Many women with epilepsy face very specific and unique challenges, ranging from concerns about how the disease affects their menstrual cycles, fertility, pregnancy, menopause, and bone health. These are important topics that I often discuss with my female patients who are living with epilepsy. Having such discussions with your health care team about these important subjects may help with guidance and support for managing your epilepsy in everyday life.
Hormones, Menstrual Cycles, and Fertility
In general, hormones do not cause seizures but they can affect how often seizures occur. Changes in hormones, such as those that arise from a woman’s menstrual cycle, can sometimes cause an increase in seizures. The worsening of epilepsy during menses is called catamenial epilepsy and is likely due to fluctuations in reproductive hormones. It is unknown why natural increases and decreases in estrogen and progesterone have such an effect on seizures.
Though not all women with epilepsy have increased seizures during menses, women should be aware of the possibility and can keep track of both menstrual cycles and changes in seizure frequency to prepare each month.
Rates of fertility in epileptic women are about 15% to 30% lower than those of the general population. There is no clear explanation why this is but is likely caused by epilepsy itself, and certain anti-epileptic drugs may play a role too. Both the disease and the medications may affect hormonal levels.
Though women with epilepsy experience higher rates of infertility, and there is a low risk that the child might develop epilepsy, the majority of epileptic women are able to become pregnant and give birth to normal, healthy babies. Still, it is important for women with seizures to plan ahead and taking some necessary cautionary steps before getting pregnant. For instance, it is recommended that all pregnant women with epilepsy take a folic acid supplement (also called folate).
Before getting pregnant, your doctor’s treatment plan will involve trying to control your seizures with the lowest dose of medication and the fewest number of drugs possible to avoid over exposure of the medications to the baby. Your doctor may perform a blood test a few times during your pregnancy to monitor the amount of anti-epileptic drugs in your blood. This approach is to help protect you and your baby. Let your doctor know if you are thinking to become pregnant.
If you become pregnant, it’s important to work closely with your healthcare team, especially your neurologist and obstetrician-gynecologist. Women’s bodies undergo various changes during pregnancy, labor and delivery, such as blood levels and protein changes, which may affect how your anti-epileptic medication works. There are some other special considerations if women with epilepsy want to breastfeed their baby.
If you are a woman with epilepsy and are contemplating pregnancy, speak with your doctor about your desires and concerns. If pregnancy is not desired, it’s important to have effective contraception.
Some anti-seizure or anti-epileptic medications interact with birth control medication and make the birth control medication less effective. Therefore women on anti-seizure or anti-epileptic medications should discuss these medications and their birth control with their doctors and pharmacists. The following questions may be good to ask:
- What is the most effective birth control method for me?
- How do the other medications I take affect this birth control medication?
- Will the birth control pills have an impact on my epilepsy? Will they affect my anti-seizure medications?
- Are there things I can do to make sure my birth control pills are effective?
- Are there other things I need to know about any of my medications?
Menopause occurs when menstruation ends due to a change in reproductive hormones or surgery. As the levels of estrogen and progesterone are naturally or surgically reduced, the number of seizures may also be reduced. This is because seizures may be directly associated with hormone levels. Since menopausal women sometimes take hormone replacement therapy (HRT), seizure occurrence may increase with such therapy. For more information about to manage menopause with epilepsy, speak with your doctor.
Osteopenia, and Osteoporosis, and Fractures
Bone health is a very important concern for women with epilepsy—especially for menopausal women. The risk of fractures and osteoporosis is increased with epilepsy – with or without anti-seizure medication use – although certain medicines are more likely to increase the risk of osteopenia and osteoporosis. Osteopenia (condition in which there is low bone density) can begin in adolescence in the female with epilepsy.
It is very important to have a conversation with your physician early on about bone sparing strategies.
Dr. Margaret L. Frazer is a neurologist and Senior Director within the Cardiovascular and Metabolic team at Pfizer.