Catamenial Epilepsy

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Around 1.7 million women in the United States have epilepsy. About 4 in 10 of these women get more seizures that are linked to their menstrual cycle. This is called catamenial epilepsy.1,2

People with catamenial epilepsy usually have more seizures at specific points in their menstrual cycle. These points can be:3

  • Around when your ovary releases an egg (ovulation)
  • Right before your period, when you start bleeding
  • During your period

The rise and fall of hormone levels throughout your menstrual cycle cause catamenial epilepsy. Lower levels of progesterone and higher levels of estrogen during ovulation usually set off seizures in people with catamenial epilepsy.3

What are the symptoms?

Catamenial epilepsy has various symptoms. These include:3

There are 3 types of catamenial epilepsy. They are labeled C1, C2, and C3. Here is a closer look at each type:1,2

  • C1 (perimenstrual) – C1 seizures happen right before or during your period. This type is the one most likely to respond to treatment.
  • C2 (periovulatory) – People with C2 have seizures more often during ovulation. This is around days 10 to 15 of your menstrual cycle.
  • C3 (luteal or inadequate luteal phase) – People with C3 have more seizures during the second half of their menstrual cycle. This second half is called the luteal phase.

How is catamenial epilepsy diagnosed?

Doctors use several methods to diagnose catamenial epilepsy. These methods include:3

  • Electroencephalogram (EEG) – An EEG is a test to measure electrical activity in the brain. It can show the unusual patterns of electrical activity that mean you have epilepsy. Doctors can identify different types of seizures by their distinct patterns.
  • Magnetic resonance imaging (MRI) or computed tomography (CT)MRI and CT are types of scans. They can help locate where in your brain a seizure is happening. Your doctor can use the images from MRI and CT to make sure your symptoms are caused by catamenial epilepsy rather than something else, like a stroke.
  • Keeping a record of your seizuresWrite down when you have a seizure and at what point in your cycle it happened. Share your notes with your doctor. They may be able to use the information to find a link between your seizures and your menstrual cycle.

Treatments for catamenial epilepsy

Medicine is the usual treatment for catamenial epilepsy. Recommended medicines include:3

  • Anti-seizure drugs – These drugs stop a seizure from occurring. Your doctor may recommend that you raise the dose you take just before the point in your cycle when seizures tend to happen.
  • Drugs that alter your hormone levels – These drugs help lower estrogen and raise progesterone levels in your body. They include:
    • Clomiphene
    • Birth control pills
    • Natural progesterone

Your doctor could also suggest surgery to remove your ovaries. But this is a last resort. It is only used for treating severe cases of catamenial epilepsy.

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