The answer is E. Use of valproate has been associated with the subsequent development of PCOS features (in this patient, anovulation and hyperandrogenism) in 10.5% of women with bipolar disorder participating in a large cohort study. A and C are incorrect because this association is not seen with lamotrigine and lithium. B is incorrect because aripiprazole does not cause substantial hyperprolactinemia and therefore would not be expected to affect menstrual function. D is incorrect because spironolactone is a treatment for, rather than a cause of, hyperandrogenism.

Publication reference : Morrell MJ, Hayes FJ, Sluss PM, et al. Hyperandrogenism, ovulatory dysfunction, and polycystic ovary syndrome with valproate versus lamotrigine. Ann Neurol 2008; 64: 200-211.
Reference URL: https://www.ncbi.nlm.nih.gov/pubmed/18756476