Women with epilepsy face unique challenges when dealing with hormonal changes throughout their lives. It’s important to be aware of these challenges, and even more important to maintain a consistent relationship with a physician to proactively manage each life stage.
Puberty
When a woman’s menstrual cycle begins at the onset of puberty, seizure patterns may change. Effects are different for every individual and can include:
- Worsening of seizure control at different points during their cycle such as menstruation or ovulation.
- Catamenial epilepsy, or epilepsy associated with menstrual cycles.
Keeping track of seizures and menstrual cycles can help women identify any potential patterns/ These patterns can be discussed with their neurologist to help determine the best management of their epilepsy.
Beginning the use of birth control (contraception)
There are many forms of birth control people use to help prevent unintended pregnancies. Many types of birth control use hormones that can impact women with epilepsy differently, for example:
- There are important interactions between some forms of birth control and some anti-seizure medications.
- Certain anti-seizure medications may make some forms of birth control less effective at preventing pregnancy.
- Birth control can also reduce the levels of some anti-seizure medications.
Because of these interactions, it’s important for women on anti-seizure medications to talk to their doctor about what birth control would be best for them.
Pregnancy
Many women with epilepsy have healthy pregnancies with no worsening of seizure control. Generally, if a woman’s epilepsy is controlled in the months leading up to pregnancy, then it’s likely to remain controlled during pregnancy. However, there are a few things to know about having epilepsy and being pregnant:
- It’s recommended that all women of childbearing age on anti-seizure medications take folic acid.
- Some anti-seizure medications are associated with birth defects; therefore, family planning should be discussed with a neurologist to make the best decisions about anti-seizure medications.
- Once pregnant, women should tell their neurologist as soon as possible, as the changes within their body can require adjustments to their medications throughout pregnancy.
- It’s important to take anti-seizure medications as prescribed during pregnancy because seizures can harm women and their babies.
After delivery, a woman’s body goes through many more changes. If anti-seizure medications were increased during pregnancy, they typically need to be lowered after delivery to avoid side effects. Therefore, it’s also important to check in with a neurologist after delivering a baby.
Breastfeeding
Women with epilepsy who are taking anti-seizure medications can breastfeed, however, they should keep in mind:
- Some anti-seizure medications may be present in breast milk, however, at low levels.
- Babies should be monitored for potential side effects of exposure to these anti-seizure medications, such as excessive sleepiness or trouble feeding.
It has been shown that breastfeeding has benefits for both babies and mothers, and with the right planning and monitoring, women with epilepsy and their babies can enjoy these benefits, too.
Menopause
Hormonal treatments are frequently used to manage symptoms of menopause; however, these hormones can potentially lead to changes in seizure control. When women with epilepsy reach menopause, they should understand:
- Hormone changes during menopause can lead to changes in seizure frequency.
- Bone loss leading to osteoporosis is more common in women after menopause and some anti-seizure medications are associated with osteoporosis, which increases the importance of monitoring and maintaining bone health.
Each stage of life presents new changes for all women, however, women with epilepsy have additional considerations they must keep in mind to maintain their health. A strong relationship with a neurologist can help make successfully navigating each step easier and more enjoyable.
Learn more about how Mayo Clinic’s epilepsy experts can help manage your epilepsy at MayoClinic.org/epilepsy.
__
Kelsey M. Smith, MD is a neurologist and epileptologist at Mayo Clinic. She sees adult patients with epilepsy. Her areas of interest include autoimmune-associated seizure disorders, genetic generalized epilepsies, and women with epilepsy.