Association between Premenstrual Mood Exacerbation in bipolar disorder with reproductive hormone-related mood disturbances: findings from STEP-BD

Abstract

Introduction: Premenstrual mood exacerbation (PME) is a frequent complaint in women with Bipolar Disorder that correlates with a worse illness course. We hypothesized that women with PME would be more likely to have mood disturbance during other changing reproductive-hormone related states - pregnancy, postpartum, on birth contraceptive pills (BCP), and PMS in their teenage years—suggesting a shared hormonally mediated susceptibility. Methods: The association of PME with other reproductive-related mood symptoms (RRMS) was analyzed in 129 (premenopause-age women (mean age 33.2 ± 5.4) with BD (58.9% type I, 38% type II, 1.6% NOS, 1.6% schizoaffective) in the Systematic Treatment Enhancement Program for Bipolar Disorder who had had at least one pregnancy using Pearson Chi-squared tests and backward elimination logistic regression analysis. Results: The prevalence of mood disturbance was 72.9% premenstrually, 50.4% during pregnancy, 59.7% postpartum, and 49.7% on a BCP. All women reported regular menstrual cycles. Women with PME were less likely to be using a BCP(16.6% vs. 31.4%), SSRI/SNRI(19.1% vs. 37.1%, p = 0.03), and more likely to have had early-onset PMS(80.9% vs. 60.0%, p = 0.02) but there was no association with other RRMS . In regression analyses adjusting for age, bipolar type, and current use of SSRI/SNRI and BCP, women with early-onset PMS were more likely to have PME of their bipolar disorder (OR 2.7, 95% CI 1.1–6.6, p = 0.03), current BCP use was an independent predictor of PME (OR 2.7, 95% CI 1.1–6.9, p = 0.04), but current SSRI/SNRI was not. Discussion: RRMS were reported frequently. There was no association between PME and other RRMS, except early-onset PMS, suggesting that there may be a different mechanism underlying susceptibility reproductive-associated mood disturbances in bipolar disorder.