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

Background: In patients with epilepsy, poly cystic ovary (PCO) syndrome has been reported to be associated with the use of the anticonvulsant divalpro ex sodium. Whether PCO syndrome is associated with divalproex use in patien ts with bipolar disorder has not previously been explored. Method: Twenty-two female outpatients with a DSM-IV diagnosis of bipolar di sorder who were between the ages of 18 and 45 years (inclusive) and who wer e taking lithium and/or divalproex (10, divalproex monotherapy; 10, lithium monotherapy; 2, divalproex/lithium combination therapy) were evaluated. Pa tients completed questionnaires about their medical, psychiatric, and repro ductive health histories, and body mass indices were calculated. In the ear ly follicular phase of their menstrual cycle, women were examined for hirsu tism, 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, luteinizin g hormone, follicle-stimulating hormone, and 17-OH progesterone. Results: All 10 patients on lithium monotherapy, 6 of 10 patients on divalp roex monotherapy, and both of the patients on divalproex/lithium combinatio n therapy reported some type of menstrual dysfunction, which, in 4 cases, h ad preceded the diagnosis of bipolar disorder. Hirsutism was not common in any,group, but obesity was prominent in all groups. Ovarian ultrasound reve aled an increased number of ovarian follicles in 1 patient taking lithium a nd in none of the patients taking divalproex. Hormonal screening did not in dicate 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-gona dal axis may be compromised in some women with bipolar disorder.