2026 ECNP Congress

PS01-1087

Menstrual cycle regularity in women with bipolar disorders: associations with premenstrual disturbances, hormonal contraceptives and course of illness

Sofie Ragnhild Aminoff — C. Barth, M. Skoge, S.H. Lyngstad, E. Mork, T.V. Lagerberg, C. Simonsen, S. Marwaha, K.L. Romm · Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway

2026 ECNP Congress

Introduction: The reproductive mental health in women with severe mental disorders such as bipolar disorders (BD) is a neglected area [1]. Women with BD seem to have higher rates of menstrual irregularities and premenstrual disturbances such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) compared to healthy controls [2], in addition to potential premenstrual exacerbations of mood episodes (PME), which may contribute to clinically significant distress and impairment [3]. Premenstrual disturbances in BD have been linked to more severe illness course, including earlier onset, greater number of mood episodes, and higher rates of rapid cycling [2]. However, most existing studies focus on symptom presence rather than underlying menstrual cycle characteristics, and the role of menstrual cycle regularity in shaping premenstrual symptom burden and illness course remains unclear. Hormonal contraceptives (HC) are among the first‑line treatments for moderate to severe PMS and PMDD in the general population, with evidence suggesting benefit through suppression of cyclical hormonal variation. Nevertheless, HC seem to be underutilized in women with BD. The aim of the present study was to investigate menstrual cycle regularity in women with BD of reproductive age and to examine its associations with premenstrual disturbances, course of illness, psychiatric medication, and use and attitudes toward hormonal contraception.

Methods: A co-created online survey was distributed to women with BD via the Norwegian Bipolar Association and through professional networks over 10 weeks in spring 2025. Data were collected on menstrual cycle regularity, premenstrual symptoms, course of illness, medication and HC use. The sample included 267 women with BD (BDI, BDII, Other BD; mean age 35.2 ± 8.3 S.D.), stratified into regular (n=166) and irregular (n=101) menstruation. Bivariate analyses with Bonferroni corrections were conducted, with subgroup analyses excluding current HC users.

Results: The preliminary findings are that women with BD and regular menstruation significantly more often reports having premenstrual disturbances (p≤0.001, Phi=24) than women with BD and irregular menstruation. Premenstrual symptoms such as irritability/anger/interpersonal conflicts (p=0.009, Phi=17) and physical symptoms (p≤ 0.001, Phi=24) were significantly more common in women with BD and regular menstruation than in women with BD with irregular menstruation. HC use was significantly more common in women with BD and irregular menstruation (p≤0.001, Phi=46). Women with regular cycles had more often discontinued HC due to side effects (p=0.007, Phi=17) and more often expressed reluctance to use hormones (p≤0,001, Phi=23). There were no significant group differences in any demographic variables, course of illness or comorbid gynecological or mental disorders, or in the use of medications for BD.

Conclusion: The preliminary findings of this study is that in women with BD regular menstruation is associated with greater premenstrual symptom burden. Women with BD and regular menstruation seem to have lower acceptance of HC. This may contribute to lower rates of HC in women with BD. Menstrual regularity is not associated with overall course of illness.

References

  1. Howard, L. M., Wilson, C. A., Reilly, T. J., Moss, K. M., Mishra, G. D., Coupland-Smith, E., Riecher-Rössler, A., Seedat, S., Smith, S., Steinberg, J. R., van Ditzhuijzen, J., & Oram, S. (2025). Women’s reproductive mental health: currently available evidence and future directions for research, clinical practice and health policy. World Psychiatry, 24(2), 196–215.
  2. Bengi, D., Strawbridge, R., Drorian, M., Juruena, M. F., Young, A., Frey, B. N., & Yalin, N. (2025). A systematic review and meta-analysis on the comorbidity of premenstrual dysphoric disorder or premenstrual syndrome with mood disorders: prevalence, clinical and neurobiological correlates. Br J Psychiatry, 1–14.
  3. Kuehner, C., & Nayman, S. (2021). Premenstrual Exacerbations of Mood Disorders: Findings and Knowledge Gaps. Curr Psychiatry Rep, 23(11), 78.