Biological factors can influence how women experience and are treated for bipolar disorder. Many people are misdiagnosed because the core symptoms—episodes of depression alternating with periods of unusually elevated mood (mania)—can be subtle or misunderstood.

For cisgender women, diagnosis and treatment can be even more complex. Like how heart disease in women can be missed because symptoms differ from those seen in men, mental health professionals may also overlook the unique signs of bipolar disorder in women, leading to delayed or missed diagnoses.

Hormonal changes, pregnancy, and other biological differences can all affect how bipolar disorder is diagnosed and managed in women.

What Is Bipolar Disorder?

Bipolar disorder exists on a spectrum, but there are two main types:

  • Bipolar I disorder: Characterized by intense manic episodes, which may include psychosis and often require hospitalization.

  • Bipolar II disorder: Defined by milder manic episodes known as hypomania, which can be mistaken for ordinary mood swings.

In both forms, individuals experience changes in mood and energy, ranging from manic (high-energy) episodes to depressive (low-energy) episodes, or sometimes mixed states that involve symptoms of both.

How Does Bipolar Disorder Affect Women?

There are several ways bipolar disorder differs in women, including how it is diagnosed, the symptoms they experience, treatment effects, and coexisting health conditions.

Diagnosis

Women are often diagnosed with bipolar disorder later than men, especially in cases of bipolar I. Additionally, bipolar II is more common in women than in men, and women are more likely to receive a bipolar II diagnosis.

Symptoms

Typical symptoms of bipolar disorder include:

  • Feeling excessively happy or outgoing

  • Irritability or agitation

  • Feeling overly energetic or “wired”

  • Speaking rapidly

  • Trouble sleeping

  • Impulsivity

  • Difficulty focusing

  • Appetite changes

  • Thoughts of death or suicide

Women with bipolar disorder are more prone to depressive episodes and rapid cycling, meaning they experience four or more mood episodes in a year.

Hormonal fluctuations throughout life—during menstruation, pregnancy, and menopause—can intensify bipolar symptoms, making them more difficult to manage or diagnose.

Treatment

Medications such as mood stabilizers and antidepressants are commonly prescribed to manage bipolar disorder. For women, a notable side effect of these treatments can be weight gain, either due to increased appetite or changes in metabolism caused by the medication.

Other Health Conditions

Women with bipolar disorder are more likely to have coexisting medical conditions, such as:

  • Alcohol use issues

  • Thyroid disorders

  • Obesity (sometimes related to medication)

  • Migraine headaches

Does Bipolar Disorder Treatment Affect Pregnancy?

Medication is the primary treatment for bipolar disorder, but some drugs may pose risks during pregnancy. Certain medications have been linked to birth defects or developmental concerns. For instance, one commonly used mood stabilizer has been associated with brain and spinal cord defects when taken during pregnancy.

However, stopping medication entirely may also pose serious risks, as untreated bipolar disorder can lead to a relapse. This can affect a woman’s ability to care for herself and her baby.

Doctors may recommend continuing mood stabilizers during pregnancy—especially for severe cases of bipolar I—while selecting medications that are safest for the developing fetus.

If the symptoms are milder, it may be possible to pause medication during the first trimester or the entire pregnancy. It’s essential to discuss all treatment options with a healthcare provider to ensure the best outcome for both mother and baby.

Can Bipolar Disorder Be Misdiagnosed?

Bipolar disorder is sometimes confused with premenstrual dysphoric disorder (PMDD), a condition marked by intense emotional and physical symptoms before menstruation.

Shared symptoms between the two conditions include:

  • Anger or irritability

  • Trouble concentrating

  • Sleep disturbances

  • Mood swings

  • Fatigue

  • Sadness or loss of interest in activities

Hormonal fluctuations, particularly in estrogen, can make bipolar symptoms worse. People who experience both PMDD and bipolar disorder may have more severe and frequent mood episodes.

Because the symptoms overlap, it's possible for someone to be misdiagnosed with one condition when they may have the other—or both. Keeping a daily record of symptoms along with tracking the menstrual cycle can help identify patterns and assist with proper diagnosis.

A Quick Review

Bipolar disorder often appears differently in women. Women are more likely to experience depressive episodes and rapid cycling, and hormonal changes throughout life can influence the severity of symptoms.

Due to overlapping symptoms, bipolar disorder may be misdiagnosed as PMDD, or vice versa. If you're experiencing mood-related symptoms, especially around your menstrual cycle, it's important to speak with a healthcare provider. Proper tracking and open communication can lead to accurate diagnosis and more effective treatment.