REPRODUCTIVE ENDOCRINE DYSFUNCTION IN WOMEN WITH EPILEPSY OR BIPOLAR DISORDER Neuroendocrine dysfunction in women with epilep-

Neuroendocrine dysfunction is prevalent among women with epilepsy or bipolar disorder. The manifestations of neuroendocrine dysfunction can include insulin resistance, hyperinsulinemia, dyslipidemia, and obesity—all of which are risk factors for coronary artery disease. Hyperandrogenism, another common neuroendocrine finding, is associated with anovulation, fertility loss, and altered sex drive. Because of the serious health consequences of neuroendocrine dysfunction, women with epilepsy or bipolar disorder should be monitored carefully for signs or symptoms so that appropriate intervention can occur. Many aspects of neuroendocrine dysfunction can be controlled or prevented through lifestyle intervention and pharmacotherapy. To date, data have not established a causal relationship between use of anticonvulsants and reproductive endocrine dysfunction in women with epilepsy or bipolar disorder, although a possible contributory role cannot be ruled out. The possible benefits of a change in antiepileptic medication should be weighed carefully against the risks of adverse events and poor efficacy of alternative therapeutic options. (Adv Stud Med. 2003;3(8A):S740-S744) W omen with epilepsy are less fertile and suffer from more menstrual irregularities, gynecologic syndromes, and reproductive endocrine disorders compared with women without epilepsy. Reproductive endocrine dysfunction is especially common in women with temporal lobe epilepsy but is also prevalent in women with generalized epilepsy. Bipolar disorder is also characterized by neuroendocrine dysfunction as reflected primarily in dexamethasone nonsuppression and blunted thyrotropin-stimulating hormone, prolactin, and growth hormone responses. Like women with epilepsy, women with bipolar disorder have more menstrual irregularities compared with their healthy counterparts. This paper discusses the implications of neuroendocrine dysfunction for the management of patients with epilepsy or bipolar disorder.