Can bupropion (antidepressant medication) cause gynecological symptoms?

Does Bupropion Cause Gynecological Symptoms?

Bupropion can cause specific gynecological symptoms, though they are relatively uncommon and generally less problematic than those associated with SSRIs. The FDA-approved labeling documents several reproductive system adverse effects, and clinical guidelines recognize bupropion as having a favorable profile for sexual function compared to other antidepressants.

Direct Gynecological Adverse Effects from FDA Labeling

The FDA label for bupropion documents the following gynecological symptoms in controlled trials 1:

• Vaginal hemorrhage: 2% incidence in the highest dose group (400 mg/day) versus 0% with placebo 1
• Dysmenorrhea: <1% with placebo versus 2% with bupropion in seasonal affective disorder trials 1
• Menstrual complaints: 5% versus 1% with placebo in immediate-release formulation trials (300-600 mg/day) 1

Additional postmarketing gynecological reports include 1:

• Dyspareunia (painful intercourse)
• Vaginitis
• Gynecomastia (though primarily a male concern, can occur in women)
• Menopause-related symptoms

Sexual Function Effects

Bupropion is notably associated with improved rather than worsened sexual function, particularly when compared to SSRIs. This represents a key distinguishing feature:

• NCCN guidelines specifically recommend bupropion as an option for treating hypoactive sexual desire disorder in cancer survivors, alongside buspirone and flibanserin 2
• The 2024 NCCN Survivorship guidelines list bupropion as a treatment option for "low or lack of desire, libido, or intimacy" 2
• Research demonstrates bupropion successfully reversed SSRI-induced sexual dysfunction in 66% of patients, improving 69% of sexual complaints 3
• Open-label studies in breast cancer survivors suggest bupropion may improve sexual function, though larger trials are needed 2

Decreased libido occurred in 3% of bupropion-treated patients versus 2% with placebo in controlled trials 1, representing a minimal increase over baseline.

Pregnancy and Lactation Considerations

During pregnancy, bupropion presents specific gynecological/obstetrical concerns 4:

• Small increased risk of cardiovascular malformations with first-trimester exposure (adjusted OR 2.9; 95% CI 1.5-5.5) 4
• Possible increased risk for spontaneous abortion 4
• One case report of neonatal seizures due to severe hyperinsulinism 4

During breastfeeding 4:

• Bupropion is present in breast milk at very low levels
• Two case reports of seizures in breastfed infants exist despite generally low transfer 4
• The American Academy of Pediatrics recommends maintaining therapeutic doses while monitoring infants for vomiting, diarrhea, jitteriness, sedation, and seizures 4

Weight Effects with Gynecological Implications

Bupropion causes dose-dependent weight loss rather than weight gain, which may indirectly affect menstrual function 1:

• 14-19% of patients lost >5 lbs versus 6% with placebo in depression trials 1
• 23% lost >5 lbs versus 11% with placebo in seasonal affective disorder trials (up to 6 months) 1

Significant weight loss can disrupt menstrual cycles and cause amenorrhea, though this is not directly documented in bupropion trials.

Clinical Management Algorithm

When prescribing bupropion to women of reproductive age:

1. Screen for pregnancy status - bupropion requires risk-benefit discussion if pregnancy is planned or possible 4

2. Document baseline menstrual patterns - to identify treatment-emergent changes in cycle regularity, flow, or dysmenorrhea 1

3. Monitor for vaginal bleeding abnormalities - particularly at doses ≥400 mg/day where vaginal hemorrhage incidence reaches 2% 1

4. Assess sexual function at baseline and follow-up - bupropion may improve rather than worsen sexual dysfunction, making it preferable when sexual side effects are a concern 2, 3

5. Track weight changes - weight loss >5 lbs occurs in 14-23% of patients and may secondarily affect menstrual function 1

6. For breastfeeding patients - maintain therapeutic dosing while monitoring infant for seizures, irritability, poor feeding, and developmental milestones 4

Important Clinical Caveats

The gynecological side effect profile of bupropion is substantially more favorable than SSRIs, which commonly cause sexual dysfunction including reduced libido, arousal difficulties, and anorgasmia 2. This makes bupropion a preferred choice when sexual function is a priority concern 2.

Menstrual complaints and dysmenorrhea are uncommon (2-5% incidence) and only slightly elevated above placebo rates 1. These effects are far less problematic than the weight gain and sexual dysfunction associated with many other antidepressants.

Vaginal hemorrhage at 2% incidence warrants attention but occurs only at higher doses and should prompt evaluation for other causes of abnormal bleeding 1.

The postmarketing reports of dyspareunia and vaginitis 1 cannot be reliably attributed to bupropion given the voluntary reporting nature and uncertain population size, but clinicians should remain alert to these possibilities.