What should you know about bipolar and perimenopause?

Hot flushes and night sweats can interrupt sleep, while menstrual changes help identify the menopausal transition. New mood symptoms should not automatically be assigned to hormones or bipolar disorder; a clinician can assess both and check for other medical or medication-related causes.

Bipolar depression may involve persistent low mood, loss of interest, slowed thinking, hopelessness, or altered sleep. Mania or hypomania may involve unusually elevated or irritable mood, much less need for sleep, rapid speech, racing thoughts, increased activity, or risky decisions. Perimenopausal mood changes may feel like irritability, anxiety, tearfulness, or reduced resilience, often alongside irregular periods or temperature symptoms.

A change from your usual pattern matters more than any single symptom. Poor sleep can destabilise mood, and medication side effects can resemble menopausal complaints. Heavy bleeding may also cause tiredness and deserves separate assessment.

Continue prescribed bipolar medicines unless the clinician managing them advises a change. Keep a daily record of sleep, mood, energy, menstrual bleeding, hot flushes, night sweats, and medicine doses; this can reveal whether symptoms cluster and helps clinicians coordinate care. Maintain regular sleep and wake times, limit alcohol, and involve a trusted person who knows your early warning signs.

Discuss menopausal treatment with both the mental health prescriber and the clinician treating perimenopause. Bring a full medication list, including supplements. Treatment can be tailored around mood history, physical symptoms, contraception needs, bleeding pattern, and other health factors.

Arrange prompt clinical review if you are sleeping far less than usual without feeling tired, becoming increasingly agitated or impulsive, hearing or seeing things others do not, feeling persistently depressed, or struggling to function. Seek emergency help now for thoughts or plans of self-harm or suicide, behaviour that places you or someone else in immediate danger, severe confusion, or loss of contact with reality. Do not remain alone while urgent help is being arranged.

Ask which signs suggest a bipolar episode rather than a short-lived menopausal mood shift, how to respond to early sleep changes, whether any current medicine could worsen sweating or sexual symptoms, and who to contact out of hours. Also clarify how any proposed hormone treatment will be monitored alongside mood and bleeding.