When I was first dx'd with bipolar, I had a horrific "full blown manic" psychotic episode, and it took me five months to recover from that and go back to work. Doctors assured me I was lucky to bounce back so well, and that the main residual effect of the episode was diminished stamina, with no "residual personality scarring". No one could tell I was sick with bipolar because the lithium worked perfectly.
I always loved work, and I think my ego was overly-attached to staying in that workforce, no matter what. I was able to remain employed from 1985 until 2000, when suddenly, my conditioned worsened appreciably, and I had to quit my dream job and go back home. I was so puzzled as to why my health declined like that, until my new psychiatrist told me that it is quite common for women with bipolar to get much worse when perimenopause starts. The hormone fluctuations are too strong and upset the whole balance of things. He said it as though it was widely known, or common knowledge.
I was aghast that none of my other doctors had warned me. I regard them as fine pdocs, but can't believe they didn't give me a heads-up. I don't know if a warning would have changed much, but at least I would have tried to save more money, just in case.
So, two years ago, I had my second, and hopefully last, psychotic episode. It was a public humiliation. I've been told that the timing was no accident, it happened at the onset of menopause -- again, the raging hormones. I am feeling so much healhier now in terms of my bipolarism, no major cycling.
I just wanted to throw this out there to you guys in case you, like me, were never warned the potential impact peri- and regular menopause can have on the course of your disorder. I picture it as having your hormones and neurotransmitters/brain chemicals having a knock down, drag out fight! (I hope it doesn't happen to you!)