Women with Epilepsy: A Handbook of Health and Treatment Issues (Chapter 13)

Menopause and epilepsy (Excerpt)

Fariha Abbasi and Allan Krumholz

Effects of menopause on seizures

There is considerable evidence that female sex hormones and their fluctuations can influence seizures in women with epilepsy. How the hormonal changes of pregnancy, the menstrual cycle, and oral contraceptive therapy affect epileptic seizures is discussed in other chapters in this book. Although the influence of female hormones such as estrogen and progesterone on seizures is a highly complex issue, the prevalent view is that estrogen may increase the tendency for seizures, whereas progesterone appears to make seizures less likely.

Because menopause is characterized by a decrease in estrogen, one might expect the risk of seizures to decrease at this time. However, the situation is probably much more complex because progesterone levels also decrease. Other hormonal, endocrine, and metabolic changes that occur during menopause can also influence the risk of seizures. It is, therefore, difficult to predict exactly what any individual woman with epilepsy should expect during or after menopause. It is the complex interaction of all these various factors combined with a woman’s own individual characteristics and sensitivities that ultimately determines the effect menopause will have on her seizures.

However, despite the fact that it is not currently possible to predict exactly how menopause will affect any individual woman with epilepsy, some recent studies offer some helpful guidelines. For example, in a study of our own comparing menopausal women with epilepsy to younger premenopausal women who also had seizures, we found that seizures were similar in frequency and severity in both groups.

However, some of the menopausal women reported that menopause did seem to influence their seizures. Among the approximately 60 women we interviewed with epilepsy preceding their menopause, the majority (60%) reported that their seizures did not change in frequency or improved with the onset of their menopause. Indeed, about 30% of patients in this group actually reported some improvement in their seizures with menopause. However, approximately 40% of these patients noted that their seizures worsened in menopause.

Our results are similar to those of a previous study in Poland that described a somewhat smaller group of menopausal women. In that study, the majority of women (70%) described no change or improvement in their seizures with menopause (50% describing no change and 20% noting improvement). This Polish study also found that seizures worsened for about 30% of women, somewhat less than in our study. Such figures are reassuring in that most women with epilepsy (60-70%) described no change or improvement in their seizures with menopause. However, it is also important to note that 30-40% reported some worsening, a concerning figure warranting attention. If such a high proportion of menopausal women with epilepsy do experience worsening of their seizures, specific treatment strategies may need to be developed for these women.

One unforeseen finding in our study was that about one-fifth of the menopausal women we interviewed first experienced seizures during menopause. This is not entirely surprising because it is well known that seizures and epilepsy can start in later years as a consequence of concomitant illness such as strokes, brain tumors, and Alzheimer’s disease. Some of the women in our study were older and the onset of their seizures was related to this type of illness. However, other women who had seizures beginning closer to the start of menopause lacked a clear etiology for their epilepsy. This observation, although still preliminary, raises the possibility that some women going through menopause may be at greater risk for developing epilepsy. Further studies need to be done to confirm this observation.

-- Excerpted from "Women with Epilepsy: A Handbook for Health and Treatment Issues" edited by Martha J. Morrell, MD and Kerry L. Flynn, M.A. Published by Cambridge University Press, 2003. It is available for purchase in our marketplace.