Perimenopause has been called a "time of chaos." Bipolar disorder can feel like one too. When both are happening at the same time, things can feel completely overwhelming. Here's what's actually going on and what you can do about it.
The Time of Chaos — And Why That Name Fits
Perimenopause has been coined a "time of chaos". That's not drama. It's an honest description of what the body and mind go through!
Perimenopause is a transitional phase that can last anywhere from 4 to 10 years before menopause. During this time, estrogen and progesterone levels don't decline gradually — they swing wildly and unpredictably. That hormonal turbulence causes full-body symptoms: intense mood shifts, anxiety, brain fog, insomnia, weight changes, and irregular periods. And it often starts in the 30s or 40s.
For many women, just having a name for what they're going through brings some relief. It means: this is real. It's not in your head. It's not a weakness. It’s natural. It's your biology going through a massive change — and initiation.
More Than Just Hormones — A Major Life Transition
Perimenopause isn't only a physical event. It's also a significant life transition — a crossing from one chapter of womanhood into another.
Many traditions recognize this phase through the archetype of the crone — not the negative cultural caricature, but something much more meaningful: a woman who has lived enough to know herself, who carries real wisdom, and who is no longer willing to shrink herself for others' comfort.
This is the phase of life that asks — sometimes demands — a hard and honest look at how you've been living. What actually brings you joy? What has been quietly draining you for years? What roles are you ready to step out of, and what do you want to carry forward?
That kind of reflection is powerful. It's also exhausting when you're simultaneously dealing with hot flashes, poor sleep, and mood swings. And for women with bipolar disorder, it can feel like too much to hold at once.
The Culture You're Doing This In Matters
The culture you live in shapes how you experience perimenopause — not just emotionally, but physically.
Research has found that women in some non-Western cultures move through this transition very differently. In certain Indigenous cultures and in parts of Asia and Latin America, the transition to elder womanhood brings increased status, respect, and social power. The woman who has lived long enough to reach this phase is valued for her wisdom, not sidelined for her age. Studies have found that women in these cultural contexts report significantly fewer negative symptoms — and in some cases, almost none at all.
Western culture tends to work in the opposite direction. It prizes youth, productivity, and a particular kind of female visibility that fades with age. Women in midlife are frequently made to feel irrelevant, invisible, or "past it" — by media, by medicine, and sometimes by the people closest to them. Menopause has historically been treated as a medical problem to be managed rather than a transition to be honored.
That cultural messaging is not neutral. When a woman moves through perimenopause in an environment that treats it as a decline rather than a crossing, the psychological weight of that adds real suffering on top of the biological reality.
This doesn't mean your symptoms aren't real or that attitude alone determines experience — especially when bipolar disorder is part of the picture. But it does mean that some of what feels personal — the shame, the invisibility, the sense that you are somehow failing at this — is not coming from inside you. It's coming from a culture that hasn't learned to value what this transition actually is.
You are not declining. You are crossing a threshold that many other cultures have always honored.
"I Don't Feel Like Myself"
One of the most painful parts of perimenopause — and one that intersects directly with bipolar disorder — is feeling caught in between. You're no longer fully who you were. You're not yet who you're becoming. You're in the middle, and the middle is uncomfortable.
"I don't feel like myself" is one of the most common things women say during this time. And it's true — the self is genuinely in transition.
This matters for bipolar disorder because big life transitions are known triggers for mood episodes. When your sense of identity, your roles, and your daily rhythms are all shifting at once, it activates a brain that's already sensitive to disruption. Add hormonal chaos on top of that, and you have a powerful combination pulling at your stability from multiple directions at once.
Identity shifts during perimenopause can look like:
Feeling disconnected from your old self — like she belonged to someone else's life
Questioning roles and responsibilities you never questioned before
Losing confidence that used to feel solid
Rethinking your career, relationships, or the way you've been living
Wanting more authenticity and less people-pleasing
Grieving younger versions of yourself or paths not taken
The grief (or excitement or ‘liminal space’ or the ‘being with’) of perimenopause isn't only about getting older. It's about losing a self you knew — and not yet knowing the one being born.
For women with bipolar disorder, this hits differently. You've already lived through episodes when your thoughts, feelings, and behavior didn't feel like your own. The question of "who am I, really?" isn't abstract — it's something you've wrestled with before. Perimenopause can bring it back with new force.
It Starts in the Brain — Not the Ovaries
Most people think of perimenopause as something happening in the ovaries. But it actually starts in the brain.
The pituitary gland — a small but powerful gland at the base of the brain — is part of the system that controls reproductive hormones. During perimenopause, as the ovaries begin winding down, the pituitary works harder and harder to compensate, sending out increasing hormonal signals trying to get the ovaries to respond.
But the pituitary doesn't only regulate reproduction. It sits right next to the parts of the brain that control mood, sleep, stress, and temperature. When it's in overdrive, those systems feel it too.
For someone with bipolar disorder, this is significant. Bipolar disorder already involves sensitive, sometimes dysregulated brain chemistry. Perimenopause isn't a hormonal storm happening somewhere distant in the body — it's happening inside the same brain that's already working hard to stay stable.
It's not two separate problems running side by side. It's one disruption landing directly on top of another.
Why Bipolar and Perimenopause Amplify Each Other
Estrogen affects serotonin, dopamine, and norepinephrine — the brain chemicals central to bipolar disorder. When estrogen surges and crashes erratically, it destabilizes the same systems your brain already struggles to keep in balance.
Progesterone has a naturally calming effect on the brain — similar to the way anti-anxiety medications work. When progesterone drops, anxiety rises, sleep gets worse, and the nervous system sits closer to the edge.
Poor sleep then becomes its own problem. Sleep disruption is one of the most reliable triggers for bipolar mood episodes. Night sweats wake you up. Hormonal anxiety keeps you awake at 3 am. And when you're not sleeping, everything else gets harder to manage. It becomes a cycle: hormones disrupt sleep, poor sleep triggers episodes, and episodes worsen sleep.
The symptoms of both conditions also overlap so much that it can be genuinely hard to know what's driving what on any given day!
Both bipolar disorder and perimenopause can cause mood swings, poor sleep, irritability and rage, fatigue, anxiety, brain fog, and a feeling of not being yourself. When both are happening at once, these symptoms don't just add up — they multiply.
Rage — Let's Talk About It
Perimenopausal rage is real. Bipolar rage is real. When both are happening at the same time, the intensity can feel terrifying.
Rage is also one of the hardest to experience because it almost always follows with shame. When anger comes fast, and we lose control of our words and actions, most women eventually turn on themselves once the dust settles and ask themselves, "What is wrong with me?" Why can't I control this?
That reaction is understandable. It's also not fair to yourself.
Here's what's actually happening: fluctuating estrogen lowers the brain's threshold for firing the threat response. The part of the brain that detects danger becomes hair-trigger sensitive. The result is a nervous system that is genuinely more reactive — not because of your personality, but because of your neurochemistry right now.
Bipolar disorder adds another layer. During mood episodes — especially mixed states and dysphoric hypomania or irritable depression— the part of the brain responsible for pausing before reacting goes offline. Anger that might be a two out of ten when you're stable can become an eight or nine when you're symptomatic.
When both are happening at once, you're dealing with a brain that is simultaneously more reactive and less able to regulate itself.
The intensity of the anger is real — and it is not the same thing as your character. You can be a kind, self-aware person who has worked hard on yourself and still have rage move through you like a wave. That's not who you are. That's what your brain is dealing with right now.
One more important thing: a sudden increase in rage — especially if it feels different from your usual emotional range — can be an early warning sign of a mood episode, particularly a mixed state.
In the moment, a few things that can help:
Breathe out longer than you breathe in. A long exhale directly activates the body's calming response. Even three or four slow breaths can take the edge off.
Get cold water on your skin. Wrists, face, or the back of the neck. It interrupts the physical heat of a rage response quickly.
Leave the room if you can. Removing yourself before you escalate is not avoidance — it's smart regulation.
Move your body. A fast walk, even just to the end of the street and back, burns off the stress hormones fueling the anger.
Name it internally. Simply thinking "this is rage, this is neurological, this will pass" can create just enough distance to keep it from taking over completely.
For a much deeper dive into perimenopausal anger and rage — including what drives it, why it's so common, and how to work with it — I'll be covering this in a dedicated post soon. It deserves its own full conversation.
Depression — The Symptom That Hides in Plain Sight
Rage tends to announce itself. Depression is quieter — and in many ways, harder to catch.
Research shows that women are significantly more likely to experience depression during perimenopause than at any other point in their adult lives. For women already living with bipolar disorder, that risk is even higher. The same hormonal fluctuations that destabilize mood upward can just as easily pull it downward — sometimes within the same week, or even the same day.
Perimenopausal depression doesn't always look the way people expect depression to look. It often shows up as:
Exhaustion that sleep doesn't fix
A flatness or emptiness that's hard to name
Losing interest in things that used to matter
Feeling like you're going through the motions
Increased anxiety alongside low mood
A short fuse — irritability that sits right on top of sadness
A sense that you've lost yourself, and don't particularly care about finding her
That last one is easy to mistake for the identity shifts of perimenopause. And sometimes it is. But when the feeling of disconnection from yourself starts to feel heavy, hopeless, or persistent — that's worth paying close attention to.
For women with bipolar disorder, depressive episodes during perimenopause carry a specific risk worth knowing about. If you seek help for depression from a provider who doesn't specialize in bipolar disorder, there is a real possibility of being prescribed an antidepressant without adequate mood stabilizer coverage. In bipolar disorder, antidepressants used alone can trigger hypomania, mania, or rapid cycling. This is not a reason to avoid treatment — it is a reason to make sure whoever is treating your depression understands your full diagnosis.
The exhaustion of perimenopause also deserves its own mention here. The fatigue can be profound — a bone-deep tiredness that doesn't respond to rest. It can be hard to know whether what you're feeling is depression, hormonal exhaustion, the aftermath of disrupted sleep, or all three at once. You don't necessarily need to figure out which one it is. But you do need to tell someone. Fatigue this deep affects everything — your mood, your cognition, your ability to cope, your relationships. It is not something to push through alone.
If depression is part of your picture, these are the most evidence-supported things you can do:
Move your body every day. Exercise is one of the most effective interventions for depression we have — comparable to medication in mild to moderate cases. It doesn't need to be intense. A 20 to 30-minute walk counts. Consistency matters far more than effort.
Eat regular meals. Skipping meals, blood sugar crashes, and poor nutrition all worsen depression and fatigue. Protein at every meal, reduced sugar, and eating at regular intervals give your brain the stable fuel it needs to function.
Keep a consistent sleep and wake time — even on bad nights. A regular sleep schedule is one of the most powerful regulators of mood in bipolar disorder. Even if sleep is broken or poor, getting up at the same time every day helps anchor your body's rhythms.
Stay socially connected — even when you don't want to. Depression pulls toward isolation, and isolation feeds depression. You don't need to be social in a big way. A text, a short phone call, a coffee with one person — small connections count and genuinely help.
Get outside and into natural light. Light exposure, especially in the morning, directly regulates the brain chemicals involved in both mood and sleep. Even ten minutes outside in the morning makes a measurable difference over time.
Tell your prescriber explicitly. Don't let depressive symptoms during perimenopause get attributed to just one cause. Make sure your provider understands both are in play.
Don't normalize exhaustion. Fatigue that is significantly affecting your daily functioning is worth investigating and treating — not just pushing through.
Depression during this phase is common, it is treatable, and it is not a sign that your illness has permanently worsened. It is a sign that your brain and body need more support right now — and that asking for that support is the right move.
Watch for Mixed States
One important warning: perimenopause increases the risk of mixed states — episodes where depression and hypomania or mania happen at the same time. These are often the most confusing and distressing episodes to experience, and rage is frequently right at the center of them.
If you notice agitation alongside low mood, racing thoughts paired with exhaustion, or anger that feels qualitatively different from your usual range — reach out to your prescriber. Don't wait for it to get cleaner or more obvious. Mixed states move fast.
Take the identity transition seriously
Herbalist and women's health advocate Susun Weed has written extensively about this crossing. In her Wise Woman tradition, the woman moving through perimenopause is not declining — she is being initiated. The discomfort, the dissolution of the old self, the rage, the grief — in her framework, these aren't signs that something is going wrong. They are the transition working exactly as it should. The old self is being composted so something truer can grow.
Weed's provocation is worth sitting with: change your life, or your body will change it for you. The symptoms of perimenopause, she suggests, are often the body's way of demanding a reckoning that has been put off too long. The things that no longer fit — the roles, the relationships, the ways of being that were never truly yours — the body starts to reject them. Working with that process, rather than fighting it, is where the real transformation lives.
Use this time to honestly look at what's working in your life and what isn't. What brings you real joy? What is quietly exhausting you?
let it move through
There is a misconception about stability that is worth naming before we close. Stability does not mean calm. It does not mean the absence of turbulence, difficulty, or pain. In fact, some of the most stable things in nature are also the most constantly in motion — just like a river. A river is never still, and yet a river with a deep, strong bed always knows where it is going, no matter how rough the surface gets.
That is the kind of stability that is possible during this time. Not the absence of chaos, but a deepening of the riverbed beneath it. Your values. Your self-knowledge. The things you have learned, often the hard way, about who you are and what you need. The practices that bring you back to yourself. These are the riverbed. They don't stop the water from moving. They give it somewhere to go.
Perimenopause and bipolar disorder will both, at times, make the surface of that river very rough. There will be times when the turbulence and strong currents feel all consuming. But the riverbed is still there. You have been building it, probably without realizing it, for years.
The work of this transition is not to become someone totally new. It is to go deeper into who you already are — to find the parts of yourself that are solid enough to hold the chaos, wise enough to learn from it, and strong enough to carry you through to the other side.
For more information on how I can support you during this fruitful (and at times excruciating) time, contact me. I’d love to hear from you.
This article is for educational purposes and is not a substitute for personal medical or psychiatric care. If you're in a mental health crisis, please contact your care team or call or text 988.