Epilepsy and Menopause: Potential Implications for Pharmacotherapy

  title={Epilepsy and Menopause: Potential Implications for Pharmacotherapy},
  author={Olafur Sveinsson and Torbj{\"o}rn Tomson},
  journal={Drugs \& Aging},
Being a woman with epilepsy is not the same as being a man with the disease. There is a complex multidirectional interaction between sex hormones, seizures and antiepileptic drugs (AEDs) with gender-specific implications. Estrogen can be a potent proconvulsant, whereas progesterone is an anticonvulsant in experimental models. It is well established that women with epilepsy can have changes in seizure propensity related to their menstrual cycle (catamenial epilepsy). There is good evidence that… 
7 Citations
Be aware of the potential effects of menopause on epilepsy and its treatment
To treat epilepsy in postmenopausal women at risk of osteopenia/fracture, treatment with non-enzyme-inducing AEDs (e.g. lamotrigine) is preferred.
Women’s Issues in Epilepsy
  • E. Bui
  • Medicine, Psychology
  • 2022
Important external hormonal influences may impact women with epilepsy particularly in the context of gender-affirming medications, hormonal replacement therapy, and fertility therapies, as well as pregnancy-related concerns around fertility, seizure destabilization, and antiseizure medication–associated teratogenicity.
Delivery of a Personalized Treatment Approach to Women with Epilepsy
Clinical studies continue to investigate the complex relationship between cycling sex steroid hormones, epilepsy, and antiepileptic medications, with hopes to better explain drug clearance changes during pregnancy, changes in seizure frequency, and neuroendocrine abnormalities.
Effects of the Menstrual Cycle on Neurological Disorders
The menstrual cycle involves recurrent fluctuations in hormone levels and temperature via neuroendocrine feedback loops, and the cessation of ovarian function with menopause may also alter the course of neurological diseases.
Change in Seizure Pattern and Menopause
A 46-year-old woman is starting to undergo menopause and is asking for your advice regarding what to expect to happen to her seizures in the next few years and whether her seizures will improve or worsen.
Neurogonadale Interaktionen bei Frauen mit Epilepsie
ZusammenfassungDie Behandlung von Frauen mit Epilepsie (WWE) stellt auch den Gynäkologen vor komplexe Anforderungen. Einerseits können die hormonellen Veränderungen während des menstruellen Zyklus
Neurogonadale Interaktionen bei Frauen mit Epilepsie
  • B. Rösing
  • Medicine
    Gynäkologische Endokrinologie
  • 2015
The reproductive endocrine function is affected by multidirectional neurogonadal interactions between epileptic and interictal impulses of the central nervous system resulting in an unbalanced hypothalamic-pituitary function, the neuroactive potential of gonadal steroids and the endocrine modulation of antiepileptic drugs.


Epilepsy and menopause
The frequency of catamenial type of epileptic seizures may increase during perimenopause due to hyperestrogenism and subside after menopause and women with epilepsy may need to take HRT, at least for symptomatic relief and to allow adequate sleep when “hot flushes” are disruptive.
The Influence of Gonadal Hormones on Neuronal Excitability, Seizures, and Epilepsy in the Female
It seems unlikely that estrogen and progesterone would exert single, uniform actions given current understanding of their complex pharmacological and physiological relationships, and their modulatory effects are likely to depend on endocrine state, relative concentration, metabolism, and many other factors.
Characterization and Health Risk Assessment of Postmenopausal Women with Epilepsy
Osteoporotic and cardiovascular preventive measures are underutilized and patient education on these protective measures should be part of the comprehensive treatment approach in this "at-risk" patient population.
Female issues in epilepsy: A critical review
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  • Psychology, Medicine
    Epilepsy & Behavior
  • 2009
Gender issues in epilepsy—The science of why it is special
Neuroendocrine considerations in the treatment of men and women with epilepsy
The role of estrogens in catamenial exacerbation of epilepsy
Most investigators in the literature maintain that fits exacerbate shortly before or during menstruation in about 50% of epileptic women, and in these women, seizures often begin or preexisting attacks recur or become worse at the menarche.
Progesterone therapy in women with epilepsy: A 3-year follow-up
Cyclic natural progesterone therapy was added to the antiepileptic drug treatment of 25 women with intractable localization-related epilepsy and catamenial seizure exacerbation, and resulted in significantly improved seizure control in 18 women (72%) in comparison to baseline.
Hormonal influences on seizures: basic neurobiology.
  • C. Frye
  • Biology
    International review of neurobiology
  • 2008