Lamotrigine & Polycystic Ovary Syndrome
An international observational study of 222 women (18-35 years of age) comparing lamotrigine (Lamictal®) and valproate (Depakote®) suggests that lamotrigine is less likely to be associated with polycystic ovary syndrome (PCOS), a condition which causes infertility. Data were presented by Dr. Martha Morrell (Professor of Neurology, Columbia University College of Physicians and Surgeons, and Director of the Columbia Comprehensive Epilepsy Center, New York-Presbyterian Hospital) to the 53rd Annual Meeting of the American Academy of Neurology in Philadelphia.
The study involved 119 women on lamotrigine monotherapy and 103 women on valproate monotherapy for periods of 8 months to 5 years. The study required 1 blood test for measuring hormone, lipid and insulin levels, 1 weight measurement of each participant, and patient-reported weight at initiation of lamotrigine or valproate treatment. Each women completed a menstrual diary of a 3-cycle time frame; those with regular menstrual cycles provided results of home urine ovulation tests performed over 1 menstrual cycle.
The study was conducted in response to growing concerns that women taking antiseizure medications may develop hormonal and metabolic disorders related to PCOS.
[PCOS, estimated to affect 5-10% of women of childbearing age, is a leading causes of infertility in women. It is characterized by obesity, irregular or absent menses, ovarian cysts, high blood pressure and elevated lipid levels, elevated insulin levels or diabetes, infertility, excessive facial or body hair and thinning of scalp hair. In particular, several published studies have reported that extended exposure to valproate has been associated with the development of PCOS symptoms.]
Women with epilepsy may receive their primary treatment from physicians who may not be aware of information showing potential infertility and menstrual disturbances associated with some antiseizure medications. This study adds to the body of evidence showing that physicians who care for women with epilepsy should be aware of signs of menstrual irregularity, weight gain and infertility.
The new data compared lamotrigine favourably to valproate in several areas. Women taking lamotrigine had lower levels of androgen [male hormones] which, when elevated, are believed to cause a number of changes which may lead to PCOS. These women also reported more regular menstrual cycles and their weight remained stable. Those taking valproate gained weight during treatment.
Key Findings
Significantly higher androgen levels were found in the valproate group: - Total serum testosterone:
0.96 nmol/L valproate versus 0.72 nmol/L lamotrigine. - Total serum androstenedione:
12.6 nmol/L valproate versus 10.1 nmol/L lamotrigine.
Lamotrigine group remained weight-gain neutral
while the valproate group showed an increase: - Mean weight in the lamotrigine group was the same at the initiation of therapy and the study visit
(71.5 kg/71.5 kg) - Mean weight of the valproate group increased during this timespan
(63.0 kg/67.7 kg).
Lamotrigine group had shorter menstrual cycles
while valproate group had longer cycles: - Women taking lamotrigine reported slightly shorter and more regular menstrual cycles:
29.5 days. - Women taking valproate reported longer and more variable cycle lengths:
31.5 days.
This research was funded by
GlaxoSmithKline.
Information
