(1)
Departments of Internal Medicine & Psychiatry, Yale University School of Medicine, New Haven, CT, USA
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women. It is related to ovarian androgen excess and manifests as hirsutism, irregular menstrual cycles, and ovarian cysts seen on an ultrasonogram. Two out of three features are required to make a diagnosis. Obesity is often associated with PCOS. Symptoms are usually seen from puberty.
The androgen excess in PCOS results from increased ovarian androgen secretion and reduced conversion to estrogen. PCOS is associated with insulin resistance and hyperinsulinemia . These women are at increased risk for infertility and metabolic syndrome and its cardiovascular complications.
Valproate and PCOS
PCOS has been observed at a higher incidence in patients on valproate. It was initially observed in people on treatment for seizure disorder and it was uncertain whether valproate or the underlying seizure disorder predisposed to PCOS. PCOS was subsequently seen in patients being treated for bipolar disorder and was more frequent in those on valproate than other mood stabilizers [1]. It occurred within a year of treatment initiation. The mechanism is thought to be both from gamma aminobutyric acid (GABA) -mediated transmission to the hypothalamus and peripheral effect on estrogen and progesterone [2].
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