated the illness as I experienced disturbed sleep and more frequent mood swings. Looking back, recognizing that link between sleep loss and hormonal shifts helped my family and me finally make sense of what was happening.”
— M. Oregon

Severe Irritability, Rage, and Emotional Outbursts

“The irritability and anger I get about a week before my period became far more frequent with perimenopause. At 47, my cycles shortened to just three weeks, meaning the mood shifts came around much faster. Even though my bipolar medications have worked well for years, disrupted sleep from these rapid hormonal changes remains my biggest warning sign.”
— Name Withheld, Massachusetts

“I would have sudden, explosive outbursts centered around small things, screaming for hours and caught up in pure rage, followed by exhaustion and weeping behind locked doors. Experiencing that extreme level of out-of-control anger was a terrifying wake-up call to how intensely hormones could hijack my moods.”
— P.B., Georgia

“I’m experiencing sleep fluctuations, increased irritability, sadness, mixed states, and apathy. Working through perimenopause has meant coordinating with my therapist, having my psychiatrist adjust my prescriptions, and using gynecologist-recommended options for night sweats to keep physical and emotional symptoms from colliding.”
— P.C., New Jersey

Cycle-Linked Mood Shifts

“I started having manic or depressive episodes at ovulation and again in the week to 10 days before my period. It took a long time to make the connection to my cycle — and even longer to convince my doctors — but recognizing that monthly rhythm was the turning point.”
— J.G., New York

“My gynecologist started me on birth control for ovarian cysts, and my manic symptoms suddenly spiked after being stable for years on the same medication. Now I’m on a progesterone cream that seems to help manage my symptoms of menopause and is not making me manic.”
— A.B., Illinois

Intense Depressive Crashes and Sudden Hypomania

“At 46, I started experiencing extreme sadness and thoughts of suicide and feeling like I was losing cognitive control. It took months of adjusting my medications, but I now feel much better. It’s scary how ‘mentalpause’ can affect your mind.”
— C., Maryland

“Throughout my life, mood dips lasted a week and never interfered with my daily routine. But entering menopause triggered severe depression and noticeable hypomania for the first time, proving that hormonal changes can push mild emotional shifts into full-blown bipolar episodes.”
— C., Alberta

Brain Fog, Confusion, and Impaired Focus

“At around age 50, the nature of my hypomania changed. Instead of generating creative ideas, my racing mind left me disorganized, confused, and unable to focus. At the same time, severe hot flashes were accompanied by anxiety attacks. According to my gynecologist, hormones are not prescribed for psychiatric symptoms. She instead prescribed them for hot flashes, which also eliminated the anxiety attacks.”
— A., Tennessee

“Since menopause, my brain has gotten noticeably foggier — more than just age can account for. When you live with bipolar disorder, unraveling what stems from hormones, what comes from brain chemistry, and what is simply aging is one of the biggest challenges.”
— D.M., Idaho

“During the onset of menopause, my thinking became so distorted that I couldn’t keep up with the changes, and my relationships suffered. Learning to accept my condition and track my daily sleep, medications, and mood patterns was the first real step in regaining control.”
— Name Withheld, Alberta

Late-Onset Episodes and Delayed Diagnosis

“Entering menopause without a prior bipolar diagnosis felt like being blindsided. I was experiencing severe mood symptoms and had to seek psychiatric care for the first time. It took significant time to find an even keel, and had I understood earlier that hormonal transitions could trigger bipolar symptoms, I would have been much better prepared.”
— M.H., Pennsylvania

“I hadn’t been correctly diagnosed when I went through menopause at age 50. Doctors assumed it was standard midlife depression, and prescribing antidepressants without a mood stabilizer only triggered severe mania and rapid cycling. Getting an accurate bipolar diagnosis finally opened the door to the right care.”
— R.B., Texas

Unexpected Complications From Hormone Replacement Therapy

“A few months before menopause, I experienced mild depression and assumed it was hormonal. But when my gynecologist started me on hormone replacement therapy, my depression deepened severely, leading to a hospitalization. Stopping the hormones and working closely with my psychiatrist to stabilize my psychiatric meds was what finally brought relief.”
— J.R., West Virginia

“I got moody and had other symptoms of menopause, but it didn’t change my bipolar cycles or moods. I did take a hormone related to estrogen, so maybe that had an effect. It was hard to find something I could take with my medications for bipolar. That was the biggest issue.”
— T. Alabama

Additional reporting by Ana Sandoiu.

Editorial Sources and Fact-Checking

bpHope follows strict sourcing guidelines to ensure the accuracy of its content, as outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, people with lived experience, and information from top institutions.

UPDATED: Originally printed as “Girl Talk,” Fall 2013