Reproductive stage progression linked to worsening bipolar disorder

By Mark Cowen

Results from a US study of women with bipolar disorder suggests that the illness may worsen with progression toward the later stages of reproductive life.

The findings follow previous studies showing that late perimenopause and early postmenopause are associated with an increased risk for depression in the general population.

Wendy Marsh (University of Massachusetts, Worcester) and team studied 519 premenopausal, 116 perimenopausal (including 13 women transitioning from perimenopause to postmenopause), and 133 postmenopausal women with bipolar disorder over a mean period of 19.8 months.

The proportion of clinic visits in which the women presented with syndromal depression, syndromal elevation, and euthymia during this time was recorded.

The team found that the proportion of visits in which the women were euthymic decreased with reproductive stage progression, from 29.3% in premenopausal women, to 27.0% in perimenopausal women, and 25.0% in postmenopausal women.

The proportion of visits in which women presented with syndromal mood elevation decreased from 5.3% to 4.1% and 3.0% in premenopausal, perimenopausal, and postmenopausal women, respectively, while the proportion of visits with subsyndromal symptoms increased from 47.3% to 50.7% and 52.7%, respectively.

The 13 women who were transitioning from peri- to postmenopause had a significantly greater proportion of visits with syndromal depression, at 24.4%, than premenopausal, perimenopausal, and postmenopausal women, at 18.1%, 18.1%, and 19.3%, respectively. There was no significant difference among the latter three groups.

Marsh and team conclude in Bipolar Disorders: "A progression in female reproductive stages was associated with bipolar illness exacerbation."

They add: "Future studies, which include hormonal assessments, are needed to confirm these preliminary findings."

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