Can psychiatric drugs cause menstrual cycle disorders in women? What experts say

Today, we are going to talk about the medical mystery between psychiatric drugs and female menstruation, which seems to have nothing to do with each other, but is actually subtly related.

01 How do psychiatric drugs affect the menstrual cycle?

The female menstrual cycle is a sophisticated and complex system that is strictly regulated by the hypothalamus, the "headquarters" in the brain, which directs the operation of the entire reproductive system.

Some psychiatric drugs, such as antidepressants and antipsychotics, help us maintain emotional stability primarily by regulating neurotransmitters in the brain, such as dopamine, serotonin, and norepinephrine. But did you know that these neurotransmitters also play an important role in regulating the hypothalamic-pituitary-ovarian axis? The hypothalamic-pituitary-ovarian axis is the main endocrine axis that controls the female reproductive system, and its dysfunction may lead to menstrual disorders.

Specifically:

(1) Affecting the secretion of hypothalamic hormones : Psychiatric drugs may interfere with the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus, thereby affecting the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the pituitary gland.

(2) Causing ovarian dysfunction : These hormonal changes will directly affect the function of the ovaries, leading to abnormal ovulation or luteal insufficiency, thereby causing changes in the menstrual cycle.

(3) Indirect effects : Psychiatric drugs may also indirectly affect the menstrual cycle by affecting other hormones such as prolactin. The release of prolactin is inhibited and regulated by dopamine secreted by the hypothalamus and transmitted to the adenohypophysis through the pituitary venous system, while serotonin, thyrotropin-releasing hormone (TRH), oxytocin, vasoactive intestinal peptide, etc. can promote the release of prolactin. High levels of prolactin can inhibit the secretion of GnRH. When the inhibition reaches a certain level, LH and FSH deficiency will occur, leading to menstrual disorders, amenorrhea and other related symptoms.

Imagine if your phone alarm was hacked and started ringing randomly, would you still be able to live a normal life? Similarly, when your brain's "alarm clock" is disrupted by psychiatric drugs, your menstrual cycle will naturally suffer. So, after taking these drugs, you may find that your menstruation has become less regular, and sometimes even amenorrhea.

02 Facing the impact: How to respond?

Different types of psychiatric drugs have different degrees of impact on menstrual disorders. Antipsychotic drugs, especially those with high prolactin effects, such as amisulpride, risperidone, and paliperidone, are more likely to cause menstrual disorders. In contrast, the risk of choosing olanzapine, quetiapine, and ziprasidone is moderate, while the risk of clozapine and aripiprazole is lower. Although prolactin levels will gradually decrease after long-term use of this type of drug until the mechanism is tolerated, they are still relatively high relative to baseline levels. Different individuals also differ in their response to drugs, and some women may be more susceptible to the effects of drugs and experience menstrual disorders. After all, everyone's physical condition is unique, just like there are no two leaves in the world that are exactly the same. Many times, these side effects are temporary, and the menstrual cycle will soon return to normal as long as the medication is stopped or changed.

Female friends, if you are taking psychiatric drugs and are worried about the impact on your menstruation, the following tips may help you:

(1) Record your menstrual status : It is also very important to regularly monitor your hormone levels and menstrual cycle changes. Keep detailed records of your menstrual cycle, menstrual volume, and dysmenorrhea to better understand your menstrual status. This helps to detect the occurrence of menstrual disorders in a timely manner and provides a basis for subsequent diagnosis and treatment.

(2) Consult a doctor promptly : If you find that your menstrual period has changed abnormally, please do not stop taking the medicine or reduce the dosage at will, as this may cause the condition to relapse or worsen. You should consult a doctor as soon as possible and discuss various strategies with the doctor to determine whether there are other factors that may cause menstrual disorders. The doctor can adjust the dosage of the medicine or change the medicine according to your specific situation to reduce the impact on your menstrual period.

(3) Maintain good living habits : Healthy living habits are very important for maintaining a normal menstrual cycle. Maintaining a regular schedule, a balanced diet, and adequate exercise can all help alleviate the side effects of medication.

(4) Learn to self-regulate : In addition to medication, you can also try some self-regulation methods to alleviate irregular menstruation. For example, deep breathing, yoga, meditation and other relaxing activities can help relieve stress and anxiety.

Although the relationship between psychiatric drugs and the female menstrual cycle is complex, it is not an insurmountable gap. As long as we face it correctly and respond positively, we can successfully get through this special period!

References:

[1] Shen Yucun, ed. Psychiatry[M]. 6th edition. Beijing: People's Medical Publishing House, 2009.1.848.

[2] Man Zhineng, Liu Huan, Li Yan, et al. Literature review on drug-induced menstrual disorders and their mechanisms[J]. Chinese Pharmacist, 2019, 22(8):1510-1516.

Author: Huang Chunyan, junior nurse at Shanghai Chongming District Mental Health Center

Planning/Review:

Xie Bin, Party Secretary of Shanghai Mental Health Center, Chief Physician

Kuang Weihong, Deputy Director and Chief Physician of the Mental Health Center of West China Hospital, Sichuan University

Produced by: Popular Science China × Chinese Association of Preventive Medicine

The pictures and cover image of this article are from the copyright gallery. Reprinting and using them may cause copyright disputes.