Regular periods, but worse symptoms: Women with bipolar disorder losing out on gynaecological care

Researchers have found that women with bipolar disorder who have regular menstrual cycles are more likely to report severe premenstrual symptoms than those with irregular cycles, according to preliminary research being presented at the 2026 ECNP Congress in Munich.

The study, led by researchers in Norway and international collaborators, surveyed 267 women of reproductive age with bipolar disorder. It found that women with regular menstruation (62% of the sample) more often than those with irregular menstruation (38% of the sample) reported premenstrual symptoms such as irritability, anger, relationship difficulties, physical symptoms and significant distress or interference with work, activities or relationships every or almost every premenstrual phase in the last year.

The researchers also found that women with regular cycles were less likely to use hormonal contraceptives than women with irregular cycles. Most of the women in the sample (93%) had tried hormonal contraceptives, but a larger proportion of women with regular menstruation had stopped because of side effects, and expressed more reluctance to use hormones.

Lead researcher, Dr Sofie Ragnhild Aminoff (of Oslo University Hospital) said “This was an unexpected finding, and raises important questions about whether some women with bipolar disorder may be especially sensitive to hormonal contraceptives, while others might potentially benefit from it”.

Bipolar disorder is a serious mental health condition involving episodes of depression and elevated or irritable mood, as well as periods with no or few symptoms. A majority of women with bipolar disorder experience some kind of premenstrual disturbance (either premenstrual symptoms or premenstrual exacerbations of the bipolar disorder), but reproductive mental health in women with severe mental illness remains an under-studied area.

Around 1% to 2% of women have bipolar disorder, meaning that there will be approximately 235,000 women with BD who are of childbearing age in a large European country such as the UK, France, Italy, with even more in Germany.

Sofie Aminoff said: “I have met many women with bipolar disorder who described changes in mood, psychotic symptoms or suicidal thoughts varying with their menstrual cycle. These experiences can have a real impact on daily life, but clinicians currently have very limited guidance on how best to help.”

She added: “Our main message is that premenstrual symptoms in women with bipolar disorder need to be taken seriously. We need more research and clearer clinical guidelines so that women and the health care system can make better-informed decisions about treatment, contraception and mood-stabilising medication.”

“These findings may have important clinical implications. Many women with bipolar disorder report that their premenstrual symptoms are not taken seriously, and few experience getting the treatment they need. Assessment and information of premenstrual symptom burden alongside tailored hormonal contraceptive and mood-stabilizing medication should be standard care but unfortunately does not appear to be so”.

The authors stress that findings are preliminary and come from an online survey, and that the work has not yet been submitted to a peer-reviewed journal.

Dr Aminoff added “These results highlight the need for closer collaboration between psychiatry and gynaecology, and for research that looks not only at mental health symptoms but also at hormonal contraception and reproductive health”.

Commenting, Professor Louise Howard (Professor Emerita in Women's Mental Health, King’s College, London) said:

“It is great to see preliminary research into the reproductive health of women with bipolar disorder being presented at this conference. This has been an under-studied area for too long and the relevance of menstrual cycle regularity on symptoms and potential interventions such as hormonal contraception is poorly understood and deserves further investigation."

Dr Clare Dolman, Co-chair of the Bipolar Commission and Ambassador Bipolar UK added:

"I totally agree with Dr Aminoff’s take-home message from this research that premenstrual symptoms in women with bipolar need to be taken more seriously. Not only can they exacerbate bipolar symptoms but sensitivity to hormonal change can be a marker for potentially dangerous relapse at other times such as pregnancy, childbirth and perimenopause. We badly need more research in this area; women’s mental health generally has been ignored for too long."

Reference:

Regular periods, but worse symptoms: Women with bipolar disorder losing out on gynaecological care, European College of Neuropsychopharmacology, Meeting: 39th ECNP Congress.