Treating women with bipolar disorder during the reproductive years requires special consideration because of the reproductive risks associated with specific psychotropic drugs and drug interactions with hormonal contraceptives. Some psychotropic drugs can disrupt the menstrual cycle, alter pregnancy potential, and increase the risk for chronic conditions associated with hormone changes, such as prolactin elevation and polycystic ovarian syndrome (PCOS). Valproate has been associated with an increased risk of PCOS features. Typical antipsychotics and risperidone can increase prolactin production, which may also disrupt the menstrual cycle. When the menstrual cycle is altered, fertility is reduced, and medical conditions such as osteoporosis and endometrial hyperplasia can result. This article advises establishing the regularity of menstrual cycles and discussing the potential reproductive impact of specific psychotropic medications before initiating treatment in women with bipolar disorder who are of reproductive age.