Just a feeling mind you.......a full hormone blood panel might be in order as well as thyroid just to be on the safe side......eostrogen, progesterone, testosterone, DHEA, androstenedione, cortisol, ACTH, TSH, T4, T3, thyroid antibodies......to name a few. She is 39 which is very a very possible age for perimenopause......some women go into menopause at this age!

Don't be surprised if the blood levels come back "within range" for eostrogen. It is not conclusive. Does she get any other symptoms like on the list on that link I gave you? Is she on medication for the Bipolar and it is not making a scrap of difference to how she feels? Does she have a competent psychiatrist or psychologist? The facial tick you speak of.......i get that too and so do many other peri or meno women.

I am not saying that this is the answer, but I am suspicious of this sudden onset of bipolar at this stage in her life(not saying that 39 year old women don't get it, but very rare, especially with no family history of the disorder).

You take care.......