The psychiatric ovarian cyst - a case report on psychotropic drug induced large ovarian mass

Abstract

Psychotropic medications used in bipolar affective disorder (BPAD) can disrupt the hypothalamic–pituitary–gonadal axis, leading to hyperprolactinemia, anovulation, and polycystic ovarian morphology. We report the case of a 29-year-old woman with BPAD on long-term multidrug therapy who presented with secondary amenorrhea, infertility, and a large multiloculated ovarian cyst. Evaluation revealed hyperprolactinemia and features mimicking polycystic ovary syndrome. Management included discontinuation of prolactin-elevating drugs and temporary use of endoxifen for psychiatric stabilization. Ultrasound-guided aspiration of enlarged follicles confirmed the functional nature of the cyst. However, persistent follicular enlargement suggested impaired ovulation, likely related to the anti-estrogenic effects of endoxifen. Following its withdrawal, ovulation induction with letrozole and intrauterine insemination resulted in successful conception. This case highlights the reversible nature of psychotropic-induced endocrine dysfunction and emphasizes the importance of individualized, multidisciplinary management.