Premenstrual Dysphoric Disorder (PMDD) and bipolar disorder are two conditions that impact mental health. They share symptoms and often occur at the same time.
1 in 20 women in the US have PMDD, while around 2.8% of the female population has bipolar disorder [1] [2]. Research shows up to 70% of women with PMDD have a psychiatric disorder, including bipolar disorder [3].
Understanding the differences and overlap between the two can help ensure you receive the right diagnosis and the most effective treatment. Let’s take a look at PMDD vs. bipolar.
What Is PMDD?
PMDD is a medical condition that affects women during the luteal phase of menstruation, around two weeks/a week before their period. It’s a more severe form of premenstrual syndrome (PMS) and causes intense, often debilitating, physical pain, as well as mood swings and emotional distress. For many women with PMDD, the condition negatively impacts their ability to work, relationships, and daily functioning.
PMDD symptoms surface at reproductive age, but most women don’t receive a diagnosis until in their 20s or 30s. PMDD is largely underdiagnosed, with one study finding close to 60% of women had probable PMDD [4].
The exact cause of PMDD isn’t known, but researchers believe it might be due to a heightened sensitivity to natural hormone changes during the menstruation cycle. They think the reaction causes a drop in serotonin, a hormone that regulates mood, sleep, and digestion [5].
Any woman can develop PMDD, but the risk is higher if they:
- Have family members with PMS or PMDD
- Have a history of depression, postpartum depression, or other mood disorders
- Don’t have access to education about PMDD management and treatment
- Smoke cigarettes
What Is Bipolar Disorder?
Bipolar disorder is a mental health condition that leads to extreme changes in mood and energy levels. It’s characterized by two states: emotional highs known as mania or hypomania, and emotional lows, known as depression.
The shifts between states affect sleep, activity, judgment, and behavior and can happen rarely or several times a year. They usually last for a few days. It’s also possible for someone with bipolar disorder to experience both mania/hypomania and depression at the same time.
Similarly to PMDD, the cause of bipolar isn’t known. Scientists suspect biological differences and genetics play a role because people with bipolar disorder show physical changes in their brain, and people with family members with bipolar disorder appear more likely to develop the condition [6].
There are different types of bipolar disorder, and the one that disproportionately affects women is called bipolar disorder II. With this type, women have depressive episodes more often, but less severe manic episodes, meaning they tend to seem capable of functioning in daily life from an outside perspective.
Overlapping Symptoms in Women
PMDD and bipolar disorder share many symptoms, which is why they can be easily misdiagnosed. The overlapping symptoms include:
- Feeling of hopelessness
- Anxiety
- Irritability
- Fatigue
- Loss of interest in activities that once brought joy
- Sleeping too little or too much
- Changes in appetite and craving certain foods
- Difficulty concentrating
Not only do bipolar disorder and PMDD have overlapping symptoms, they regularly occur together. One study found women with PMDD were eight times more likely to have bipolar disorder. Meanwhile, PMDD is common among women with bipolar disorder [3].
PMDD vs Bipolar: Key Differences
There are signs to indicate when a woman is experiencing PMDD or bipolar disorder. These can help support a more accurate diagnosis, as well as better manage the symptoms they have.
Unlike PMDD, bipolar disorder symptoms are not connected to the menstrual cycle. Bipolar disorder symptoms can last for weeks or months. PMDD symptoms tend to last between 1-2 weeks before a period.
During, and after, a period, women with PMDD report feeling like themselves, with no symptoms of the condition. Bipolar disorder involves big shifts in symptoms that can occur irregularly and with varying intensity.
To receive a bipolar disorder diagnosis, episodes of clinical mania/hypomania have to be present. PMDD does not include clinical mania.
Symptoms of PMDD stop temporarily during pregnancy, or may stop permanently after menopause. Bipolar disorder is a lifelong condition that doesn’t pause or stop with hormonal changes.
Treatment for PMDD and Bipolar Disorder
Treatment pathways for PMDD and bipolar need to be different. One woman with PMDD was incorrectly diagnosed as having bipolar disorder and was prescribed lithium. As a result, her symptoms stayed present for a longer period of time [7].
Treatment for PMDD should be centered around hormonal sensitivity and timing in the menstruation cycle. Antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs) are most commonly prescribed to take daily or in the luteal phase. Alternatively, contraceptive pills can help stop natural hormone fluctuations that contribute to symptoms.
Reducing caffeine and sugar intake, exercising, and stress management can help improve PMDD symptoms. Psychotherapy, including Cognitive Behavioral Therapy (CBT), additionally supports coping strategies to lower distress and overwhelm.
Bipolar disorder, on the other hand, requires lifelong treatment. Mood stabilizers such as lithium or anticonvulsant medications are prescribed to control shifts between mania/hypomania and depression. Antipsychotics may also be used to treat severe symptoms. SSRIs are not part of treatment for bipolar disorder because they carry a risk of triggering manic episodes.
CBT is also integrated into bipolar disorder care to help identify negative thought patterns. Other evidence-based therapies, such as Interpersonal and Social Rhythm Therapy (IPSRT), focus on creating healthier sleeping and eating routines for people with bipolar disorder.
Mental Health Treatment at Colorado Mental Health Services
If you’re navigating your mental health right now, you’re not alone. Our team of licensed physicians have years of experience supporting people as they find stability.
Our Intensive Outpatient Program (IOP) runs from our center in Lakewood, Colorado, and is designed for mental health conditions, including bipolar disorder. We tailor all care around your needs, factoring in co-occurring health considerations that worsen symptoms and your sense of safety.
Our treatment combines evidence-based psychotherapy, such as Cognitive Behavioral Therapy (CBT) to address harmful thinking patterns and to help build your self-belief that you can live a fulfilled life. We also offer medication management, monitoring your dose and frequency, and making informed changes when necessary.
We work with patience and empathy, and we support you as you move forward at a pace that’s right for you.
You deserve to heal. Call our admissions team when you’re ready.
Sources
[1] Office on Women’s Health. 2025. Premenstrual dysphoric disorder (PMDD). womenshealth.gov.
[2] National Institute of Mental Health. Bipolar Disorder. nimh.nih.gov.
[3] Sepede, G. et al. 2020. Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges. Neuropsychiatric Disease and Treatment.
[4] Pataki, B. et al. 2024. Premenstrual dysphoric disorder—an undervalued diagnosis? A cross-sectional study in Hungarian women. Comprehensive Psychoneuroendocrinology.
[5] John Hopkins Medicine. Premenstrual Dysphoric Disorder (PMDD). hopkinsmedicine.org.
[6] Mayo Clinic. 2026. Bipolar disorder. mayoclinic.org.
[7] Iakimova, R. et al. 2020. A Case Report of a Woman with Premenstrual Dysphoric Disorder Misdiagnosed as Having Bipolar Affective Disorder. Journal of Biomedical and Clinical Research.