Can tardive dyskinesia affect a woman's fertility at age 34?

Question

Hello doctor,

I have developed tardive dyskinesia after being on long-term antipsychotic treatment for bipolar depression. I experience involuntary facial movements and tongue thrusting, which makes me very self-conscious. Apart from this, my periods have become irregular, and sometimes I skip them entirely. I am 34 years old and was considering pregnancy, but I am worried that these drugs or my condition may harm my fertility or cause problems for the baby.

Could the medications or the movement disorder itself be affecting my hormones or menstrual cycles?
Are there safe treatment options for tardive dyskinesia in women who want to conceive?
Would IVF (in vitro fertilization) be a better option than trying naturally?
Also, could stress from this condition worsen PMS (premenstrual syndrome) symptoms or menopause later on?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

You are raising very important points. Let me explain step by step in simple terms:

Why does tardive dyskinesia (TD) happen? Long-term use of antipsychotics can sometimes cause abnormal involuntary movements of the face, lips, tongue, or limbs. This is due to changes in dopamine receptors in the brain. TD itself does not directly affect fertility, but the medicines that caused it can influence hormones.
Irregular periods: Some antipsychotics raise prolactin, a hormone from the pituitary. High prolactin can suppress ovulation and cause skipped or irregular periods. This explains why your cycles have changed; it is a medication side effect, not the TD itself. Correcting high prolactin (for example, by adjusting medication) often restores regular cycles.
Fertility and pregnancy safety: Most women with bipolar disorder can conceive naturally once cycles are regular. Some psychiatric medicines (for example, Valproate) are unsafe in pregnancy, while others (for example, Lamotrigine or some atypical antipsychotics) can be used more safely. Pregnancy planning should be coordinated between your psychiatrist, neurologist, and gynecologist so that medicines can be reviewed and adjusted before conception. TD itself does not harm the baby, but the choice of medicines during pregnancy matters.
Safe treatments for TD if planning pregnancy: VMAT-2 inhibitors (Valbenazine, Deutetrabenazine) are effective for TD, but safety data in pregnancy are limited, so they are used cautiously. Sometimes reducing the dose of the offending antipsychotic or switching to a different agent reduces symptoms. Non-drug strategies include relaxation techniques, physiotherapy, and botulinum toxin injections for focal facial movements in selected cases.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.