Onika L. Dainty

Aging with Bipolar disorder can significantly impact women’s mental health, oftentimes leading to more depressive episodes, increased rapid cycling and mixed episodes and a higher likelihood of co-occurring disorders like anxiety or substance use disorder. As women with Bipolar disorder age they may experience a shift in their symptoms from hypomanic and manic episodes to more frequent and longer depressive episodes, and a possible increase in the number of mood episodes especially around perimenopause. 

Perimenopause and Bipolar Disorder 

Perimenopause is the transitional period leading up to menopause, characterized by fluctuating hormone levels and changes in menstrual cycles, potentially causing symptoms like hot flashes, irregular periods, and mood changes. Perimenopause has been linked to a higher risk of developing Bipolar disorder or experiencing the exacerbation of existing symptoms related to the mood disorder due to the hormonal shifts that occur specifically the decline in estrogen. For women with pre-existing Bipolar disorder perimenopause can lead to more intense and frequent mood episodes.

Depressive Episodes and Aging

As women with Bipolar disorder age there is a shift toward more depressive episodes and fewer manic episodes however these depressive episodes may be more prolonged. Some research has shown with the passage of decades in the Bipolar disorder illness there is an increase in the predominance of depressive symptoms including lowered motivation, changes in sleep patterns and appetite changes. Some women may also experience cognitive issues as they age in this illness. There is also the possibility that symptoms become resistant to medications that worked previously. If you are noticing any of these changes in your Bipolar disorder illness it's important to consult your medical team for support during this time of transition.    

Understanding Your Needs

Aging with Bipolar disorder is a part of the process that is sometimes overlooked. Just like aging is different for men as for women, transitioning from decade to decade with a severe mental illness will also look different. As women there is more to consider such as perimenopause, menopause, mood fluctuations due to hormonal shifts and how the illness of itself ages with you. It’s important to know your needs when dealing with mental illness and be aware of the changes in your cycle. Relying on your past knowledge of Bipolar disorder can help you understand who you were in your illness rather than where your mood disorder is going as you age and what your unique needs are as you transition.    

Emotional and Psychological Impact of Aging with Bipolar Disorder: A Woman’s Insight

When I was in my 20s and 30s dealing with my illness my focus was on medication and symptom management. Because I deal with Bipolar I disorder, I have always focused on the emergence of manic symptoms as my baseline leans toward hypomania. I’m now in my 40’s and I have started to experience several depressive episodes, though temporary in nature they surprised me. My lack of understanding of what I need psychologically and physiologically in this next phase of my Bipolar disorder journey has led me to start doing my research on what this mood disorder looks like in this season of my life. 

I recently went to see my OBGYN regarding irregularities in my menstrual cycle. In my 30s I was advised due to my medication regime I was experiencing fluctuations in my cycle and after a few months my period stopped completely. A week or so before my 40th birthday my cycle returned but it was irregular and caused concerns. For the past two years though, I have felt almost normal with the return of my cycle. I have also experienced emotional and psychological ups and downs including rapid cycle manic episodes and major depressive episodes. My OBGYN said the irregular cycle is due to my age and because he is not an expert in mental health he was unable to address the psychological changes that were occurring. 

It was an older friend in her 50s that mentioned I could be experiencing perimenopause, the transitional period leading to menopause. So, I began to do my research and discovered the emotional and psychological complexities of Bipolar disorder can become more challenging during this transitional period as well as during menopause. It is well known that Bipolar disorder is derived from chemical imbalances so when women age there are fluctuations in body chemistry that affect the way mood episodes occur. For example, I find myself crying more often and experiencing days when I’m unable to get out of bed. My energy is high one minute and low the next. Recently, I went on vacation and experienced a two day manic episode, one of the shortest I’ve ever had which was brought on by lack of sleep. I have also experienced moments of visual hallucination in the past few months. 

After speaking with my psychiatrist, he advised that we shorten the time between our sessions and that I continue to monitor these fluctuations in mood. He also ordered a full blood work-up to determine whether or not there needs to be adjustments made to my treatment plan. He recommended that if unexplainable mood episodes occur to contact him right away to schedule an appointment. I have been fortunate to work with a healthcare provider that listens to my concerns, keeps an open mind and provides proactive treatment solutions. 

Bipolar disorder is a continuous rollercoaster of emotional and psychological challenges but managing your symptoms is key especially as we age. Oftentimes when you feel you have a handle on this illness life will throw you a curve ball and everything feels brand new again. It's important to remember that you have the strength and resilience to manage your mood disorder regardless of the challenges that come your way. Through self-care, support, psychoeducation, medical management and self-compassion aging with Bipolar disorder will become a phase in life you conquer rather than one that defeats you. If you are currently dealing with symptoms of aging with Bipolar disorder consult your healthcare professional for information on how you can proactively manage these new challenges.       

Medication and Treatment Adjustments for Older Women with Bipolar Disorder

When you are aging and dealing with a mental illness like Bipolar disorder it's important to remember that the illness changes as you change, psychologically, physically and emotionally therefore medication and treatment adjustments may need to be made. If you are noticing a difference in medication effectiveness or treatment strategies contact your healthcare provider to discuss adjustments that can help you continue to manage your mental illness effectively. For example, there are several medications in the categories of mood stabilizers, anti-psychotics or anticonvulsants that may currently be in your medication regime that require careful monitoring to mitigate side effects or toxicity. In other words, the medications that previously worked to manage your symptoms may need readjustment in dosage or frequency as you age to remain effective. 

Lifestyle changes should also be considered to promote mental health, physical health and to avoid developing other health concerns like diabetes, high cholesterol and blood sugar or blood pressure issues from arising and creating further health challenges. A healthy lifestyle, including regular exercise, a balanced diet and adequate sleep can play a significant role in managing Bipolar disorder especially as one ages. Also seeking the counsel of a therapist, groups or peer support can prove valuable as they have knowledge and understanding of the challenges you may face during this transitional phase.

Whichever route you choose as you grow and change in your Bipolar disorder journey it's important to remember there are supports in your community and on your team to assist you in understanding how to navigate the new path of aging and managing Bipolar disorder. The complexities of managing a severe mood disorder along with the process of aging with your illness will have its challenges but with time, research, support and continued resilience you can overcome the physical, psychological and emotional trials that often come with aging and Bipolar disorder.        

Practical Strategies for Coping with Aging and Bipolar Disorder

Coping with aging and Bipolar disorder can be challenging. Below are some practical strategies for maintaining a balanced lifestyle while dealing with this new transition and managing your mood disorder.

Establish and Maintain Structure, Routine and Good Habits

• Sleep Hygiene: Aim for a consistent sleep schedule, wake-up and go to bed at the same time daily even on weekends as disturbances in sleep can trigger mood swings.

• Structured Daily Activities: Incorporate a daily routine of activities such as exercise, regular meals and social activities like groups or meeting with friends.

• Medication Management: Take your medication daily and/or as prescribed and discuss side effects or concerns with your healthcare provider as issues arise. 

Physical and Mental Health

• Nutrition: Limit processed foods and incorporate a balanced diet rich in vegetables, fruits and whole grains. Instead of take-out food consider cooking meals daily based on your budget.  

• Exercise: Engage in physical activities you enjoy like hiking, cardio workouts, daily walking or yoga. Exercising releases endorphins and dopamine, the feel good chemicals that can combat feelings of stress or depression. 

• Stress Management: Incorporate relaxation practices like medication, breathing exercises or grounding in the morning or before bedtime to release stress. 

• Mental Stimulation: Engage in activities that stimulate the brain like reading, puzzles or learning a new skill such as refinishing furniture or crocheting. 

Build a Strong Support System

• Connect with Others: Build and maintain relationships with family, friends and support groups who can support you during difficult times.

• Professional Support: Seek the help of professionals such as psychologists, counselors or psychiatrists who can address mood fluctuations and help you develop coping skills.

• Self-Advocacy: Communicate your needs to your healthcare team and support network. Openly share your experiences to find circles of support from like-minded individuals.  

More Strategies

• Address Age-Related Changes: Monitor potential age-related changes in your emotional and psychological cycle to address with your healthcare providers. 

• Manage Chronic Conditions: If you have any other chronic conditions such as diabetes or blood pressure concerns, work with your healthcare team to manage them effectively. 

• Stay Active and Engaged: Continue to do activities that bring you joy and fill your life with purpose. 

• Memory Aids: Use tools like calendars, to-do lists, daily planners, reminders and alarms to help keep track of medications and appointments. 

Final Thoughts

Aging with Bipolar disorder presents unique challenges, but with the right strategies, support, and self-awareness, women can navigate this journey with confidence. From understanding how symptoms change over time to adjusting treatment plans and nurturing relationships, the key is to remain proactive and practice self-compassion. When you grow and change so will your Bipolar disorder and how you manage your symptoms. Aging has never been an easy process with everyday, year or decade that passes so does the emotional and psychological needs of women. Remember Bipolar disorder is a lifelong  and complex condition. How you handle the challenges and pitfalls of this complicated mood disorder is up to you. Through psychoeducation and vigilant observation of your changing Bipolar cycle it's possible to maintain control of your journey to wellness especially during the aging process.   

If you or a loved one are facing aging with Bipolar disorder, it’s essential to seek out professional guidance, stay connected with supportive networks, and develop practical coping mechanisms. Remember every day is an opportunity to do something you’ve never done before, so today embrace the process of aging with Bipolar disorder and prioritize your mental health  and wellness every step of the way.

 “You treat men like disposable objects, like trash, you hurt them, men like me who want love and relationships with your destructive behaviours. You made up this stupid word ‘situationships’ to exempt you from being responsible for how your actions affect the other person. You hate men, you use them and abuse them and I’m sorry you were raped so much but maybe you should deal with your problems before you engage in another relationship, maybe you should try being a worthwhile person who deserves love…” 

Michael, which is not actually his name but for the sake of confidentiality it’s what I am going to call him, had so much more to say and he said it with a certain and violent anger as if he and I had been engaged in one of these situationships and he was the man I had hurt, used and abuse instead of meeting in January 2025 online for the first time  at least that's how it came across to me. I have been in a Cognitive Processing Therapy group for the last 10 weeks attempting to understand how my past trauma has affected my present life and interpersonal relationships. I was told in my intake last December 2024, that an unusual occurrence had happened in this intake where there were more men wanting to address their trauma than the organization had seen in many years. My psychotherapist realized because of the nature of my trauma, Gender-Based Violence, I may experience some discomfort with their presence. I was determined to join however not 100% comfortable with the idea but willing to explore it.

For the first 5 or 6 weeks I barely said anything, I just sat in my big red  chair, well mannered and well groomed, listening to the other group members share some of the most horrific traumas outside of my own that I had ever heard. I empathized with all of them but I kept quiet only speaking when asked to share my weekly emotions during check-in and my group take-away during check-out. I realized around session seven that I was not only afraid to share my trauma with the men in the group I was terrified of their judgement and rejection. 

Every week a member of the group would go over our homework worksheet where the three facilitators would help us understand our “Stuck Points” (the elements of the trauma that was keeping us in the trauma rather than moving forward and healing). Every week I would try to do some of the homework and I would fail, not because I didn’t find it relevant or useful but because I had avoided and covered up my pain and trauma so long it was like it was never even there like a picture you hang over a giant hole in your wall instead of fixing the wall, you know there is damage there but the pretty picture covers it so well you forget. I feel with my lack of engagement in the group perhaps Michael could only see the pretty picture I presented and not the giant empty and hollow hole of trauma that lived inside me. 

By week eight I made up my mind to share my homework and thus share my story with the group. I can remember the day of group, March 17, 2025 and what my stuck point was: “When there are too many men in a room with me, especially if they are intoxicated, I can’t control the situation and I will be attacked and raped because all men are dangerous and capable of rape.” When my group facilitator asked me why I felt this way, a watershed of emotional blockage came unstuck and I told the group everything. I was molested as a child, I was gang-raped at 14-years old by five boys in highschool, I was raped at 18-years old by my boyfiend and I was drugged and raped at 27-years old by a stranger I met at a club. This is the trauma I carry inside of me and the narrative that goes with it is: 

“All men are dangerous and even if you are attracted to them, the minute you lose control of the situation aka situationship run far, run fast, do something destructive to push them away because they will destroy you anyway so don’t give them your power ever again.”  

I didn’t realize I felt this way until week eight when I shared my trauma with the group. I believed these feelings were in the past and I could explain all my self-destructive behaviours related to men by placing the label of Mania or Psychosis in Bipolar disorder on it. The truth is however, as angry, hurt and embarrassed as I was over what Michael screamed in my face during group last week there is also a sense of release and self-discovery because for the first time since therapy started I had a breakthrough. I don’t agree with most of what he said or how he said it but I must honour the mirror he put up to my face. 

When I look at myself in that mirror I see a woman with decades of unaddressed trauma who avoids relationships because she is afraid and does not feel worthy of love because she is damaged. I see a woman who doesn’t feel safe anywhere, not even in her own home; I see a woman that sexualizes herself so men will find her worthwhile; lastly I see a little girl who got dealt a bad hand but has grown into a strong person who is trying to release the lifetime of pain she's been carrying in her mind, body and spirit. I don’t know where my trauma healing journey will lead me and I don’t know if my fellow group member is correct in saying stay away from men until you heal (kinder way of rephrasing). I do know everyday I fall a little more in-love with myself, everyday I feel a little stronger, everyday I feel a little more worthy and at peace with myself and everyday I feel closer to the ultimate goal of self-love and forgiveness. I may never heal to the point of being in a loving partnership, it may be me and all my journals for the rest of my life (I have no animals yet) either way I’m excited to find out.

If this self-reflection was as hard for you to read as it was for me to write, reach out, leave kind comments as its been a hell of a week, let’s connect, let’s have a conversation that takes us beyond the stigma of trauma to a place of healing, forgiveness and self-love.