Reproductive Endocrine Function in Women after Starting Valproate for Epilepsy
Abstract number :
3.237
Submission category :
Year :
2001
Submission ID :
2115
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J.I.T. Isojärvi, M.D., Department of Neurology, University of Oulu, Oulu, Finland; A.J. Pakarinen, M.D., Department of Clinical Chemistry, University of Oulu, Oulu, Finland; J.S. Tapanainen, M.D., Department of Gynecology, University of Oulu, Oulu, Finlan
RATIONALE: Valproate (VPA) medication has been reported to be associated with reproductive endocrine disorders characterised by polycystic ovaries (PCO), hyperandrogenemia and menstrual disorders in women with epilepsy. On the other hand, it has been suggested that the use of oral contraceptives (OCs) may protect against the development of these disorders. We report here prospective follow-up data on reproductive endocrine function in six women before and after starting treatment with VPA.
METHODS: Six consecutive women starting to be treated with VPA for epilepsy were followed up for reproductive functions. The age of the women ranged from 16 to 39 years when starting VPA. One of the women was on OCs before starting treatment with VPA, and another started OCs 3 months after starting VPA. The other four women did not take OCs or any other hormonal preparations. The patients were examined before starting VPA treatment, and the follow-up examinations will be conducted 3, 12 and 24 months thereafter. The body weight and height are measured, and the body mass index is calculated, the menstrual cycle length recorded, a blood sample for serum testosterone and androstendione assays obtained and ultrasonography of the ovaries performed on each occasion.
RESULTS: One of the six women had PCO before starting VPA; the other five had normal ovarian structure. The evaluation after 24 months has now been conducted in four women (including the one with pre-treatment PCO). Each of these four women had PCO and they were detected in both of the women who were taking OCs. The mean serum androstendione level increased from 9.1[plusminus]1.1 nmol/L to 20.2[plusminus]8.5 nmol/L (p=0.021) and the mean serum testosterone level tended to increase from 2.1[plusminus]0.6 nmol/L to 2.6[plusminus]1.0 nmol/L (p=0.136) during the first year of the medication. Two of the six women gained a considerable amount of weight during the follow-up. The development of PCO or the increase in serum androgen levels were seen in the women regardless of whether they gained weight or not or whether they were on OCs or not.
CONCLUSIONS: This small prospective follow-up series demonstrates the development of hyperandrogenemia and PCO in women after starting VPA medication for epilepsy. These reproductive endocrine changes appear to emerge independent of weight gain or OC use.
Support: University of Oulu
Disclosure: Grant - Dr. Isojärvi has received a Research Grant from Glaxo Wellcome Finland Ltd. Consulting - Dr. Isojärvi has been a consultant for GlaxoWellcome since 1998 and for RW Johnson Pharmaceutical Research Institute since February 2000, and for UCB Pharma Finland since 1999. Honoraria - Dr. Isojärvi has received honoraria for speaking from GlaxoWellcome, Novartis, Sanofi and UCB Pharma during the years 1998-2000.