Age at menarche and course of bipolar illness

Several studies have hypothesized a close connection between puberty and mood disorders. Hormonal fluctuations that happen during menarche can exert a dysregulation of mood throughout interactions with hypothalamic-pituitary-adrenal axis, at a time of major susceptibility to external stress factors. Hence, it has been speculated that the age at menarche can be linked to the onset of mood disorders, including bipolar illness. However, studies are largely insufficient and results are contradicting. Moreover, studies on the effect of pubertal time on the long-term course of bipolar disorder are lacking. Based on the results of a recent study run by our research group, data suggest that in women with bipolar disorder late menarche is related to lower risk of peripartum mood episodes, while early menarche is associated with higher risk of metabolic syndrome. Although more studies are needed to deepen the underlying mechanisms, these findings might improve the ability to predict long-term outcomes of bipolar disorder and to choose tailored treatments for specific subgroups of patients.