Considerations in managing bipolar disorder in females of childbearing potential

If the patient is pregnant or in the postpartum, see also Considerations in managing bipolar disorder during pregnancy or Considerations in managing bipolar disorder in the postpartum.

Some drugs used for bipolar disorder (ie sodium valproate, carbamazepine, lithium) are associated, to varying degrees, with fetal malformations—educate a female of childbearing potential who has bipolar disorder about these risks and discuss options for contraception.

Some antipsychotics increase blood prolactin concentration and consequently reduce fertility; see Approximate relative frequency of common adverse effects of antipsychotics for the relative frequency of hyperprolactinaemia with individual antipsychotics. Inform a patient of childbearing potential taking an antipsychotic that causes hyperprolactinemia that their fertility may be impaired and that if the antipsychotic causing hyperprolactinemia is stopped, they may be at increased risk of becoming pregnant.

Inform a female of childbearing potential with bipolar disorder that relapse is common during the perinatal period and that ideally, they should plan a pregnancy with their general practitioner, psychiatrist and significant other to allow time to consider and trial treatment options—see Considerations in managing bipolar disorder during pregnancy and Principles of psychotropic use in females of childbearing potential.

For further information about psychotropic use in females of childbearing potential, including principles of use and advice on individual drugs, see here.