Background: Vitamin E is well known for its antioxidant property and has potential role in treatment of infertility. Fluoxetine is an antidepressant from SSRI group having effect on reproductive organs by increasing oxidative stress.
Aim: To explore the role of vitamin E on uterine myometrium after treatment with fluoxetine

Methods: 8-12 weeks old female rats albino of wistar strain (n=10) were divided into three groups Group A (control), group B (experimental) and group C (protective) and were treated with distilled water, oral fluoxetine (80mg/kg) and oral fluoxetine along with vitamin E simultaneously (80mg/kg and 250mg/kg) respectively for 15 days. Gross and histological examination of uterine horns of all rats along with measurement of serum prolactin level was done on 15th day. Mean±SD, One-way ANOVA and fisher exact test was applied to analyze data

Results: Weight, volume of uterus, utero-somatic index, serum prolactin level and myometrial thickness was significantly increased (P value=0.001) along with prescence of adenomyosis in experimental group B which was given fluoxetine alone. however its was observed that in group C which was given vitamin E along with fluoxetine, ameliorated these changes and results were comparable with control group A.

Conclusion: Vitamin E has a role in protection of reproductive organs owing to its antioxidant properties when administered along with fluoxetine which produces oxidative stress related changes serum prolactin levels and uterine myometrium.

Female reproductive organs have a delicate relationship with hormonal levels. Savaskan et al., 2007 observed fluoxetine use related oxidative stress and commented on its role in alteration of histological structure of reproductive organs. Jan et al., 2008 reported hormonal imbalance in rats upon treated with fluoxetine. Mori et al., 1999 observed changes in ultra-structure of uterus caused by increase in serum prolactin levels.

The animals of group C when treated simultaneously with fluoxetine along with vitamin E, showed normal thickness and histological architecture of myometrium which is similar to findings in animals of control group A. Vitamin E has been reported to ameliorate the hormonal changes inflicted by raised level of oxidative stress in body (Yin et al., 2012) .A study done by Jalili et al. 2014 supports the observations made in current study on protective ability of vitamin E in reproductive organs because of its antioxidant properties.

Medication use is a common cause of hyperprolactinemia, and it is important to differentiate this cause from pathologic causes, such as prolactinomas.

To ascertain the frequency of this clinical problem and to develop treatment guidelines, the medical literature was searched by using PubMed and the reference lists of other articles dealing with hyperprolactinemia due to specific types of medications.

The medications that most commonly cause hyperprolactinemia are antipsychotic agents; however, some newer atypical antipsychotics do not cause this condition.

Other classes of medications that cause hyperprolactinemia include antidepressants, antihypertensive agents, and drugs that increase bowel motility.

Hyperprolactinemia caused by medications is commonly symptomatic, causing galactorrhea, menstrual disturbance, and impotence.

It is Important to ensure that hyperprolactinemia in an Individual patient is due to medication and not to a structural lesion in the hypothalamic/pituitary area; this can be accomplished by (1) stopping the medication temporarily to determine whether prolactin levels return to normal, (2) switching to a medication that does not cause hyperprolactinemia (in consultation with the patient’s psychiatrist for psychoactive medications), or (3) performing magnetic resonance imaging or computed tomography of the hypothalamic/pituitary area. If the patient’s hyperprolactinemia is symptomatic, treatment strategies include switching to an alternative medication that does not cause hyperprolactinemia, using estrogen or testosterone replacement, or, rarely, cautiously adding a dopamine agonist.

Medications That May Cause Hyperprolactinemia

  • Antidepressants
    • Tricyclic and tetracyclic antidepressants
    • Monoamine oxidase inhibitors
    • Selective serotonin reuptake inhibitors
    • Other
  • Opiates and cocaine
  • Antihypertensive medications
    • Verapamil
    • Methyldopa
    • Reserpine
  • Gastrointestinal medications
    • Metoclopramide
    • Domperidone
    • Histamine2 receptor blockers?
  • Protease inhibitors?
  • Estrogens

Introduction: Fluoxetine is a commonly prescribed drug which is used in the psychiatric practice and adenomyosis is a common medical problem in women of the reproductive age group.

Objective: To explore the role of fluoxetine in the causation of adenomyosis.

Methods: Female Wistar rats (n=18) were divided into three groups (group I (the control), group II and group III) and they were treated with normal saline and oral fluoxetine (4mg/kg and 8 mg/kg) respectively for 100 days. Periodic serum prolactin measurements and histopathological examinations of the uterine horns of all the rats were done at the end. Comparison of the mean serum prolactin levels between the patients (n=15) who were diagnosed with adenomyosis, the healthy age sex matched controls and the female patients (n=20) who received fluoxetine for more than 3 months, before and after the fluoxetine administration, was done separately. Appropriate (paired or unpaired) t tests were used for the data analysis.

Results: Out of the 12 test group rats, 10 rats showed the features of adenomyosis histopathologically, along with significantly (p < 0.05) raised serum prolactin levels. The mean serum prolactin levels of the patients of adenomyosis in comparison to those of the controls and of the patients who were treated with fluoxetine (before and after the fluoxetine administration), were significantly high (p=0.001 in both the cases).

Conclusion: Fluoxetine may have some role in the causation of adenomyosis (via raising serum prolactin levels); although for a stronger evidence, the follow-up of the patients who are treated with fluoxetine on a long term basis should be ideal.

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