Medication Status and Polycystic Ovary Syndrome in Women With Bipolar Disorder: A Preliminary Report
J Clin Psychiatry 2000;61(3):173-178
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: In patients with epilepsy,
polycystic ovary (PCO) syndrome has been reported to be
associated with the use of the anticonvulsant divalproex sodium.
Whether PCO syndrome is associated with divalproex use in
patients with bipolar disorder has not previously been explored.
Method: Twenty-two female outpatients with a
DSM-IV diagnosis of bipolar disorder who were between the ages of
18 and 45 years (inclusive) and who were taking lithium and/or
divalproex (10, divalproex monotherapy; 10, lithium monotherapy;
2, divalproex/lithium combination therapy) were evaluated.
Patients completed questionnaires about their medical,
psychiatric, and reproductive health histories, and body mass
indices were calculated. In the early follicular phase of their
menstrual cycle, women were examined for hirsutism, given a
pelvic ultrasound, and/or assessed for changes in laboratory
values such as serum levels of testosterone, free testosterone,
estradiol, estrone, dehydroepiandrosterone,
dehydroepiandrosterone sulfate, luteinizing hormone,
follicle-stimulating hormone, and 17-OH progesterone.
Results: All 10 patients on lithium monotherapy,
6 of 10 patients on divalproex monotherapy, and both of the
patients on divalproex/lithium combination therapy reported some
type of menstrual dysfunction, which, in 4 cases, had preceded
the diagnosis of bipolar disorder. Hirsutism was not common in
any group, but obesity was prominent in all groups. Ovarian
ultrasound revealed an increased number of ovarian follicles in 1
patient taking lithium and in none of the patients taking
divalproex. Hormonal screening did not indicate PCO-like changes
in any patient.
Conclusion: In this pilot study of bipolar
patients, PCO-like changes were not seen in women receiving
divalproex or lithium. However, independent of therapeutic agent
used, the bipolar women in this study reported high rates of
menstrual disturbances, suggesting that the
hypothalamic-pituitary-gonadal axis may be compromised in some
women with bipolar disorder.