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

Authors

  • Margaret F Reynolds-May,

    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Heather A Kenna,

    1. Stanford Center for Neuroscience in Women's Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Wendy Marsh,

    1. Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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  • Pascale G Stemmle,

    1. Stanford Center for Neuroscience in Women's Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Po Wang,

    1. Bipolar Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Terence A Ketter,

    1. Bipolar Disorders Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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  • Natalie L Rasgon

    Corresponding author
    1. Stanford Center for Neuroscience in Women's Health, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
    • Corresponding author:

      Natalie Rasgon, M.D., Ph.D.

      Department of Psychiatry and Behavioral Sciences

      Stanford University School of Medicine

      401 Quarry Road, MC 5723

      Stanford, CA 94305-5723

      USA

      Fax: 650-724-3144

      E-mail: nrasgon@stanford.edu

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Abstract

Objectives

The purpose of the present 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, aged 18–45 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 (MAs), 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-hydroxyprogesterone levels were higher in controls (p = 0.052 and 0.004, respectively), but there were no other differences in biochemical levels. Medication type, dose, or duration was not associated with MA or biochemical markers, although those currently taking an atypical antipsychotic agent 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 agent use was associated with a higher rate of current or past MA and should be further investigated. The incidence of stress-induced amenorrhea should be further investigated in this population, as should the comorbid incidence of eating disorders.

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