Bipolar disorder in women: Contraception and preconception assessment and counseling
- Victoria Hendrick, MD
Victoria Hendrick, MD
- Clinical Professor
- Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine, UCLA
Prepregnancy counseling is relevant to all female patients with bipolar disorder who are of reproductive age, regardless of their plans regarding pregnancy . Unplanned pregnancies are common in the general population, and the risk of unplanned pregnancies appears to be greater in women with bipolar disorder than in healthy controls . Contraception should be encouraged for patients who wish to avoid pregnancy, and patients who consider becoming pregnant should receive preconception counseling about the risks to the patient and her child.
This topic reviews contraception and the preconception assessment and counseling of women with bipolar disorder. Indications for maintenance pharmacotherapy during pregnancy, selecting preconception and prenatal maintenance treatment for bipolar patients, and the teratogenic and postnatal effects of medications used for bipolar disorder are discussed separately. (See "Bipolar disorder in women: Indications for preconception and prenatal maintenance pharmacotherapy" and "Bipolar disorder in women: Preconception and prenatal maintenance pharmacotherapy" and "Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy".)
DEFINITION OF BIPOLAR DISORDER
Bipolar disorder is characterized by episodes of mania (table 1), hypomania (table 2), and major depression (table 3) . The subtypes of bipolar disorder include bipolar I and bipolar II. Patients with bipolar I disorder experience manic episodes, and nearly always experience major depressive and hypomanic episodes. Bipolar II disorder is marked by at least one hypomanic episode, at least one major depressive episode, and the absence of manic episodes. Additional information about the clinical features and diagnosis of bipolar disorder is discussed separately. (See "Bipolar disorder in adults: Clinical features" and "Bipolar disorder in adults: Assessment and diagnosis", section on 'Diagnosis'.)
Bipolar patients who want to avoid pregnancy should receive information about contraceptive methods. Many female bipolar patients of childbearing age are treated with medications, but do not use contraception and are not trying to conceive. In a survey of 136 female patients receiving maintenance pharmacotherapy (including drugs that appear to be teratogenic), 41 percent did not use birth control .
Female bipolar patients should be encouraged to use long-acting reversible contraceptives, such as intrauterine devices or implants; these require much less attention from the user and are among the most effective methods. In particular, the copper intrauterine device will not interfere with concurrent medications, is nonhormonal, and can be effective for at least 10 years. Contraceptive techniques are discussed separately. (See "Contraceptive counseling and selection".)
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- DEFINITION OF BIPOLAR DISORDER
- Drug interactions between antiepileptics and hormonal contraceptives
- PRECONCEPTION ASSESSMENT
- PRECONCEPTION AND PRENATAL PHARMACOTHERAPY
- RISKS ASSOCIATED WITH PREGNANCY
- Risk of maternal mood episodes
- - Relapse during pregnancy
- Relapse after discontinuing pharmacotherapy
- - Postpartum mood episodes
- Congenital defects in offspring
- Risk of pregnancy complications
- Prenatal infections and bipolar disorder in offspring
- Obstetric complications and bipolar disorder in offspring
- Risk of child inheriting psychopathology
- - Bipolar disorder
- - Other disorders
- Reducing risks
- INFORMATION FOR PATIENTS