Women and Epilepsy

Women and Epilepsy

Summary

Women with the brain disorder epilepsy may have several special considerations because of the relationship between the female sex hormones, estrogen and progesterone, and seizures. Some women find that the frequency and pattern of their seizures fluctuate during times of significant hormonal change, such as during puberty, pregnancy and menopause (the end of menstruation). Many women also notice a change in their seizures during their menstrual cycle.

Estrogen and progesterone are hormones that regulate the menstrual cycle and prepare the body for reproduction. Estrogen excites electrical activity in the brain, increasing the risk of seizures, whereas progesterone suppresses electrical activity and reduces seizure risk. Therefore, when imbalance occurs and there is more estrogen in the body than progesterone, it can increase the risk of seizures in women with epilepsy.  

Over 90 percent of women with epilepsy give birth to a normal, healthy baby, according to the National Institute of Neurological Disorders and Stroke (NINDS). However, there are special considerations for pregnant women with epilepsy. For example, most pregnant women with epilepsy are encouraged to lower their dose of seizure medication or switch to a different medication to reduce the risk of birth defects. Additionally, women should take special precautions after giving birth to ensure the safety of themselves and their child, such as avoiding bathing the child alone and feeding the child on the floor to reduce the risk of an accidental fall should a seizure occur.

When women enter menopause, their seizure activity may or may not change. In addition, some menopausal women with epilepsy experience complications related to hormone replacement therapy (HRT) because of its use of synthetic estrogen and progesterone.

Additionally, women with epilepsy may face special complications associated with their seizure medications. For example, some seizure medications interfere with the effectiveness of oral contraceptives.

About women and epilepsy

The interaction between hormones and seizures can result in special considerations for women with epilepsy. Most of these considerations stem from the fact that the female sex hormones (estrogen and progesterone), which control and maintain the reproductive system, also influence the frequency and pattern of seizures in women with epilepsy. These hormones affect certain areas of the brain, including the temporal lobe, where partial seizures often begin.

Despite the presence and fluctuating levels of these hormones in the female body, women are no more likely than men to develop epilepsy. However, these hormones may make controlling their seizures difficult at times.

The relationship between epilepsy and hormones is poorly understood by scientists and physicians. Some types of seizures may stop by puberty, whereas others become more frequent. In addition, many women experience changes in the pattern and frequency of their seizures during their menstrual cycle.

A seizure occurs when there is a sudden increase in electrical activity in the brain. This can cause the brain to become overwhelmed and can result in seizures, depending on the part of the brain affected.

The hormone estrogen excites electrical activity in the brain, increasing the risk of seizures, whereas progesterone inhibits electrical activity and reduces the risk of seizures. Therefore, when there is an imbalance between the two, and more estrogen is present than progesterone, there may be an increased risk of seizures in patients with epilepsy. This type of hormonal imbalance typically occurs during puberty, menstruation and ovulation, pregnancy and menopause (the end of menstruation).

Seizures that occur during the menstrual cycle are referred to as catamenial seizures. They most often take place during ovulation, when an egg is released from the ovary and estrogen levels are at their highest. Seizures may also occur during the first few days of a woman’s cycle, as estrogen levels begin to rise when an egg begins to grow. Women who have catamenial seizures and have irregular menstrual cycles (which usually indicates a hormonal imbalance) may not be able to predict when they are likely to have seizures, because it may not be obvious when their menstrual cycle is occurring. Not all women with epilepsy experience catamenial seizures.

Women who experience catamenial seizures may be able to control them by taking seizure medications at certain points during their menstrual cycle. Ongoing studies are researching whether progesterone supplements can suppress catamenial seizures in women with epilepsy.

Epilepsy and pregnancy

About 90 percent of women with epilepsy give birth to normal, healthy babies, according to the National Institute of Neurological Disorders and Stroke (NINDS). Even so, women with epilepsy face special considerations concerning pregnancy.

Women with epilepsy may have a slightly lower fertility rate than nonepileptic women. This is believed to be due to hormonal imbalances, as well as factors such as sexual dysfunction and certain social issues, which may be more common in people with epilepsy.

Women with epilepsy are also more likely than nonepileptic women to develop certain reproductive disorders. This includes polycystic ovaries (multiple cysts in the ovaries) or polycystic ovary syndrome, which can lead to infertility and heart disease. They may also be more likely to develop early menopause as well as irregular or no ovulation.

Women with epilepsy who wish to become pregnant are advised to consult their physician well in advance about steps they may have to take for a healthy pregnancy. Most seizure medications increase the risk of birth defects and miscarriage (spontaneous termination of a pregnancy), so women who are taking seizure medications may have to change their dosage or switch medications during pregnancy. Because of the increased risk of seizures associated with a change in medication, this should only be attempted under the close supervision of a physician.

In some cases, seizure activity may increase or decrease during pregnancy even if there is no change in medications. This is thought to be related to fluctuating hormone levels and their effect on concentration levels of seizure medication in the body.

It is imperative that women with epilepsy control their seizures as effectively as possible while pregnant. Having seizures during pregnancy may harm a developing fetus or lead to miscarriage. Women who have tonic clonic seizures or who otherwise lose consciousness during a seizure are at risk of damaging the fetus if they fall. Tonic-clonic seizures that occur in the last month of pregnancy or during labor may cause complications during childbirth. However, many women who have seizures during their pregnancy go on to deliver normal, healthy babies.

Seizures triggered by sleep deprivation can be avoided by establishing a regular sleeping pattern. Women should also consult their physician about taking prenatal vitamins and folic acid. Some physicians may recommend vitamin K supplements during the last few weeks of pregnancy, which is believed to reduce the risk of a blood-clotting disorder caused by fetal exposure to seizure medications. Additionally, women with epilepsy can increase the likelihood of having a healthy pregnancy by receiving proper prenatal care, avoiding alcohol, tobacco and illegal drugs and finding ways to manage and reduce stress.

Women with epilepsy are more likely to experience morning sickness while pregnant. They are also at a higher risk for vaginal bleeding, pre-eclampsia (pregnancy-induced high blood pressure), premature labor and delivery, and cesarean section than nonepileptic women. However, unless the epilepsy is hereditary, the chance of a child also developing epilepsy is low.

After birth, most women with epilepsy are able to competently care for their baby and most are able to breastfeed their child. Although certain seizure medications may be secreted in breast milk, this is not thought to seriously affect the child. Women who give birth prematurely may wish to consult their physician about the safety of breastfeeding while on seizure medications, due to the increased risk of toxicity in premature babies.

Women who have poorly controlled seizures may wish to take certain precautions to protect both themselves and their child. These may include avoiding bathing the child alone, using a safety gate at all times and sitting on the floor while feeding the child to reduce the risk of dropping the child should a seizure occur. Additionally, parents should share the responsibility of childcare to enable a mother with epilepsy to receive adequate rest.

Epilepsy and menopause

When women enter menopause (the end of menstruation), numerous hormonal changes take place. Women are generally considered to have entered menopause if they do not have a menstrual cycle for 12 consecutive months. This happens to most women between the ages of 45 and 55, although it can occur earlier or later.

During menopause, the ovaries stop releasing eggs, which causes female sex hormone (estrogen and progesterone) levels to drop significantly. Hormonal levels that become imbalanced may affect the frequency and pattern of seizures in women with epilepsy.

It is understood that estrogen excites electrical activity in the brain and progesterone suppresses it. However, going through menopause does not always mean that seizures will stop or become less frequent. Some women with epilepsy experience more seizures during menopause, whereas others have less. Most women with epilepsy do not notice any change in the pattern or frequency of their seizures.

To relieve the symptoms of menopause, some women choose to undergo hormone replacement therapy (HRT). This usually takes the form of synthetic estrogen and progesterone supplements. There are several benefits associated with HRT, such as reduced bone loss. However, there is also evidence that HRT can contribute to breast cancer and may increase the risk of seizures in some women with epilepsy. Women with epilepsy should consult their physician about whether HRT is appropriate.

Women and seizure medication

Most women with epilepsy have several considerations related to the use of seizure medications. One of the most significant is the use of birth control because some seizure medications interfere with the effectiveness of certain contraceptives.  

Seizure medications called liver enzyme-inducing drugs increase the breakdown of substances in the liver. This includes breaking down oral contraceptives (birth control pills), which makes them less effective as birth control. The effectiveness of hormonal implants and hormonal injections used as birth control may also be adversely affected by these types of seizure medications.  

Liver enzyme-inducing medications may also increase a woman’s risk of osteoporosis.

Instead of oral contraceptives, women with epilepsy may wish to use natural forms of family planning or barrier methods, such as a diaphragm or condom, along with spermicidal cream. There is no evidence to suggest that women who are taking enzyme-inducing seizure medications cannot take the morning-after pill, although they may have to take a higher dose. Women with epilepsy are advised to consult their physician about their birth control options.

Taking seizure medications may pose additional complications for women with epilepsy before and after childbirth. Women who take more than one type of seizure medication are at an increased risk of having a child with a birth defect, although the risk is relatively small. Furthermore, women who are taking certain types of seizure medications, such as phenobarbital, may notice that their child appears sedated for hours or days after birth. This sedation usually wears off. However, the baby may show signs of withdrawal, including, irritability, tremors, vomiting and poor sucking. These signs are rarely serious and usually resolve themselves within weeks or months of birth.

Questions for your doctor regarding epilepsy

Preparing questions in advance can help patients to have more meaningful discussions with healthcare professionals regarding their condition. Women with epilepsy may wish to ask their doctor the following questions:

  1. How can I control my seizures during my menstrual cycle?
  2. Could my epilepsy be to blame for my difficulties becoming pregnant?
  3. Should I make changes to my seizure medications?
  4. What should I do if I have a seizure while pregnant?
  5. Are there any birth defects associated with my seizure medication?
  6. Are there any prenatal supplements that I should avoid?
  7. What are the chances of my child being born with epilepsy?
  8. Will my seizures stop when I begin menopause?
  9. Will my seizure medications interact with my birth control pills?
  10. Will my seizure medications affect my baby after birth?
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