Medication status and polycystic ovary syndrome in women with bipolar disorder: a preliminary report.
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.


METHODS
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.


CONCLUSIONS
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.
Rasgon
N L
NL
Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA), USA.
Altshuler
L L
LL
Gudeman
D
D
Burt
V K
VK
Tanavoli
S
S
Hendrick
V
V
Korenman
S
S
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006628:Hirsutism / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008094:Lithium / Q000009:adverse effects / Q000627:therapeutic use; D008599:Menstruation Disturbances / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D010865:Pilot Projects; D011085:Polycystic Ovary Syndrome / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D013739:Testosterone / Q000097:blood; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
D000927:Anticonvulsants; D013739:Testosterone; D014635:Valproic Acid; D005640:Follicle Stimulating Hormone; D008094:Lithium