Women’s Hormones and Epilepsy

Some women are at greater risk of having a seizure during pregnancy and at certain times of their menstrual cycle because of changing levels of the hormones estrogen and progesterone. These hormones continually increase and decrease throughout a woman’s life. Increased estrogen levels increase your risk of having seizures. Increased progesterone levels decrease your risk of having seizures. 
  • Menstruation 
  • Pregnancy
  • Family planning 
  • Menopause 
  • Sources
Menstruation

During the menstrual cycle, progesterone and estrogen levels move up and down. The average menstrual cycle lasts 28 days. The first day of the menstrual cycle is when bleeding (menses) starts. Estrogen levels slowly rise until they reach a peak in the middle of the cycle. The high estrogen level causes an egg to be released. Estrogen levels then drop off sharply and progesterone levels rise quickly to prepare the uterus for a fertilized egg. This is followed by another small rise in estrogen levels. If there is no fertilized egg, the progesterone and estrogen levels will fall again. A few days later, menses begins and the cycle repeats.

Women with epilepsy are more likely to have irregular menstrual cycles or cycles without ovulation. They may avoid sexual intercourse because of pain, lack of desire, and fear of having a seizure. They are also more likely to have trouble getting pregnant.

Any change in estrogen or progesterone can affect the menstrual cycle. Seizures can change the release of hormones that control estrogen and progesterone levels. Some medications may also affect the breakdown of estrogen and progesterone in your body.

Some women have seizures related to their menstrual cycle. This is called catamenial epilepsy. Most women find this pattern by keeping a seizure and menstruation diary. It is also helpful to note other factors that may affect seizures and menses. Stress, sleep deprivation, and missed medication may play a role.

There are three common patterns to catamenial epilepsy. Seizures are more likely to happen: 
  • Just before or early in your period 
  • When the egg is released, or 
  • During the last half of your menstrual cycle
Catamenial seizures can be hard to manage. Treatment incluces antiepileptic drugs, sometimes in combination with oral hormones.

Pregnancy

Most women with epilepsy are able to become pregnant. They are also able to give birth to normal babies. We recommend that women discuss their risks of pregnancy before becoming pregnant.

There are a number of factors that increase the risk of seizures during pregnancy, including:
  • Rising estrogen levels
  • Faster clearance of antiepileptic drugs from the body
  • Not being able to get enough sleep
  • The stress of labor
Seizures can harm both the mother and the fetus. When a pregnant mother has a seizure, her baby is more likely have seizures. Her baby is also more likely to suffer from developmental delays. In addition, a seizure may cause injury and may reduce the baby’s oxygen.

Family planning

Many women with epilepsy choose to use birth control. This is a personal choice that you should discuss with your doctor.

There are two different types of contraception: hormonal and nonhormonal. Birth control pills and Depo-Provera shots are examples of hormonal contraception. Nonhormonal methods include using a condom, diaphragm, abstinence, natural family planning, and intrauterine devices.

Antiepileptic drugs interact with most hormonal contraceptives. This does not necessarily mean that you can’t use birth control pills, but you may need a higher dose. Birth control pills are not likely to increase seizure frequency. As with any woman, if you don’t use contraception as directed, it will not be effective.

Before becoming pregnant, women with epilepsy generally should be well controlled on one drug. The medication you use should be chosen carefully because some antiepileptic drugs are more likely to cause birth defects than other drugs. Cleft palate and heart defects are the most common birth defects caused by antiepileptic drugs.

Antiepileptic blood levels are measured frequently during pregnancy. It may be necessary to increase your drug dose during her pregnancy, but it generally not a good idea to change medications once you become pregnant. Talk to your doctor if you’re pregnant and unable to take your medications.

All pregnant women should take a prenatal vitamin with folic acid daily. This reduces the chance of neural tube defects.

Menopause

A woman enters menopause when her ovaries no longer produce eggs and the menstrual cycle stops. This typically occurs around age 50. Menopause is a gradual change and results in low estrogen and progesterone levels. Common symptoms that you may notice include hot flashes, mood swings, dry skin, headache, and night sweats.

Seizures may increase or decrease during menopause. As you age, you may have more side effects from your antiepileptic medications. You also may take more medications, which increases your risk of drug interactions.
 
Because estrogen protects women from osteoporosis, your risk of this condition increases when you reach menopause. However, some antiepileptic drugs cause bone loss and osteoporosis and increase the risk of falling. Hormone replacement therapy (HRT) many be an option to reduce your risk of osteoporosis and manage other symptoms of menopause. Like birth control pills, HRT can interact with some antiepileptic drugs. It has not been shown to increase seizure activity.

Women who’ve reached menopause should also talk with their doctor about the need to take daily doses of calcium and vitamin D.

To learn more about Providence Epilepsy Center services for women, contact Dr. Mark Yerby’s office: (503) 291-5300.

Sources 
  • Morrell, M. J. & Flynn, K (eds). (2003). Women with epilepsy: A handbook of health and treatment issues. Cambridge University Press: Cambridge, United Kingdom. 
  • Cramer, J. A., Gordon, J., Schacter, S., Devinsky, O. & the Epilepsy Therapy Development Project Women’s Issues Work Group. (2006). Women with epilepsy: Hormonal issues from menarche through menopause. Epilepsy & Behavior 2007; in press.