5, 95% CI 1.7-34.1, P=0.002). When it occurred, oligomenorrhea began within the first 12 months of valproate use. This study demonstrated an association between valproate and new-onset oligomenorrhea with hyperandrogenism in women with bipolar disorder. A subsequent follow-up study completed follow-up assessments (after 17+I-7-months) in 14 Inhibitors,research,lifescience,medical women (5/9 with treatment-emergent PCOS, 9/1 9 valproate use “6 months).41 Of 7 women who developed

valproate-asso ciatcd PCOS, reproductive features of PCOS remitted in 3/4 women discontinuing valproate and persisted in all 3 continuing valproate. Compared with women continuing valproate, menstrual-cycle irregularities improved among valproate discontinucrs whose PCOS features remitted (P=0.01). There was a trend toward lower serum testosterone (P=0.06). Body weight,

was unchanged. Valproate may also be associated with PCOS features because increase in body weight Inhibitors,research,lifescience,medical or insulin resistance secondary to valproate therapy36,42-43 may lead to the development of PCOS through insulin effects in the ovary.44 However, menstrual-cycle irregularities or PCOS are uncommon in women with obesity or type 2 diabetes.45-47 Prospective research is needed to examine the relationship between weight, insulin resistance, and predisposition or development of PCOS features. The Inhibitors,research,lifescience,medical collective literature demonstrates that rates of menstrual disturbances are high in women with bipolar disorder, regardless of their treatment history. It appears that treatment with valproate further predicts the development of menstrual abnormalities and an increase in testosterone levels over time. However, little is known about the additive impact of previous exposure, duration of exposure, and age of women who are most vulnerable

Inhibitors,research,lifescience,medical to development of this constellation of symptoms.48 More research is needed to understand the relationship between etiology of reproductive and hormonal irregularities, onset of bipolar disorder, and treatment history. Endocrine effects of medication treatments Women Inhibitors,research,lifescience,medical are at greater risk than men for the development of lithium-associated hypothyroidism. Clinical hypothyroidism during lithium treatment is present, in 14% of women, versus 5.5% of men.49 Lithium-treated women may also be at higher risk for lithium-induced thyroiditis.13 Effects of pharmacotherapy Cilengitide on oral contraceptives The efficacy of oral contraception (OC) can be impaired by concomitant use of medications that induce liver enzymes (eg, carbamazepine, oxcarbazepine), which may be secondary to enhanced hepatic metabolism of the OC hormones. make it clear Therefore, if women are prescribed these medications for treatment of symptoms of bipolar disorder, clinicians should advise them to use barrier methods of birth control, monitor for spotting, and/or work with the gynecologist to increase oral contraceptive pill (OCP) dose.