Bipolar Disorder and Perimenopause: An Update.

Abstract

Perimenopause has been associated with mood worsening in some individuals, including increased depressive symptoms. Yet, the link between bipolar disorder (BD) and perimenopause remains understudied. This review aimed to provide an update on recent original studies and contextualize findings within the broader literature to guide future research and clinical practice. A systematic search was conducted on Embase (January 1, 2018 to August 5, 2026) to identify studies on BD (I, II, or NOS/BD spectrum) that directly or indirectly examined perimenopause and BD. Pooled samples were included if they reported separate BD results. Results were narratively synthesized. Fourteen studies were identified from Australia (n = 4), Italy (n = 3), UK (n = 2), Taiwan (n = 1), South Korea (n = 1), Sweden (n = 1), USA (n = 1), and one study of international trials. There is converging evidence showing that perimenopause is a period of higher risk of first onset BD. Among individuals with existing BD, increased depression and heightened anxiety during perimenopause were the most consistent illness-course findings, whereas findings for hypo/mania were mixed. Evidence concerning psychotherapy or pharmacological treatment, including hormone replacement therapy, was limited or absent. This review provides an updated perspective on BD and perimenopause, extending existing knowledge beyond mood symptoms and identifying several clinical and research gaps. Clinicians should consider the potential impact of perimenopause in BD management. Research using standardized menopause staging criteria (e.g., STRAW+10) is encouraged to inform mechanisms, illness trajectories, treatments, and to better support individuals with BD through perimenopause.