On the association between valproate and polycystic ovary syndrome

Recent studies by Isojarvi et al. have raised the issue of an increased inc idence of polycystic ovary syndrome (PCOS) in women with epilepsy treated w ith valproate (VPA) and have proposed replacement with lamotrigine (LTG). P oly cystic ovaries (PCO) are a common finding, with a prevalence >20% in th e general population, and are easily detected by pelvic or vaginal ultrason ography, whereas PCOS is comparatively rare: few women with PCO have fully developed PCOS, which includes hirsutism, acne, obesity, hypofertility, hyp erandrogenemia, and menstrual disorders. From an extensive re view of the c urrent literature, it appears that there are no reliable data on the actual prevalence of PCOS in normal women and in women with epilepsy. The pathoge nesis of PCO is multifactorial, including genetic predisposition and the in tervention of environmental factors, among which weight gain and hyper insu linism with insulin resistance may play a part. The roles of central (hypot halamic/pituitary), peripheral. and local ovarian factors are still debated . PCO and PCOS appear to be more frequent in women with epilepsy, but there are no reliable data showing a greater prevalence after VPA. The recent st udies by Isojarvi et al. may have been biased by the retrospective selectio n of patients. To date, there is no reason to contraindicate the use of VPA in women with epilepsy. However, patients should be informed about the ris k of weight gain and its consequences.