How bipolar disorder shows up in women

Bipolar disorder is a chronic mood disorder characterized by dramatic shifts in mood, energy, and behavior. The condition affects men and women equally, but bipolar symptoms in women may present a bit differently. For example, women are more likely to experience longer periods of depression — possibly due to hormones and stress. 

How you manage bipolar disorder may depend on your symptoms, triggers, and lifestyle. If you or a woman in your life is experiencing bipolar episodes, here’s what you need to know about understanding and coping with the condition. 

A note on language: At Rula, we believe that people of all genders deserve research-backed mental health support. Much of the existing research on bipolar disorder has historically focused on people assigned female at birth (AFAB), which has shaped how symptoms, risks, and treatment patterns are understood.

While gender identity and lived experience matter, many of the biological risk factors discussed in this article relate specifically to AFAB people. At the same time, we recognize that bipolar disorder affects people of all genders and that socialization, access to care, and diagnostic bias all influence how bipolar disorder is recognized and treated. As research becomes more inclusive and expands beyond binary frameworks, we’re committed to updating our content to reflect these advances.

Signs of bipolar disorder in women

There are different types of bipolar disorder, but bipolar 2 is most common among women ^[1]. Bipolar 2 involves episodes of depression and hypomania, a milder form of mania. To be diagnosed with bipolar 2, your depressive episodes must last for at least two weeks, and your hypomanic episodes must last at least four days.

While most men experience manic episodes to start, women are more likely to experience depression first. Possible signs of a depressive episode in women include: 

• Low energy and fatigue

• Feelings of shame, guilt, or worthlessness

• Difficulty with focus and concentration

• Trouble falling and/or staying asleep

• Unintentional changes in appetite or weight

• Thoughts of suicide* or self-harm

Research has also found that women are more likely to experience mixed mania ^[2]. This is when you experience periods of high and low mood either at the same time or one quickly after the other. For example, you might feel energized while also feeling upset or depressed. This can be particularly challenging because it's harder to understand what you're feeling and know how to get help.

Learning about the signs and symptoms of bipolar disorder is key to getting the right help for your needs. Bipolar disorder in women is sometimes misdiagnosed as other mental health conditions. These include: 

• Depression

• Attention-deficit hyperactivity disorder (ADHD)

• Anxiety disorders

• Borderline personality disorder (BPD)

*The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. If you’re experiencing a life-threatening emergency or need immediate help, please call 911.

How bipolar disorder impacts women differently

Both men and women can develop bipolar disorder, but the condition can affect people differently depending on the gender they were assigned at birth. Here's what you should know about the differences in risk factors, symptom development, and diagnosis. 

Later onset and diagnosis 

Women tend to have their first bipolar episode later than men. The average age of onset is 27 years for women ^[2] and 22 years for men. Women are also more likely to be diagnosed later, possibly due to misdiagnosis or co-occurring conditions. 

Different symptoms

Compared to men, women with bipolar disorder are more likely to experience depressive episodes, mixed mania, and rapid cycling ^[3]. With rapid cycling, your mood can shift quickly and intensely. Women may find that this impacts their relationships and caregiving responsibilities or makes them come across as "too emotional" at work.

Correlation with hormones

Hormones can also influence bipolar episodes ^[4] in women. Menstruation, pregnancy, postpartum, and menopause are all associated with hormonal changes that may worsen symptoms. 

Co-occurring concerns

Research has found that women with bipolar disorder have an increased risk of certain health concerns ^[3], like:

• Anxiety disorders

• Thyroid disease

• Diabetes 

• Suicidal thoughts and behaviors

• Obesity 

What causes bipolar disorder in women?

The exact cause of bipolar disorder is unknown, but some possible risk factors include genetics, brain chemistry, and early life experiences. For example, you may be more likely to develop bipolar disorder if you have a close family member with the condition. Traumatic experiences, like sexual abuse or chronic stress, may also contribute to the development of bipolar disorder. 

Studies show ^[5] that hormones can play a key role in the development of bipolar disorder in women. The postpartum period is considered high risk ^[6] for the onset and recurrence of symptoms, with data showing that up to two-thirds of women with bipolar disorder report experiencing postpartum mania or depression. Having premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) may also worsen symptoms for women with bipolar disorder. 

Diagnosis and treatment options for women

Learning to effectively manage bipolar disorder begins with an accurate diagnosis. If you think you may be showing signs of bipolar disorder, it’s best to consult a mental health professional. Look for a provider who specializes in treating bipolar disorder and understands how the condition affects women. You also want someone who makes you feel comfortable and can help you meet your personal treatment goals.

Because bipolar disorder symptoms in women sometimes mirror those of other conditions, it can take time to diagnose the condition. Your provider may use a range of tools, including screening tests, a mental health evaluation, and blood work to rule out possible medical conditions. From there, treatment will likely involve a combination of talk therapy and medication. 

Talk therapy

Therapy can help you understand your thoughts, feelings, and behaviors. Some of the most common types of therapy for bipolar disorder include cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and dialectical behavior therapy (DBT). You may even want to include your loved ones with family-focused therapy (FFT).

Medication

Most people with bipolar disorder can benefit from taking medication to help balance their moods. Prior to starting any medication, it’s important to discuss benefits and possible side effects with your provider. For example, some medications may not be safe while breastfeeding or may contribute to undesirable side effects, like weight gain.

Other tips for coping with bipolar disorder as a woman

Receiving a bipolar disorder diagnosis can be scary, but it doesn't have to change your quality of life. In addition to professional support, other strategies to help women cope with bipolar disorder include: 

Getting enough sleep

A lack of sleep can bring on manic episodes ^[7] — especially among women and people with bipolar 1 disorder. To get better sleep, focus on creating a peaceful sleep environment, following a consistent sleep schedule, and avoiding caffeine before bed. Screen time can also interfere with sleep, so try to avoid using your phone, computer, or TV an hour before bed.

Looking for behavior patterns

Over time, you may begin to realize that certain feelings or situations bring on bipolar episodes. Some of the most common bipolar disorder triggers for women include stress, sleep disturbances, and hormonal changes. Unhealthy substance use is another well-known trigger for bipolar disorders. While it can affect people of any gender, rates of unhealthy substance use are generally lower in women than in men.

Leaning on your support network 

Living with bipolar disorder can feel lonely at times, but remember that you don’t have to manage it on your own. Whether it’s friends, family, or bipolar disorder support groups, make time for people who offer encouragement, actionable advice, and gentle support when you need it. 

Setting clear boundaries  

Setting healthy boundaries may help you avoid stress-related triggers. For example, you might block off short, planned breaks on your calendar to prevent burnout — without stepping away during critical deadlines. Boundaries may also include protecting consistent sleep and wake times ^[8], limiting late-night commitments, and saying no to activities that significantly disrupt your routine. Over time, these boundaries can support emotional regulation and lower your risk of mood episodes.

Clinician’s take

In my experience, bipolar symptoms in women are often mistaken for anxiety, depression, or emotional reactivity. Hypomania can look like productivity, caregiving, or ‘doing it all,’ rather than a mood episode. When elevated symptoms aren’t recognized as part of bipolar disorder, women may receive treatment for the wrong condition, which can delay accurate diagnosis and effective care.

Brandy Chalmers, LPC

Clinical reviewer