Abstract
Abstract
Fluoxetine exerts wide ranges of side effects which encompass both common and other uncommon side effects. Here we report a case, who developed coital bleeding after being treated with fluoxetine. A 30-year-old married lady developed coital bleeding after being treated with fluoxetine 20 mg. The blood was fresh; however, the penetrations were not painful, vagina was well lubricated and both partners were psychologically ready. There is no history of bleeding without any effort of penetration. The bleeding stopped after discontinuing fluoxetine and subsequently meticulous search was done to find out other causes which revealed nothing contributory. The holistic impact of this newer class of antidepressants on women during reproductive age is mostly unknown.
Introduction
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), widely used in treating depression, obsessive compulsive disorder, anxiety disorders, stress-related disorders, eating disorders, and others such as premenstrual dysphoria.1, 2 It has a wide range of side effects which encompass both common side effects such as agitation, headache, insomnia, anorexia, sexual dysfunctions, and other uncommon side effects such as spontaneous bleeding causing bruises, amenorrhea, hyperprolactinemia, and menorrhagia.2-5 Few cases have been noted as unexpected onset of menses. 2 Here, we report a case of an adult Bangladeshi female medical graduate who developed coital bleeding after being treated with fluoxetine.
Case
Mrs A, a 30-year-old married lady, was diagnosed as a case of adjustment disorder by psychiatrist, prescribed capsule fluoxetine 20 mg in the morning after meal with necessary psychological interventions, and advised a follow-up visit after 3 weeks. After 2 weeks, the lady presented with coital bleeding for last 1 week along with other side effects. The blood was fresh which frightened the couple and they were bound to stop intercourses. However, the penetrations were not painful, vagina was well lubricated, and both partners were psychologically ready. Her menstrual cycle was regular before starting the medication and there was no previous history of such events. Moreover, there is no history of bleeding without any effort of penetration. The couple had regular penovaginal sex without such events before starting the medication with regular use of condom. The psychiatrist stopped the fluoxetine and made referral to gynecologist, hematologist, and internal medicine. Routine physical examinations and investigations, that is, complete blood count, liver function test, kidney function test, urinalysis, bleeding time, and clotting time, revealed nothing contributory. Also, the referred physicians advised to stop fluoxetine and a further follow-up after 2 weeks. After 2 weeks the couple attended for consultation with happy faces as they made successful intercourses without any bleeding for the last 4 days. Further rechallenge with fluoxetine was not attempted as further options were available.
The holistic impact of this newer class of antidepressants on women during reproductive age is mostly unknown. 2 Previous few studies found that fluoxetine showed significant association with increased menstrual cycle disorder and increased bleeding tendency which was also directly associated with the dose of fluoxetine.2-5 Other anecdotal reports revealed that fluoxetine was associated with bruises that subsided after stopping fluoxetine. 2 Authors aimed to report a rare side effect of fluoxetine manifested as coital bleeding which may raise cautiousness of clinicians to scrutiny of side effects of fluoxetine. In exploring this phenomenon, authors found a dearth of published data examining the effect of fluoxetine on coital bleeding.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.