Both conditions involve shifts in mood. However, premenstrual syndrome (PMS) is related to your menstrual cycle, and bipolar disorder episodes can operate independently of your cycle.
Bipolar disorder and PMS may be connected, but their relationship is complex.
Research suggests that some people with bipolar disorder may experience heightened symptoms of mood instability during the premenstrual phase, potentially due to hormonal fluctuations.
However, having PMS does not cause bipolar disorder. The two conditions require distinct approaches to diagnosis and treatment.
There’s no evidence to suggest that bipolar disorder causes PMS or vice versa.
However, the hormonal changes associated with PMS can worsen mood symptoms in people with bipolar disorder. A 2021 review found that premenstrual exacerbations (PME) of bipolar disorder symptoms are common.
In many cases, PME of bipolar disorder symptoms can look like the symptoms of PMS. Overlapping symptoms of bipolar disorder and PMS include:
- anxiety
- extreme changes in energy (fatigue or restlessness)
- feelings of sadness and hopelessness
- irritability
- sleeping too much or too little
People with bipolar disorder may also be more likely to experience premenstrual dysphoric disorder (PMDD), a mental health condition often described as “extreme PMS.”
A 2021 systematic review found that people with bipolar disorder, especially bipolar II disorder, may be more likely to experience PMDD than the larger population.
This could be due to how hormone fluctuations affect mood regulation, particularly in those already predisposed to mood disorders.
Still, PMS does not increase the risk of developing bipolar disorder. Instead, it may amplify existing mood-related symptoms in those who already have a diagnosis of bipolar disorder.
Research indicates that comorbidity between bipolar disorder and PMS is not uncommon. One 2014 study found that
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This comorbidity can affect people’s overall treatment plan and outlook. For example:
- Differentiating between bipolar disorder mood episodes and PMS symptoms can be difficult, which could make it harder to diagnose bipolar disorder.
- Hormonal changes may also trigger bipolar disorder episodes.
- You may need to adjust your bipolar disorder treatment to address PMS.
If you experience both bipolar disorder and PMS, it’s important to discuss this with the healthcare professional who treats your condition, whether it’s a primary care physician, psychiatrist, or therapist.
The key differences between these conditions lie in the timing, duration, and intensity of symptoms:
- PMS: Symptoms typically occur in the luteal phase (1 to 2 weeks before menstruation) and resolve shortly after menstruation begins. Symptoms are generally mild to moderate and include irritability, fatigue, bloating, and mood changes.
- PME: People with bipolar disorder may experience a worsening of their usual symptoms, such as depression or mania, during the premenstrual phase. PME aligns with hormonal changes but is more severe and persistent than typical PMS.
- Bipolar disorder episodes: Symptoms of bipolar disorder, such as prolonged periods of depression, mania, or hypomania, occur outside the context of the menstrual cycle. These episodes typically last longer than PMS and can interfere significantly with daily functioning.
If you think you may have PMS, bipolar disorder, or both, you might benefit from tracking your symptoms over several menstrual cycles. Keeping a symptom diary can provide valuable insights for you and your healthcare professional.
Bipolar disorder and PMS are distinct conditions, but they can overlap or interact. Understanding the relationship between these conditions can help guide treatment and improve quality of life.
If you’re experiencing significant mood changes or worsening bipolar disorder symptoms during your menstrual cycle, talk with a healthcare professional. They can help you identify patterns, adjust treatments, and develop a tailored management plan.
Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.