Do bipolar medications affect hormones and fertility?

Question

Hello doctor,

I am a 28-year-old woman. I suffer from bipolar depression and use mood stabilizers. I have found that my mood becomes more unstable around my period, and sometimes I miss periods or they are erratic.

Can my psych meds affect my hormones or my period?
I am planning to get married soon, and I am worried about getting pregnant while taking these medications.
If I become pregnant, is it usually safe to keep taking them, or should I change or stop them before trying to conceive?
Also, could the hormonal changes during pregnancy or after giving birth make my bipolar symptoms worse?

Could you tell me if there are specific antidepressants or mood stabilizers that are safer to use during pregnancy and breastfeeding? I am also concerned about whether hormonal birth control can interact with medications like lithium or change their effects.

Sometimes I have trouble telling the difference between mood changes from PMS and symptoms of bipolar disorder.

Are there any practical ways to tell them apart so I can better manage my symptoms?

Please help.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com

I read your query and understand your concern.

Some mood stabilizers and psychiatric medications can affect your hormones and may lead to irregular or missed periods. It is a good idea to talk with both your psychiatrist and gynecologist so they can help figure out the cause and guide you.

If you are planning a pregnancy, do not stop or change your medications on your own, since this can raise your risk of relapse. Some bipolar medications, such as lithium and valproate, may have risks during pregnancy. It’s best to meet with your psychiatrist and obstetrician before trying to conceive, so you can review your treatment plan together and look at safer options if needed.

Pregnancy and especially the time after giving birth bring big hormonal changes, which can make mood swings or relapses more likely for people with bipolar disorder, especially if medications are stopped. It’s important to have close monitoring and support during this period.

Several medicines, such as lamotrigine and several SSRIs, are regarded as safer to take in pregnancy and during breastfeeding. The best choice depends on your symptoms, treatment history, and overall health, it is crucial to make this decision with your doctor.

Hormonal contraceptives can change how your body handles lithium and may affect how well it works. If you are taking lithium, your doctor might suggest checking your blood levels more often when you start or change contraceptives.

Keeping a detailed symptom diary can be very helpful. Mood changes from PMS usually happen before your period and get better once it starts. Bipolar symptoms are often stronger, last longer, and may not follow your cycle. Tracking your symptoms over time can help you and your doctor tell the difference.

I hope this information is helpful.

Please keep seeing your healthcare providers regularly so you can get advice that’s right for you and make sure your treatment stays safe.

Thank you.