As is often the case with women and mental illness, hormonal and reproductive functions play a part in diagnosis and treatment. For women the depressive symptoms of bipolar are the most prominent. Depression for women with bipolar disorder may be longer in duration and more difficult to treat. Bipolar in women may be disguised as a depressive disorder, a personality disorder, a behaviour disorder or a general medical disorder; diagnosis needs a careful assessment with a full patient history especially as it relates to possible manic or hypomanic episodes in the past. Women are more likely to experience rapid-cycling bipolar disorder; having at least four episodes in one year. Both hormones and anti-depressant medication can have a causal relationship to rapid-cycling bipolar disorder in women. One concern for women taking mood stabilizing medication is the effect on reproductive functions and organs. Women with bipolar disorder taking medications for the illness should consult with their doctor if they are pregnant or, better still, before making the decision to become pregnant. Pregnant women taking bipolar medications should never go off their medications without consultation with a mental health professional.   

As women age and enter into menopause, changing hormone levels can cause mood disorders, whether or not they are diagnosed with bipolar disorder. For women with the diagnosis, fluctuating estrogen levels during perimenopause (the period during onset of menopause) can be an especially vulnerable time, bringing on depression symptoms. During this time a medication change and/or hormone therapy may help.