Evaluation of reproductive function in women treated for bipolar disorder compared to healthy controls

Abstract

Objectives The purpose of this study was to investigate the reproductive function of women with bipolar disorder (BD) compared to healthy controls. Methods Women diagnosed with BD and healthy controls with no psychiatric history ages 18 to 45 years were recruited from a university clinic and surrounding community. Participants completed a baseline reproductive health questionnaire, serum hormone assessment, and ovulation tracking for three consecutive cycles using urine luteinizing hormone (LH)-detecting strips with a confirmatory luteal-phase serum progesterone. Results Women with BD (n = 103) did not differ from controls (n = 36) in demographics, rates of menstrual abnormalities (MA), or number of ovulation-positive cycles. Of the women with BD, 17% reported a current MA and 39% reported a past MA. Dehydroepiandrosterone sulfate and 17-hydroxyprogresterone were higher in controls (p = 0.052 and 0.004, respectively), otherwise there were no differences in biochemical levels. Medication type, dose, or duration was not associated with MA or biochemical markers, except those currently taking an atypical antipsychotic indicated a greater rate of current or past MA (80% versus 55%, p = 0.013). In women with BD, 22% reported a period of amenorrhea associated with exercising or stress, versus 8% of controls (p = 0.064). Self-reported rates of bulimia and anorexia nervosa were 10% and 5%, respectively. Conclusions Rates of MA and biochemical levels did not significantly differ between women with BD and controls. Current atypical antipsychotic use was associated with a higher rate of current or past MA and should be further investigated. Incidence of stress-induced amenorrhea should be further investigated in this population, as should comorbid incidence of eating disorders.

Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort

“…[157]  PCOS-like symptoms in clinical samples of women treated for bipolar disorder with valproate, but evidence also suggests that these symptoms are present before treatment. [176,177] Personality disorders  Personality disorders are significantly more common in women with PCOS compared with controls. [126,148] Eating disorders  Substantial evidence linking the menstrual and hyperandrogenic symptoms of PCOS with binge eating and other bulimic behavior, [178,179] although it is unclear which is a cause or a consequence of the other.…”

Valproate, bipolar disorder and polycystic ovarian syndrome

“…All these findings suggest that more objective ways of monitoring menstrual cycle and ovulation are necessary. In some studies, psychotropic drugs were not associated with biochemical markers of menstrual cycle disorders although drugs from AAP group showed a slightly higher association with the increased rate of the present or menstrual irregularities in the past [18,25].…”

“…Women with bipolar disorder are often treated with combinations of psychotropic medications including atypical antipsychotics (AAPs), a class of medication that has been associated with weight gain, central adiposity, and the development of insulin resistance and type 2 diabetes. All of these side effects can be potential risk factors in the development of PCOS symptoms [18].…”

Lamotrigine and GABAA receptor modulators interact with menstrual cycle phase and oral contraceptives to regulate mood in women with bipolar disorder

“…Thirty control women with BD ages 18–45 who were not taking lamotrigine were recruited for a concurrent study of reproductive functioning in women with BD (Reynolds-May et al 2014). These women maintained their existing medication regimens and did not receive lamotrigine during the course of the study.…”