Illness Episodes in Relation to Reproductive Cycle Events in Women With Bipolar Disorder: Data From the Bipolar Disorder Research Network

Background and Aims: Reproductive cycle events are associated with mood episodes in at least some women with bipolar disorder. We aimed to establish whether illness episodes in relation to menstruation, childbirth and menopause are associated with each other in women who have bipolar disorder.

Method: Participants were 339 post‐menopausal women with DSM‐IV bipolar disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). History of premenstrual mood change was measured using the self‐report Premenstrual Symptoms Screening Tool (PSST). History of postpartum episodes was measured via semi‐structured interview (Schedules for Clinical Assessment in Neuropsychiatry, SCAN) and inspection of case‐notes. Participants self‐reported illness episodes during the perimenopausal period via questionnaire.

Results: History of a postpartum episode within six months of delivery (OR=2.13, P=0.03) and history of moderate/severe premenstrual syndrome (OR=6.33, P<0.001) were significant predictors of the presence of a perimenopausal episode, even after controlling for demographic factors. When we narrowed the definition of premenstrual mood change to premenstrual dysphoric disorder it remained significant (OR=2.68, P=0.007). History of postpartum psychosis was a significant predictor of a manic (OR=2.84, P=0.03) but not depressive episode during perimenopause.

Conclusion: Some women who have bipolar disorder may be particularly vulnerable to illness episodes in relation to reproductive cycle events throughout their life. There is a need for prospective longitudinal studies of women with bipolar disorder providing frequent contemporaneous ratings of their mood across reproductive cycle events to overcome the limitations of retrospective self‐report data.