Androgen, insulin, and lipid profiles were compared in young women and men treated with valproate (VPA) monotherapy and matched with controls taking lamotrigine (LTG), in a study at Western Infirmary, Glasgow, Scotland. Four obese VPA-treated women were hyperinsulinemic (P=0.05); 3 had abnormal menstrual cycles and 1 a raised testosterone level. Obese patients of both sexes and VPA-treated men had elevated insulin levels. Testosterone and triglyceride levels were higher in VPA-treated women compared with those taking LTG. Only a minority of obese VPA-treated females had polycystic ovarian syndrome. [1]

COMMENT. VPA therapy may cause a subclinical hperinsulinemia in patients of either sex. In women, testosterone and triglycerides may also be elevated, indicative of polycystic ovarian syndrome. Women with obesity and a history of menstrual irregularities should receive a biochemical hormone screen. Those with abnormal chemistries should be advised to lose weight and avoid treatment with VPA.