Harvard Mental Health Letter

In Brief: Premenstrual mood disturbances increase chances of relapse in women with bipolar disorder

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.)

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