Epilepsy in Women

Reviewed by: HU Medical Review Board | Last reviewed: November 2021

Epilepsy is equally common in men and women. However, hormone changes are a common seizure trigger, and this can complicate women’s epilepsy. The severity and frequency of women’s seizures may change at puberty, with every menstrual period, during pregnancy, and at menopause. These life stages may mean changes in treatment each time.1,2

Epilepsy may have other effects on a woman’s life by impacting:1-6

  • Fertility
  • Birth control
  • Family planning
  • Conditions like polycystic ovary syndrome (PCOS) and osteoporosis

Catamenial epilepsy

Catamenial epilepsy is a type of epilepsy in which seizures are linked to the menstrual cycle. Roughly half of women with epilepsy say they have more seizures at certain times of their menstrual cycle. It may be just before or during their period, or at ovulation. Ovulation is when the ovary releases an egg into the fallopian tube.1,3

In women with catamenial epilepsy, seizures seem to be triggered by rising estrogen levels and falling progesterone levels that naturally happen during a menstrual cycle. These changing hormone levels also impact how well some anti-seizure medicines work.3

Catamenial epilepsy is easier to diagnose in women who have regular, consistent monthly cycles. It can be harder to diagnose in women with irregular periods.3

Anti-seizure drugs and birth control

Anti-seizure drugs can complicate birth control and family planning. Some of these medicines are less reliable when taken with certain forms of birth control. In turn, some anti-seizure drugs make birth control less reliable. This is why some women need to take a higher dose of birth control to prevent pregnancy.2

Work with your epilepsy doctor on family planning. You may need to change your anti-seizure drugs or take a different dose if you are using certain types of birth control. You will also need to plan any pregnancies. It may be necessary to stop taking or switch medicines months or weeks before trying to become pregnant.2

Treatment during pregnancy

Some studies show women with epilepsy have higher rates of infertility. More research is needed to know whether this is due to epilepsy itself or its treatments.4

Any woman of child-bearing age who takes anti-seizure drugs should take folic acid daily. The amount depends on which drugs are taken and whether you are trying to get pregnant or not. This is important for the development of a growing baby’s nervous system. Low levels of folate in the mother are tied to birth defects.4

Women who are pregnant or nursing often need to make changes to their anti-seizure drugs or dosing. Some of these drugs should not be taken while pregnant or breastfeeding because they can harm the baby.2,4

The link to polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a condition in which eggs in the ovary do not properly develop. Rather than being released each month, eggs stay in the ovary to form cysts. PCOS is more common in women with epilepsy. Doctors do not fully understand why.5

PCOS may be more common in women with epilepsy because:5

  • Women with seizures beginning in the left temporal lobe may have hormone imbalances common to PCOS.
  • The hormone imbalances that prevent eggs from being released may also increase or worsen seizures.
  • The anti-seizure drug Depakote® (valproate or valproic acid) has been linked to higher rates of PCOS.

Epilepsy and osteoporosis

Anti-seizure drugs may increase a woman’s risk of developing osteoporosis. Osteoporosis is a condition in which the bones become thinner and break more easily. This can happen in epilepsy when anti-seizure drugs interfere with how the body processes vitamin D. Vitamin D is important to maintaining bone health.

This risk is highest for women who take multiple anti-seizure drugs for many years.6

Women with epilepsy should have regular bone scans and take extra vitamin D and calcium supplements. This helps counteract the effects of the anti-seizure drugs.6

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