Polycystic ovary syndrome and valproic acid

The reproductive functions of epileptic females often display alterations. This dysfunction can be due to psychological, physiological or pharmacological factors. These women have been described as having, for example, a higher incidence of anovulatory cycles, infertility, alterations affecting the hypothalamic or pituitary hormones and the peripheral sex hormones. The greater incidence of polycystic ovary syndrome is subject to debate, since the prevalence varies according to the eligibility criteria used for the syndrome. The series that show a positive relation between polycystic ovary syndrome and epilepsy tend to understand it to be a side effect of antiepileptic medication, especially valproic acid. Two theories are considered: it has a direct action on the sex hormones or hyperinsulinism that is secondary to weight gain. As neurologists, in our daily practice we must show concern for the conceive. Moreover, we must determine the baseline reproductive hormonal functioning of the epileptic female before beginning antiepileptic therapy, provide laboratory backed evidence of any sexual function disorder and refer them to the reproductive and sexual health of epileptic women. To do so, we need a patient record that is aimed at detecting possible problems, with special attention being given to the warning signs , such as changes in weight, variations of the menstrual cycles or mid cycle bleeding, the appearance of androgynous obesity, signs of virilisation, miscarriages or difficulties to endocrinologist or gynaecologist. Knowledge about both pathologies will enable us to modify antiepileptic therapy if the relation it has with them is confirmed, since this side effect could be reversible.