Epilepsy Epilepsy Basics

Unique Concerns for Women and Girls with Epilepsy

By Christine Haran

Hormones have the power to take men and women of all ages on emotional and physiological rollercoasters that, at times, they'd like to get off. Epilepsy adds a number of twists and turns to this ride. For women and girls, both epilepsy itself and the medications used to treat seizures can have a major impact on their reproductive health. Likewise, the hormonal changes women undergo throughout their lives, beginning with menstruation and continuing through menopause, can have a significant effect on their seizures.

More than one million women and girls in the United States are living with epilepsy. Below, Joyce Liporace, MD, director of the Women's Health and Epilepsy Program at Jefferson Comprehensive Epilepsy Center in Philadelphia, discusses the complex relationship between epilepsy and women's reproductive health.

What is the relationship between the menstrual cycle and seizures?
Many women will begin having seizures when they begin menstruating. So it's very common for women to begin having seizures around age 12 or 13, or earlier.

The other issue is that seizures in women with epilepsy can be linked to the hormonal changes that occur during the menstrual cycle. There are a couple of patterns that women can have. In general, estrogen promotes seizures and makes seizures worse and progesterone protects against seizures. The most common pattern is that women may have seizures just before the onset of bleeding because progesterone levels drop, so women aren't protected against seizures. Women can also have seizures midcycle with ovulation because at that time in the cycle, estrogen peaks.

There's also an increased risk of irregular menstrual cycles for women with epilepsy because seizures can disrupt the signals in the brain that tell the ovary when to release an egg.

Why does polycystic ovary syndrome (PCOS) often occur together with epilepsy?
This is actually a very complicated issue. We know that epilepsy is associated with abnormalities in the hypothalamic-pituitary-gonadal axis, which is how the brain and ovaries communicate. Normally, the hypothalamus in the brain releases hormones that act on the pituitary gland, which then releases hormones that stimulate the ovaries produce estrogen and progesterone. Both seizures and anti-epileptic drugs can alter this pathway. This syndrome causes ovarian cysts, irregular menstrual cycles, and excess body and facial hair. It's usually associated with obesity and sometimes people will have diabetes.

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