Hormones and Highs: Navigating Bipolar Stability Through Your 30s and 40s

”The fluctuation of the reproductive hormones estrogen and progesterone and their impact on neurotransmitter systems are key contributors to the ‘vulnerable window’ for mood instability in women with bipolar disorder during their thirties and forties,” says Adriana Phan, MD, a psychiatrist with Hackensack University Medical Center in New Jersey. “This period, particularly the perimenopausal transition, is characterized by erratic hormonal fluctuations that disrupt the neurotransmitter balance that’s critical for mood regulation.”

Here’s what you need to know about how hormones and mood intersect and ways to enhance your care if you’re dealing with both bipolar disorder and hormone changes.

Estrogen and progesterone rise and fall throughout the menstrual cycle and during life stages like pregnancy and menopause, according to Cielo Gnecco, MD, an ob-gyn with Orlando Health Women’s Institute Center for Obstetrics and Gynecology in Kissimmee, Florida.

“These hormones directly affect brain chemicals that control mood, energy, sleep, and emotional regulation,” she says. “Estrogen generally supports mood by helping serotonin and dopamine work more effectively, which can improve emotional stability and resilience. Progesterone has a calming effect on the brain, but when its levels drop quickly, that calming effect can disappear suddenly.”

In people with bipolar disorder, whose brain chemistry is already more sensitive, these hormonal shifts can make mood regulation harder and increase the risk of depression, irritability, anxiety, or mood swings, Dr. Gnecco explains.

“The thirties and forties are often considered a vulnerable time for women with bipolar disorder because hormone patterns start to become less predictable during these years,” she says. “Ovulation may not occur consistently, and estrogen levels can fluctuate more from month to month, even before menopause begins.”

At the same time, many women in this age group experience competing responsibilities of work, childcare, and sometimes caring for aging parents. That can mean more stress and disrupted sleep. These biological and life factors together can lower mood stability and make bipolar symptoms more likely to emerge or worsen, Gnecco adds.

During perimenopause, which is the transition period before menopause, your hormone levels decline. It’s usually gradual, but it isn’t steady. The erratic nature of these hormone changes can significantly affect women with bipolar disorder, Gnecco says.

Mood changes are a common aspect of perimenopause even without a psychiatric diagnosis, says Gail Saltz, MD, a clinical associate professor of psychiatry at the NewYork-Presbyterian Hospital Weill-Cornell Medicine Medical College and a psychoanalyst with the New York Psychoanalytic Institute. That can make it challenging to identify how much of an episode of mood fluctuations is driven by hormones and how much is bipolar disorder.

• Inconsistent menstrual schedule and changes in flow
• Hot flashes and night sweats
• Vaginal dryness and more susceptibility to vaginal infections
• Weight gain, particularly in the midsection
• Migraine headaches, typically accompanied by sensitivity to light and sound
• Brain fog, such as forgetfulness and inability to concentrate

“If your mood changes are purely a symptom of bipolar disorder, it’s likely you won’t be experiencing any of these perimenopause signs,” says Dr. Saltz.

“That said, even if your mood shifts are coming from hormonal changes, you’ll want to discuss that with your psychiatrist [or primary care physician] and address those changes accordingly,” she adds. “You don’t want something like mild or moderate depression — no matter what’s the cause — to go into severe or psychotic major depression or tip into mania because it’s going untreated.”

Careful management of your bipolar disorder is essential for navigating mood fluctuations while dealing with hormone changes, says Maral Malezadeh, MD, a gynecologist and director of clinical operations at Advanced Women’s Health and Surgery in Westlake, Ohio. She offers these suggestions:

• Put together a collaborative care team that includes your psychiatrist and ob-gyn, so they can work together to address any challenges.
• Talk with your psychiatrist about potential medication dosage changes during specific phases of your menstrual cycle or when you’re experiencing perimenopause symptoms.
• Keep a journal of potential symptoms, whether they’re tied to bipolar disorder, hormonal shifts, or both; this might include notes on irritability, sadness, euphoria, and anger as well as tracking your menstrual cycle to see if you can spot patterns.
• Discuss hormone therapy with your ob-gyn if perimenopause symptoms are disruptive.

In addition, healthy lifestyle habits are crucial for helping manage both bipolar disorder and hormonal changes, Dr. Malezadeh explains.

“Sleep loss, in particular, can be a major trigger for mood episodes in bipolar disorder since insomnia and sleep disruption can significantly destabilize mood regulation,” she says. “In addition to prioritizing consistent sleep, it’s also important to focus on stress reduction, regular exercise, stable routines, and limiting alcohol, since all of these habits can reduce vulnerability and help with mood regulation.”

• Managing hormonal health is an important part of managing mental health for every woman, particularly those with bipolar disorder.
• Tracking mood fluctuations is your most powerful tool for distinguishing between mood changes caused by bipolar disorder and those prompted by hormonal shifts, since both play a role in bipolar episodes.
• That information should be shared with both your gynecologist and psychiatrist so they can work together for meaningful care.