ENDOMETRIOSIS AND SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) PRESCRIPTION

Objectives:We report a case of intermenstrual bleeding associated with SSRIs and a literature review.Background:Antidepressants influence blood serotonin levels, and consequently can increase the risk of abnormal bleeding. It has been established that menstrual complaints are more common among women taking antidepressants. However, the underlying mechanism is still unknown. Our aim is to report an association between abnormal uterine bleeding after SSRI prescription in a woman with endometriosisMaterials and Methods:Clinical information was extracted from the patient’s clinical record. Inform consent was obtained. In addition, we searched Pubmed database with the terms “SSRIs”, “menstruation disorders”, “endometriosis”, “paroxetine” and “abnormal bleeding”. Six articles published between 2004 and 2016 were selected.Results and Conclusions:A 43-year-old woman, diagnosed with endometriosis, developed depressive symptoms and anxiety. The diagnosis of Moderate Depressive Episode (ICD 10th version) was made and paroxetine prescribed. Her menstrual cycle was stable on oral contraceptive pill for years. Four weeks later she developed daily intermenstrual bleeding and abdominal pain. One week after paroxetine cessation the bleeding stopped. A switch to bupropion led to clinical remission without menstrual complains. Risk factors for antidepressant-induced menstruation disorders are still unknown. According to Uguz et al (2012), the highest frequency of menstrual disturbances was observed with the use of paroxetine, sertraline and venlafaxine. A higher serotonin reuptake potency appears to be related to an increased risk of bleeding.Conclusions: The literature about this possible SSRI side effect is sparse. Clinicians should carefully interrogate and inform women about menstrual-related side effects when prescribing these antidepressants.