At 35, can my schizophrenia affect my fertility?

Question

Hello, Doctor,

I am a 35-year-old woman diagnosed with schizophrenia five years ago. I have been stable on Risperidone 4 milligrams, but lately, my periods have stopped completely. My prolactin level came back at 82 ng/mL.

Sometimes I also feel excessively sleepy and have gained 10 kg in the past year. My psychiatrist said it’s a side effect, but I am very worried. I am scared of relapse if my medicine changes. My husband and I were thinking of starting IVF next year. Please tell me,

Will this affect my fertility?
Is it safe to undergo hormonal stimulation with my psychiatric history? Could switching medications help balance my hormones?
Can risperidone cause breast discharge?
Is there a way to manage both mental stability and menstrual health together?
Can long-term use of these drugs increase the risk for diabetes or cholesterol issues in women?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your missed periods and high prolactin level are very likely related to Risperidone (an antipsychotic medication). Risperidone blocks dopamine activity in the brain, and dopamine normally helps keep prolactin levels under control. In women, normal prolactin levels are usually below 25 nanograms per milliliter (ng/mL), so your prolactin level of 82 ng/mL is significantly elevated.

High prolactin levels can cause

Absent periods.
Infertility due to a lack of ovulation.
Breast discharge.
Reduced estrogen levels.
Low libido.
Long-term bone thinning.

So yes, Risperidone can definitely cause breast discharge and menstrual irregularity.

The good news is that this condition is often reversible. Once prolactin levels improve, your menstrual cycles and ovulation may return. This means your fertility may improve as well. Many women with medication-related hyperprolactinemia are still able to undergo IVF successfully after proper hormonal management.

You should not stop Risperidone suddenly or change the dose on your own because maintaining psychiatric stability is extremely important.

Several treatment approaches may help balance both your mental stability and hormone levels.

Adding a low dose of aripiprazole to risperidone sometimes lowers prolactin without causing psychiatric relapse.
Slowly switching to a prolactin-sparing antipsychotic such as aripiprazole.

In some cases, endocrinologists may consider medications like cabergoline, but this requires careful coordination because dopamine-stimulating medications can occasionally affect psychiatric symptoms.

Your excessive sleepiness and weight gain are also common side effects of Risperidone. These symptoms occur because the medication can affect metabolism, appetite, and energy regulation. Long-term use of some antipsychotic medications can cause the following issues,

Increase the risk of diabetes.
Insulin resistance.
High cholesterol.
Obesity.
Cardiovascular disease.

Because of this, you should have regular monitoring of fasting blood sugar, HbA1c, lipid profile, blood pressure, weight, and waist circumference.

Regarding IVF and hormonal stimulation, in vitro fertilization (IVF) is not automatically unsafe in women with schizophrenia if the condition is stable. Many women with stable psychiatric illness undergo fertility treatment successfully. However, hormonal fluctuations during IVF can sometimes affect mood or emotional stability, so close monitoring by your psychiatrist during treatment is important. Ideally, your condition should remain stable for at least six months before starting IVF.

I hope this information helps you.

Feel free to ask further queries.

Thank you.