Antipsychotic medication, prolactin elevation, and ovarian function in women with schizophrenia and schizoaffective disorder

Canuso, Carla M.; Goldstein, Jill M.; Wojcik, Joanne; Dawson, Ree; Brandman, Danielle; Klibanski, Anne; Schildkraut, Joseph J.; Green, Alan I.

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Volume 111, Issue 1 , Pages 11-20, 5 August 2002

Antipsychotic medication, prolactin elevation, and ovarian function in women with schizophrenia and schizoaffective disorder

Carla M. Canuso
- Commonwealth Research Center, Boston, MA 02115, USA
- Harvard Department of Psychiatry at the Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Corresponding author. Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115, USA. Tel.: +617-626-9633; fax: +617-734-6206
Jill M. Goldstein
- Harvard Department of Psychiatry at the Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Massachusetts General Hospital, Boston, MA 02115, USA
- Harvard Institute for Psychiatric Epidemiology and Genetics, Boston, MA 02115, USA
Joanne Wojcik
- Commonwealth Research Center, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
Ree Dawson
- Commonwealth Research Center, Boston, MA 02115, USA
- Frontier Science Technology, Boston, MA 02115, USA
Danielle Brandman
- Commonwealth Research Center, Boston, MA 02115, USA
Anne Klibanski
- Harvard Medical School, Boston, MA 02115, USA
- Massachusetts General Hospital, Boston, MA 02115, USA
Joseph J. Schildkraut
- Commonwealth Research Center, Boston, MA 02115, USA
- Harvard Department of Psychiatry at the Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
Alan I. Green
- Commonwealth Research Center, Boston, MA 02115, USA
- Harvard Department of Psychiatry at the Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA

Received 29 August 2001; received in revised form 29 April 2002; accepted 6 May 2002.

Abstract

Some, but not all, antipsychotics elevate serum prolactin. Antipsychotic-induced hyperprolactinemia is thought to account for high rates of menstrual dysfunction and diminished estrogen levels in women with schizophrenia. However, few studies have directly assessed the relationships between prolactin, menstrual function, and ovarian hormone levels in this population. Sixteen premenopausal women with schizophrenia and schizoaffective disorder, eight treated with an antipsychotic with prolactin-elevating potential (five with typical antipsychotics and three with risperidone) and eight treated with an antipsychotic with prolactin-sparing potential (seven with olanzapine and one with clozapine), were studied for eight weeks. Data were collected on menstrual functioning and on serum prolactin, estradiol, and progesterone levels, and were compared between subjects who received an antipsychotic with prolactin-elevating potential and an antipsychotic with prolactin-sparing potential, and between subjects with hyperprolactinemia (N=6) and normoprolactinemia (N=10). Additionally, peak ovarian hormone levels were compared to normal values. While mean prolactin levels of subjects who received an antipsychotic with prolactin-elevating potential were significantly greater than those of subjects who received an antipsychotic with prolactin-sparing potential, there were no differences in rates of menstrual dysfunction or in ovarian hormone values between the two groups. Additionally, similar rates of menstrual dysfunction and ovarian hormone values were observed between the hyperprolactinemic and normoprolactinemic subjects. Moreover, irrespective of medication type or prolactin status, most subjects had peak estradiol levels below normal reference values for the periovulatory phase of the menstrual cycle. While our sample size is small, warranting the need for further investigation, the findings of this preliminary study suggest that antipsychotic-induced hyperprolactinemia, alone, may not adequately explain the observed ovarian dysfunction in women with schizophrenia.

Keywords: Schizophrenia, Schizoaffective disorder, Antipsychotic medication, Psychosis, Prolactin, Women, Ovarian function