---
title: What is the impact of having both bipolar disorder and premenstrual dysphoric disorder?
description: Women with both conditions experience significantly worse bipolar illness: earlier onset, more rapid cycling, more mood episodes, and higher rates of anxiety
url: https://niyora.com/research/papers/increased-illness-burden-in-women-with-comorbid-bipolar-and-premenstrual-2017/
---

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- What is the impact of having both bipolar disorder and premenstrual dysphoric disorder?

Survey study, 2017

# What is the impact of having both bipolar disorder and premenstrual dysphoric disorder?

Women with both conditions experience significantly worse bipolar illness: earlier onset, more rapid cycling, more mood episodes, and higher rates of anxiety disorders and other conditions. They also experience more severe symptoms during pregnancy and while taking oral contraceptives.

 Early or limited evidence

1,099 women with bipolar disorder from the STEP-BD study

## What they did

Cross-sectional study of 1,099 women with bipolar disorder who participated in the STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder). Psychiatric diagnoses were made using structured interviews, and PMDD was diagnosed using standard criteria. Female-specific mental health was assessed using self-report questionnaires.

## What they found

Women with both bipolar disorder and PMDD had earlier onset of bipolar illness (p < 0.001), higher rates of rapid cycling (p = 0.039), more past-year hypo/manic episodes (p = 0.003), and more lifetime and past-year depressive episodes (p < 0.05). They also had higher rates of panic disorder, post-traumatic stress disorder, generalized anxiety disorder, bulimia nervosa, substance abuse, and adult ADHD. Mood symptoms were more severe during pregnancy and while taking oral contraceptives (p < 0.001).

## What it means for you

Having both PMDD and bipolar disorder is associated with worse overall illness and suggests that hormone sensitivity may affect both conditions. This was studied in women already being treated for bipolar disorder in a specialized program, so results may not apply to all women with bipolar disorder.

1,099

women with bipolar disorder studied

p < 0.001

earlier bipolar onset with PMDD

p = 0.039

higher rapid cycling rate with PMDD

## About the study

Original title Increased illness burden in women with comorbid bipolar and premenstrual dysphoric disorder: data from 1 099 women from STEP-BD study Authors Slyepchenko A, Frey BN, Lafer B et al. Journal Acta psychiatrica Scandinavica Year 2017 Study design Survey study Participants 1,099 What was tested Examination of comorbid PMDD in women with bipolar disorder Open access Yes Read the paper [doi.org/10.1111/acps.12797](https://doi.org/10.1111/acps.12797)

## Topics

[Premenstrual dysphoric disorder (PMDD)](https://niyora.com/research/topics/condition-pmdd/)[Low mood and depression](https://niyora.com/research/topics/symptom-depression-mood/)[Anxiety and tension](https://niyora.com/research/topics/symptom-anxiety/)[Oral contraceptives and drospirenone](https://niyora.com/research/topics/treatment-hormonal-contraceptives/)[ADHD](https://niyora.com/research/topics/comorbidity-adhd/)[Bipolar disorder](https://niyora.com/research/topics/comorbidity-bipolar/)[Anxiety disorders and OCD](https://niyora.com/research/topics/comorbidity-anxiety-disorders/)[Eating disorders](https://niyora.com/research/topics/comorbidity-eating-disorders/)[Quality of life and daily functioning](https://niyora.com/research/topics/life-area-quality-of-life/)[Adolescents and young people](https://niyora.com/research/topics/life-area-adolescents/)

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## Related studies

Review, 2026

Is premenstrual dysphoric disorder now recognized in the international diagnosis system?

Study, 2026

Could early stress or past trauma make PMDD symptoms worse later in the cycle?

Survey study, 2025

Are women with ADHD more likely to have PMDD?

Randomised trial, 2020

How should premenstrual syndrome be diagnosed and treated?

Cohort study, 2010

How do anxiety disorders differ across different life stages?

Review, 1999

Do SSRI antidepressants work for PMDD?

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