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Research into epilepsy drugs and PCOS

30 May 2001

New data from an observational study comparing two commonly used epilepsy treatments, lamotrigine and valproate, suggests that lamotrigine is less likely to be related to disorders associated with polycystic ovary syndrome (PCOS), a condition which may cause infertility.

The international study, which evaluated 222 women aged 18-35, was conducted in response to growing concerns among epilepsy specialists that their female patients may develop hormonal and metabolic disorders related to PCOS when taking anti-epileptic drugs (AEDs)

PCOS is one of the leading causes of infertility in women and is estimated to affect 5-10 per cent of women of childbearing age. It is characterized by obesity, irregular or absent menses, ovarian cysts, high blood pressure and elevated lipid levels, elevated insulin levels or diabetes, infertility, excessive facial or body hair and thinning of scalp hair. In particular, several published studies have reported that extended exposure to valproate has been associated with the development of PCOS symptoms.

“Many women with epilepsy receive their treatment from primary care and community physicians who may not be aware of recent information showing that infertility and menstrual disturbances may be associated with some antiepileptic drugs. While this type of study doesn’t allow for conclusions about drug-related causation, it certainly adds to the evidence that physicians caring for women with epilepsy should be alert to signs of menstrual irregularity, weight gain and infertility,” commented one of the report's authors, Dr. Martha Morrell, Professor of Neurology at Columbia University College of Physicians & Surgeons and Director of the Columbia Comprehensive Epilepsy Center of New York Presbyterian Hospital.

The study involved 119 women taking lamotrigine as their sole AED and 103 women taking valproate as their sole AED for a period of eight months to five years. 

“The new data indicate that lamotrigine compared favorably to the older drug valproate in several key areas. Patients on lamotrigine had lower androgen levels, or male hormones, which when elevated are believed to effect a number of changes that lead to PCOS,” said Dr. Morrell. “These patients on lamotrigine also reported more regular menstrual cycles, and their weight remained stable whereas those on valproate had gained weight since initiation of that treatment,” she added.