---
title: Do lithium and valproate levels change during the menstrual cycle?
description: In women with bipolar disorder, lithium levels decreased during the luteal phase (before the period) despite stable doses, linked to worsening mood symptoms.
url: https://niyora.com/research/papers/lithium-and-valproate-serum-level-fluctuations-within-the-menstrual-cycle-a-2019/
---

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- Do lithium and valproate levels change during the menstrual cycle?

Systematic review, 2019

# Do lithium and valproate levels change during the menstrual cycle?

In women with bipolar disorder, lithium levels decreased during the luteal phase (before the period) despite stable doses, linked to worsening mood symptoms. In healthy women, lithium levels were not affected by the menstrual cycle.

 Moderate study design

Women with bipolar disorder, epilepsy, and healthy women

## What they did

Systematic review of 5 studies examining whether blood levels of lithium and valproate change during different menstrual cycle phases. Most studies included women with bipolar disorder or epilepsy.

## What they found

In women with bipolar disorder, lithium levels showed a significant decrease during the luteal phase despite stable oral doses, linked to cyclic worsening of mood symptoms before the period. In healthy women, lithium levels were not influenced by menstrual cycle phases or oral contraceptive use. Valproate levels in epileptic women showed a small, nonsignificant decline during the mid-luteal phase.

## What it means for you

If you take lithium for bipolar disorder, your blood levels may drop before your period, potentially worsening mood symptoms. Talk to your doctor about dose adjustments during your cycle. This finding comes from a small number of studies.

5

studies reviewed

4

studies assessing lithium levels

1

study assessing valproate levels

## About the study

Original title Lithium and valproate serum level fluctuations within the menstrual cycle: a systematic review Authors Carmassi C, Del Grande C, Masci I et al. Journal International clinical psychopharmacology Year 2019 Study design Systematic review What was tested Monitoring of lithium and valproate levels during menstrual cycle Open access Yes Read the paper [doi.org/10.1097/yic.0000000000000253](https://doi.org/10.1097/yic.0000000000000253)

## Topics

[Premenstrual exacerbation (PME)](https://niyora.com/research/topics/condition-pme/)[Menstrual cycle and mood](https://niyora.com/research/topics/condition-cycle-mood/)[Oral contraceptives and drospirenone](https://niyora.com/research/topics/treatment-hormonal-contraceptives/)[Anxiolytics and other psychotropics](https://niyora.com/research/topics/treatment-anxiolytics/)[Bipolar disorder](https://niyora.com/research/topics/comorbidity-bipolar/)[Epilepsy](https://niyora.com/research/topics/comorbidity-epilepsy/)

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Calm down, see it another way, and decide what to say, with a PMS and PMDD app built by a doctor.

## Related studies

Case-control study, 2015

Does lamotrigine reduce menstrual cycle-related mood changes in women with bipolar disorder?

Case report, 2025

Can birth control medication help menstrual cycle-related psychosis?

Study, 2024

Can PMDD cause psychosis that returns with each menstrual cycle?

Survey study, 2011

Why do some women experience negative mood with hormone changes?

Review, 1971

Could hormone-driven changes in brain chemicals explain premenstrual mood swings?

Systematic review, 2023

What hormonal treatments have been tested for PMDD, menstrual migraine, and catamenial epilepsy?

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