Q:  Bipolar Disorder & Pregnancy Test Results

My wife has been diagnosed as BP for two years now. She is on Zyprexa, Wellbutrin and Prozac. She is now one month late on her period, after being regular for two years. We've taken three home pregnancy tests, and each one did not give a clear yes or no indication. We went to the doctor, and those results were also inconclusive. The doctor is baffled, just like us. Could bipolar disorder or the medications interfere with the results? 
 

Dear Dennis -- 
Can bipolar disorder or these three medications interfere with home pregnancy tests and a doctor's pregnancy test? (If the doctor's was a urine test, not a blood test, it may not be all too terribly different from the three you did at home; but if it was a serum HCG (human chorionic gonadotropin, an obvious marker for pregnancy), then that would be a further oddity).  Let's return to that question after examining one better understood aspect of bipolar disorder and reproductive hormones. 

You may have heard of "metabolic syndrome", as this has been associated with Zyprexa:  a pattern of weight gain, primarily through an increase in abdominal fat, occurring along with an increase in cholesterol levels, blood glucose, and blood pressure.  Metabolic syndrome appears to be more common in people with bipolar disorder even if they're not taking Zyprexa, which makes figuring out whether Zyprexa caused it, in a particular person, quite difficult sometimes. 

What does metabolic syndrome have to do with unusual pregnancy test results? Hang on, we're getting there.  One version of metabolic syndrome, a particular variation found in some women, is called "polycystic ovarian syndrome", or PCOS.  (If you get really intrested in this and want to know the difference between metabolic syndrome and PCOS, take that link -- but otherwise, like all the links in this note, just keep reading).  PCOS causes irregular menstrual cycles (ah, maybe now we're getting somewhere...). 

The irregular menstrual cycles, meaning "missed periods", occur because ovulation has not occurred.  Without ovulation, there is no rise in progesterone levels, the fall of which is what triggers menstruation.  But there is no rise in HCG either, so there is no obvious marker on a pregnancy test.  

Now, whether any of this applies to your wife's situation I cannot know.  It's just a story you would want to know in order to make sure that there isn't something like this going on to explain the missed periods.  She could indeed be pregnant, and somehow that just hasn't been detected yet.  Is there a test for metabolic syndrome or PCOS?  The latter can sometimes cause cysts, small collections of fluid (which actually are eggs in their little follicles, trying but not succeeding in busting loose) on the surface of the ovaries, but the presence of such cysts doesn't clinch the diagnosis and neither does their absence.  There are some hormone changes called "androgenization" which also go along with PCOS in its more extreme versions.  While you and your wife and her doctors are trying to figure this all out, I think it is worth knowing about PCOS and metabolic syndrome, but these conditions might have nothing to do with the "real" explanation of what's going on.  I hope it gets sorted out without too much more delay or difficulty. 

Dr. Phelps


Published December, 2005