Risk-to-befit ratios of consecutive antidepressants for heavy menstrual bleeding in young women with bipolar disorder or major depressive disorder

Chuanjun Zhuo, Guangdong Chen, Chongguang Lin, Jing Ping, Jingjing Zhu, Lina Wang, Shili Jin, Chuanxin Liu, Qiuyu Zhang, Lei Yang, Qianchen Li, Chunhua Zhou, Langlang Cheng, Hongjun Tian, Xueqin Song
In: Frontiers in Psychiatry · 2022 · vol. 13 , pp. 1012644 · doi:10.3389/fpsyt.2022.1012644 · PMID:36386987 · W4307705056
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This study found that certain antidepressants and their combination with valproate increased the risk of heavy menstrual bleeding in young women with bipolar or major depressive disorder, with varying risks between diagnostic groups.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This retrospective multi-hospital cohort study investigated whether heavy menstrual bleeding (HMB), assessed using pictorial blood loss assessment charts over prior 24 months, was associated with specific antidepressants and with antidepressant–valproate combinations in young women (18–35 years) with bipolar disorder (BP) or major depressive disorder (MDD) (n=1,949). Multivariate logistic regression estimated odds ratios for HMB for individual antidepressants, showing varying risks by diagnosis group (e.g., venlafaxine ORs ~5.27 in BP vs ~4.58 in MDD; reboxetine ORs ~0.45 in both). When antidepressants were combined with valproate, HMB odds increased substantially with distinct profiles across drugs (e.g., venlafaxine+valproate ORs ~8.48 in BP vs ~6.70 in MDD). A key limitation is that HMB assessment relied on retrospective clinician illustration and PBAC validity for prior HMB status was stated as not fully verified. Relevance to endometriosis/adenomyosis: the paper focuses on HMB risk in psychiatric medication users and does not explicitly discuss endometriosis or adenomyosis.

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Abstract

The occurrence of heavy menstrual bleeding (HMB) induced by pharmacological agents has been reported in young adult women. This study aimed to investigate a possible association between the occurrence rates of HMB and different treatment methods such as antidepressant agents alone and in combination with other pharmacological agents. The examined cohort included young women (age 18–35 years, n = 1,949) with bipolar disorder (BP) or major depressive disorder (MDD). Menstruation history for 24 months was recorded and evaluated according to pictorial blood loss assessment charts of HMB. Multivariate analyses were conducted to determine odds ratios (ORs) and 95% confidence intervals. The examined antidepressant agents had varying ORs for patients with BP vs. those with MDD. For example, the ORs of venlafaxine-induced HMB were 5.27 and 4.58 for patients with BP and MDD, respectively; duloxetine-induced HMB, 4.72 and 3.98; mirtazapine-induced HMB, 3.26 and 2.39; fluvoxamine-induced HMB, 3.11 and 2.08; fluoxetine-induced HMB, 2.45 and 1.13; citalopram-induced HMB, 2.03 and 1.25; escitalopram-induced HMB, 1.85 and 1.99; agomelatine-induced HMB, 1.45 and 2.97; paroxetine-induced HMB, 1.19 and 1.75; sertraline-induced HMB, 0.88 and 1.13; reboxetine-induced HMB, 0.45 and 0.45; and bupropion-induced HMB, 0.33 and 0.37, in each case. However, when antidepressant agents were combined with valproate, the OR of HMB greatly increased, with distinct profiles observed for patients with BP vs. those with MDD. For example, the ORs of HMB induced by venlafaxine combined with valproate were 8.48 and 6.70 for patients with BP and MDD, respectively; for duloxetine, 5.40 and 4.40; mirtazapine, 5.67 and 3.73; fluvoxamine, 5.27 and 3.37; fluoxetine, 3.69 and 4.30; citalopram, 5.88 and 3.46; escitalopram, 6.00 and 7.55; agomelatine, 4.26 and 5.65; paroxetine, 5.24 and 3.25; sertraline, 4.97 and 5.11; reboxetine, 3.54 and 2.19; and bupropion, 4.85 and 3.46, in each case. In conclusion, some antidepressant agents exhibited potential risks of inducing HMB. Therefore, a combined prescription of antidepressant agents and valproate should be carefully considered for young women with HMB.

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organisms 8
noordeloos 2009062 noordeloos 2009062 noordeloos 2009062 noordeloos 2009062 noordeloos 2009062 noordeloos 2009062 noordeloos 2009062 noordeloos 2009062
chemicals 94
venlafaxine duloxetine mirtazapine fluvoxamine fluoxetine citalopram escitalopram agomelatine paroxetine sertraline reboxetine bupropion valproate venlafaxine valproate venlafaxine sertraline fluoxetine glucose valproate chlorpromazine fluoxetine sodium valproate diazepam valproate venlafaxine duloxetine mirtazapine fluvoxamine fluoxetine citalopram escitalopram agomelatine paroxetine sertraline reboxetine bupropion valproate valproate venlafaxine valproate duloxetine mirtazapine fluvoxamine fluoxetine citalopram escitalopram agomelatine paroxetine sertraline reboxetine bupropion valproate venlafaxine duloxetine mirtazapine fluvoxamine citalopram escitalopram +34 more

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