"Although time to relapse to a syndromal episode did not differ between women with premenstrual exacerbation and those without
during follow-up, time to relapse in those with premenstrual exacerbation was half that of those without when relapse was
defined more broadly as a syndromal or subsyndromal episode," wrote lead author Rodrigo Dias, M.D., and colleagues at Massachusetts
General Hospital. "Women with premenstrual exacerbation also had more severe depressive and mood elevation symptoms during
follow-up, reflecting greater symptom burden. Taken together, these findings suggest that premenstrual exacerbation may be
a marker for a more recurrent and symptomatic course of illness among premenopausal women with bipolar disorder."