The Impact of Reproductive Events on the Course of Bipolar Disorder in Women. [CME]
J Clin Psychiatry 2002;63(4):284-287
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Little is known about the impact
of female reproductive hormones on the course of
bipolar disorder. This study was designed to assess
the influence of reproductive events and hormonal
therapies on the course of bipolar disorder in women.
Method: Fifty women with DSM-IV bipolar
disorder completed a structured clinical interview
to assess the impact of reproductive events on the course of their illness.
Results: The onset of bipolar disorder
occurred before menarche in 32% (N=16) of women;
18% (N=9) experienced the onset within 1 year of
menarche. Most women did not receive an accurate
diagnosis of nor treatment for bipolar disorder until
after they had children, and therefore the majority
were not treated with mood stabilizers during or
immediately after pregnancies. Of women with children,
20 (67%) of 30 experienced a postpartum mood episode. Of the women who had postpartum
episodes after delivery of a first child, all had episodes
after subsequent pregnancies. Having a postpartum
mood episode after a first pregnancy significantly
increased the risk of a postpartum episode after
subsequent deliveries (p=.02). Postpartum episodes were
almost exclusively depressive. Increased
depressive symptoms during pregnancy were significantly
associated with postpartum mood episodes (p=.01). Women who were not using hormone
replacement therapy (HRT) were significantly more likely
than those who were using HRT to report worsening
of symptoms during perimenopause/menopause (p=.02).
Conclusion: These data suggest that
hormonal fluctuations are associated with increased risk
of affective dysregulation and mood episodes in
women with bipolar disorder.