Abstract
Controversy persists about links between psychotropic drug use, obesity, and consequent menstrual irregularities. Although these interrelationships have been suggested to possibly explain polycystic ovarian syndrome among women taking valproate, less is known about menstrual irregularities associated with weight gain caused by other psychotropics. Clozapine, sparing of prolactin-related menstrual effects yet often associated with weight gain, offers a model psychotropic from which to test such hypotheses. We studied outpatient premenopausal women from a clozapine clinic to preliminarily assess the association between menstrual cycle patterns and body mass index (BMI). Records were reviewed for 13 female premenopausal schizophrenic, bipolar, or schizoaffective outpatients who took clozapine with no conventional antipsychotics for ≥ 6 months. Mean 6-month menstrual cycle lengths were compared with BMIs and relative weight changes since starting clozapine. Subjects took clozapine (mean ± SD dose 392.2 ± 195.7 mg/day) for a mean ± SD of 4.4 ± 3.2 years, with a mean preclozapine weight increase of 27%. Twenty-three percent had menstrual irregularities in the preceding 6 months (mean ± SD cycle length = 36.4 ± 18.1 days), although no significant associations were observed between cycle length and (a) mean ± SD BMI (32.0 ± 8.4) (r = -0.09, p = 0.78) or (b) weight change since starting clozapine (r = -0.10, p = 0.75). The observed lack of association between clozapine-induced weight gain and menstrual disturbances would provisionally suggest that iatrogenic weight gain does not robustly explain the emergence of irregular menses among premenopausal women taking clozapine.