Menopause associated with increased risk of mania and bipolar disorder

Menopausal women are more likely to experience mania and severe depression, according to new research from Cardiff University.

In a study of 128,294 women across the UK, a team from the University's School of Medicine and Bipolar UK investigated whether perimenopause – the several years before and after your last menstrual period – is associated with an increased risk of developing mental illness.

The study grew out of Professor Ariana Di Florio's direct experience with the women she saw in her mental health clinic.

“During menopause – the several years before and after the last menstrual period – around 80% of people experience symptoms such as hot flashes, cognitive impairment, sleep disorders and mood-related symptoms. However, the extent to which this influences the development of severe mental illness was unclear,” said Professor Di Florio, who was awarded an ERC Starting Grant in 2020.

“In my clinic, I've found that some women who had lived lives without previously experiencing serious mental health problems develop serious mental illnesses around the time of menopause.”

“I feel an obligation to the women I work with, and I wanted to provide them and others with answers as to why they might be feeling this way,” she added.The study is the first known to examine the link between mental health issues that first appear in the years around menopause.

The team focused on the four-year period around the last menstrual period and found that rates of mental illness increased significantly compared to six to 10 years earlier. Rates of mania increased 112% around the time of menopause. Rates of major depression increased 30%.

No association was found between menopause and the occurrence of schizophrenia spectrum disorders.

An increased risk of mania and major depression was associated with a brief period of 4 years during menopause, with the risk decreasing substantially once women entered the postmenopausal stage.

Professor Di Florio said: “Studies like this are crucial as women undergo major changes in their lives and bodies and we currently lack a detailed understanding of these changes.”

“We can broaden knowledge about the mental health changes associated with menopause, which could help to explain, diagnose and support women who may not have been informed about what is happening to them.”

Claire Dolman, ambassador for the Bipolar Disorder UK Association and patient and public engagement lead for the project, said: “This study is extremely important as it demonstrates for the first time in a large sample that the menopausal transition has a measurable impact on women's mental health.”

“To me, this confirms what we've observed and what we've heard from women with bipolar disorder: that hormonal changes are a critical component of mood disorders and deserve to be studied thoroughly.”

“I myself am a woman who has bipolar disorder and gone through menopause, and I hope the research community will recognise the importance of this funding. This research will enable us to predict women's risk of unexpected illness during this time. That knowledge could save lives.”

This study focused on first-time experiences of mental illness during the perimenopause and did not explore the association with recurrence of existing mental illness during the perimenopause. Further research focusing on people with a history of mental illness is needed.

The research The study, published in Nature Mental Health, examines first-episode symptoms of mania, schizophrenia spectrum disorder, and major depressive disorder during menopause. European Research Council.

About Cardiff University

Cardiff University has been recognised in an independent government assessment as one of the UK's leading teaching and research universities and is a member of the Russell Group of the UK's most research-intensive universities. In the 2021 Research Excellence Framework, 90% of the University's research was rated as world-leading or internationally excellent. Its academic staff include two Nobel Prize winners, including Professor Martin Evans, winner of the 2007 Nobel Prize in Medicine. Founded by Royal Charter in 1883, the University today combines impressive modern facilities with a dynamic approach to teaching and research. The University's wide range of expertise includes the College of Arts, Humanities and Social Sciences, the College of Biomedical and Life Sciences, and the College of Physical Sciences and Engineering. The University's research institutes address some of the challenges facing society, the economy and the environment. more