Abstract

     Several lines of research suggest that reproductive-related hormonal events may affect the course of bipolar disorder in some women. However, data on associations between bipolar disorder and menarche, menstrual cycle, and menopause are mixed. This article reviews the literature on the potential effects of menarche, menstrual cycle, and menopause on bipolar disorder.

     A narrative review of published articles on bipolar disorder and menstrual cycle events was conducted. The primary outcome assessed was the impact of menarche, menstrual cycle and menopause on the course of bipolar illness. Databases searched were PubMed, Ovid, Scopus, PsycINFO, Medline, and Cochrane Libraries from inception to August 2021.

     Twenty-two studies were identified and included in the narrative synthesis. Research suggested that a subset of women with bipolar disorder are vulnerable to the impact of menstrual cycle events. Menarche seems to be associated with age at onset of bipolar illness especially in case of bipolar disorder type I and the specific age at menarche may predict some clinical features of the disorder. Menstrual cycle likely affects the course of bipolar disorder but the pattern of mood variability is not clear. Menopause appears to be not only a period of vulnerability to mood alteration, especially depressive episodes, and impairment of quality of life, but also a potential trigger of bipolar illness onset.

     The impact of menarche, menstrual cycle, and menopause on bipolar disorder is largely understudied. Preliminary evidence suggests that a subset of women with bipolar disorder may have their mood shifts affected by menstrual cycle events, with different patterns depending on the type of bipolar disorder also. Further researches are needed to deep the impact of menarche, menstrual cycle, and menopause on bipolar illness.

Introduction

     Bipolar disorder is a lifelong episodic illness characterized by fuctuations in mood state and energy (Grande et al. 2016). The course of bipolar disorder is associated with both inter-individual variation and heterogeneity between patients and can lead to functional, occupational, and cognitive impairments (Miller and Black 2020). Thus, over a lifetime any one patient may experience many forms of the disorder including depressive and manic or hypomanic episodes, mixed emotional states, and psychosis (Vieta et al. 2011). Bipolar disorders are classifed according to the longitudinal course: bipolar I disorder requires the occurrence of at least one fully syndromal lifetime manic episode, although depressive episodes are common; bipolar II disorder requires the occurrence of at least one hypomanic episode and one major depressive episode (American Psychiatric Association, 2013). The prevalence of bipolar illness is consistent across diverse cultures and ethnic groups, with an aggregate lifetime prevalence of 2.4% (Carvalho et al. 2020). Although bipolar disorder has an equal rate among men and women, some gender-related diferences have been found in the clinical features of the illness(Diforio and Jones 2010). Overall, it is reported that depressive episodes, rapid cycling, and mixed mania are more frequent in women than men (Altshuler et al. 2010; Marsh et al. 2012). Furthermore, there is accumulating evidence that bipolar disorder course is affected by reproductive-related hormonal events in women (Diforio and Jones 2010). Sex diferences have been hypothesized to be related to organizational and activational efects of sex hormones on the nervous system (Steiner et al. 2003). Gonadal steroids play a role in all stages of neurodevelopment, including neurogenesis, synaptogenesis, neural migration, growth, diferentiation, and cell survival (Payne 2003).

Results

     A fowchart of studies selected and included in the narrative review is provided in Fig. 1. From all databases combined, the initial search yielded 1229 results. After duplicates had been removed, 1197 articles remained. At title and abstract screening, 1028 articles were removed as they were not clinically relevant. A total of 169 articles were found to be suitable for inclusion in the full text screening. Full text screening of these articles eliminated 147 articles that did not meet the inclusion criteria. Twenty-two articles in total were included. Table 1, Table 2, and Table 3 list the studies that were included in the narrative synthesis.

Methods

Results

Discussion

References

Abstract

Purpose The purpose of the study was to describe the prevalence and patterns of prescription of hormonal contraceptive medications to young women with cerebral palsy (CP) and determine if CP topography or ambulatory status was associated with the type of contraceptive prescribed.
Methods Data were extracted by manual chart review for women with CP between the ages of 15 and 25 years who were seen at a tertiary pediatric hospital and a rehabilitation hospital between the years of 2011 and 2013. CP topography was defined as the number and pattern of limbs affected (hemiplegia, diplegia, triplegia, or quadriplegia), and ambulatory status was defined as whether a wheelchair was used for community mobility. Logistic regression analysis was used to assess associations between patient age, CP topography, ambulatory status, and contraceptive prescription.
Results Data were collected for 483 women with CP with an average age of 19 years (standard deviation: 3 years). One hundred thirty-one patients (27%) were prescribed hormonal contraceptives. Estrogen–progestin combined oral contraceptives were most frequently prescribed (73%). Prescription of hormonal contraceptives was not associated with CP topography (p = .95) or ambulatory status (p = .44); however, older subjects were more likely to be prescribed hormonal contraceptives (p = .01). There was no association detected between CP topography and contraceptive composition (p = .09) or between ambulatory status and contraceptive composition (p = .06). There was also no association detected between CP topography (p = .18) or ambulatory status (p = .09) and depot medroxyprogesterone acetate prescription.
Conclusion Ambulatory status and CP topography were not associated with the types of hormonal contraceptives prescribed in this cohort.

Although Attention-Deficit/Hyperactivity Disorder shows (ADHD) male predominance, females are significantly impaired and exhibit additional comorbid disorders during adolescence. However, no empirical work has examined the influence of cyclical fluctuating steroids on ADHD symptoms in women. The present study examined estradiol (E2), progesterone (P4), and testosterone (T) associations with ADHD symptoms across the menstrual cycle in regularlycycling young women (N=32), examining trait impulsivity as a moderator. Women completed a baseline measure of trait impulsivity, provided saliva samples each morning, and completed an ADHD symptom checklist every evening for 35 days. Results indicated decreased levels of E2 in the context of increased levels of either P4 or T was associated with higher ADHD symptoms on the following day, particularly for those with high trait impulsivity. Phase analyses suggested both an early follicular and early luteal, or post-ovulatory, increase in ADHD symptoms. Therefore, ADHD symptoms may change across the menstrual cycle in response to endogenous steroid changes.

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common and impairing childhood neurodevelopmental disorder (APA, 2013; Bernfort et al., 2008; Pelham et al., 2007, Polanczyk et al., 2007; Sayal et al. 2017; Thomas et al., 2015) that often persists into adolescence and adulthood with a prevalence of approximately 3% in adults (Faraone & Biederman, 2005; Fayyad et al., 2017; Kessler et al., 2006; Wilcutt, 2012). ADHD is a heterogeneous condition, currently conceptualized theoretically using multiple pathway models (Nigg et al., 2004; SonugaBarke, 2005) and most accurately described using two continuous symptom dimensions of inattention and hyperactivity-impulsivity (Haslam et al., 2006; Larsson et al., 2012; Marcus & Barry, 2011). Although ADHD is more frequently diagnosed in males, females with ADHD often become particularly impaired and exhibit comorbid disorders beginning during adolescence (Biederman et al., 1999; Hinshaw et al., 2012; Hosain, et al., 2012; Lahey et al. 1994; Quinn, 2005; Robison et al., 2008). The mechanisms of such sex differences remain unclear yet fundamental to understanding ADHD and sex differences in ADHD. Prior work suggests a role for organizational testosterone (T) in ADHD symptoms in both sexes (Wang et al., 2017), but particularly males (Martel, 2009; McFadden et al., 2005). Women and girls are under-studied and in particular, activational hormonal effects remain essentially unstudied in ADHD. Case studies have suggested that ADHD symptoms may worsen the week before menstruation (during declining estrogen and progesterone; Quinn, 2005) and improve during pregnancy (during elevated estrogen and progesterone (Nadeau & Quinn, 2002), but empirical work is lacking. Higher estradiol (E2) and progesterone (P4) have been generally linked to enhanced executive function (EF) and attention (e.g., Hatta & Nagaya, 2009), which appear to improve during cycle phases characterized by elevated E2 and P4 (Gogos, 2013; Howard et al., 1988; Jacobs & D’Esposito, 2011; Lord & Taylor, 1991; Rosenberg & Park, 2002; Segal, 2012; Vranic ́ & Hromatko, 2008; Solís-Ortiz & Corsi-Cabrera, 2008; Solis-Ortiz et al., 2004). Further, verbal fluency, verbal learning and memory appear to improve with administration of T in women (Davison et al., 2011; Drake et al., 2000), whereas response inhibition performance decreases (Bjork et al., 2001). Given that weak EF is a prominent correlate and possible marker of ADHD, this prior work suggests a potential role for cycling reproductive steroids in daily ADHD symptom expression.

Infertility is defined as the inability of a couple to conceive a child after one year of regular sexual life without contraceptive techniques (Tekin et al., 2004). Infertility is one of the major health-therapeutic problems in different societies. The high prevalence (8 to 12%) of this problem makes it very important. A significant proportion of infertility is dependent on environmental conditions and acquired risk factors which are preventable. Different environmental conditions show the necessity of studying the different causes of infertility in each region. In today’s modern world there are many reasons for infertility in men and women, one of the most important of which from the viewpoints of experts is the age of the couple. Couples should be aware that the fertility rate of a woman under 25 years of age is more than 80% but for a woman over 35 this rate is under 50% (Tekin et al., 2004).

It is likely that the number of ova is limited after reproductive age; that factor alone can reduce fertility and increase the risk of birth defects in the fetus and newborn. In addition, men over 35 compared with men under 35 have less chances of fertility, and the risk of chromosomal abnormalities is higher in their children. One of the factors with a significant impact on male infertility is environmental, industrial and air pollution, which minimizes the sperm counts, and decreasing fertility (Tekin et al., 2004).

According to studies, obesity and ovarian dysfunction in women are risk factors for infertility. Various studies conducted around the world have shown that women who are overweight or obese require more time to get pregnant, compared with normal or standard weight women, and pregnancy in obese women is more likely to be unsuccessful. According to experts, obesity in men and women increases the level of hormones in their bodies, affecting the reproductive process. In fact, abnormal secretion of hormones can lead to weight gain and negative effects on the male and female germ cell production (Tekin et al., 2004).