Background: Depression and anxiety disorders frequently affect women during reproductive years, when sexual function, menstrual health, and fertility are clinically important. Antidepressant medications, particularly serotonergic agents, can influence neuroendocrine pathways and may contribute to reproductive adverse outcomes.
Objectives: This study evaluated the impact of antidepressant exposure on women’s reproductive health by examining sexual dysfunction, menstrual irregularities, endocrine modulation (with emphasis on prolactin and ovarian reserve markers), and fertility-related outcomes, while accounting for psychiatric severity and key confounders.
Methods: A comprehensive observational study was conducted among reproductive-age women with depressive and/or anxiety disorders, comparing SSRI-, SNRI-, and other antidepressant-exposed groups with antidepressant-unexposed psychiatric controls. Standardized reproductive health assessments were performed alongside hormonal testing. Group comparisons used chi-square/Fisher’s exact tests for categorical outcomes and ANOVA/Kruskal-Wallis tests for hormonal endpoints. Multivariable regression models estimated adjusted associations, and time-to-pregnancy analyses were evaluated in the attempting-to-conceive subgroup using Kaplan-Meier and fecundability modeling.
Results: Sexual dysfunction was more frequent in serotonergic exposure groups, showing a class-gradient pattern (SSRI > SNRI > other antidepressants ? unexposed). Menstrual irregularities were modestly elevated among antidepressant-exposed participants. Endocrine analyses suggested higher prolactin distributions and increased hyperprolactinemia prevalence in SSRI/SNRI groups, supporting a biologically plausible pathway linking serotonergic modulation to reproductive effects. Ovarian reserve signals (AMH) showed small between-group differences requiring cautious interpretation. In the fertility subgroup, cumulative pregnancy probability and fecundability estimates were numerically lower in SSRI/SNRI groups, although effect precision varied.
Conclusion: Antidepressant treatment, particularly serotonergic agents, is associated with a clinically meaningful burden of sexual dysfunction and measurable hormonal modulation in women, with additional signals for menstrual disturbance and potential fertility impacts in some subgroups. Integrating baseline reproductive screening, proactive counseling, endocrine-aware monitoring, and individualized antidepressant selection is essential to optimize both mental health and reproductive outcomes.
International Journal of Clinical Obstetrics and Gynaecology
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Research Journals