In women with bipolar disorder, premenstrual mood changes are associated with more depressive episodes and more severe symptoms, researchers have found.

The findings from the study of nearly 300 women offer evidence that premenstrual flare-ups of mood symptoms may be a clinical marker predicting greater severity of bipolar disorder in reproductive-age women, said Dr. Rodrigo Dias and colleagues at Massachusetts General Hospital.

The bipolar women with pre-mentrual mood changes had more episodes of depression and worse symptoms the following year, compared with bipolar women without premenstrual mood changes, the researchers found.

The study is published in the Feb. 15 online edition of the American Journal of Psychiatry.

Through their action on the central nervous system, estrogen and other reproductive hormones influence mood, the researchers explained. the time period following childbirth and the menopause transition are also times when women with bipolar disorder are more vulnerable to relapse.

In general, the way fluctuating hormone levels influence mood may result in greater mood instability among these patients, the study authors noted.

“The results reinforce the importance of identifying mood fluctuations across the menstrual cycle in women with bipolar disorder,” Dias said in a journal news release. “The women with premenstrual mood changes may benefit from more intensive monitoring. the value of antidepressants isn’t clear, since on the one hand, these women were less likely to be taking antidepressants and might have benefited from them. But on the other hand, antidepressants can trigger manic symptoms in bipolar patients.”

The American Academy of Family Physicians has more about bipolar disorder.

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Robert Preidt