Most women have mild mood fluctuations and physical distress in the days before menstruation. One-fifth have moderate to severe symptoms that interfere at least partially with work, school, and relationships — although only a minority of them meets the diagnostic criteria for premenstrual dysphoric disorder detailed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). In spite of how common premenstrual mood disturbances are, little is known about how they affect women with bipolar disorder.
To learn more, researchers at Massachusetts General Hospital and colleagues in Brazil and Italy analyzed symptoms and outcomes for 293 women with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial. This federally funded, multi-site investigation enrolled patients typical of those treated in the community, so that the results are considered clinically relevant.
As in the general population, premenstrual mood symptoms were common, affecting 65% of women with bipolar disorder enrolled in STEP-BD. These symptoms worsened outcomes. Women with premenstrual symptoms experienced more mood episodes (most often bipolar depression) — and more severe symptoms — over a 12-month period. (However, they did not experience so many different mood cycles that they could be diagnosed with rapid-cycling bipolar disorder, generally defined as four or more distinct mood cycles within a 12-month period.)
In addition, women with premenstrual symptoms were more likely to relapse, and do so more quickly, than those who did not have such symptoms. On average, women with subthreshold symptoms of premenstrual dysphoric disorder (meeting some of the criteria for this disorder) relapsed in 4.5 months, while those with milder premenstrual symptoms, or without these symptoms, relapsed in 8.5 months.
The study suggests that women who have bipolar disorder and also experience moderate to severe premenstrual symptoms may want to take extra effort to maintain their mental health. This means adhering to medications as prescribed, increasing doses as needed, and maintaining healthy lifestyle habits such as getting enough sleep and eating and exercising regularly.
Dias RS, et al. "Longitudinal Follow-Up of Bipolar Disorder in Women with Premenstrual Exacerbation: Findings from STEP-BD," American Journal of Psychiatry (Feb. 15, 2011): Electronic publication ahead of print.