Women and Epilepsy
From the seizures themselves to medication side effects, epilepsy has several important implications for women’s health. The epilepsy experts at Mount Sinai are trained to work with many of these issues, including those below.
Menstruation and Epilepsy
Catamenial epilepsy refers to epilepsy affected by the menstrual cycle and changes in the ratio of estrogen to progesterone. A higher estroge- to-progesterone ratio increases the risk of seizures, and some women may experience worsened seizures during ovulation or just before their periods. While there are no treatments approved by the U.S. Food and Drug Administration (FDA) for catamenial epilepsy, there are a number of strategies that can help.
Epilepsy and Pregnancy
If you are considering pregnancy, it is important to optimize your medications and to supplement with folic acid. Some medications are much safer in pregnancy than others. While taking any medication or combination of medications, the vast majority of women with epilepsy have healthy babies. If you needed medication before pregnancy, it is important to keep taking it during pregnancy. For these reasons, at Mount Sinai, we will discuss whether you are sexually active and your plans regarding pregnancy.
Oral Contraceptives and Epilepsy
Many anti-epileptic drugs interact with oral contraceptives making the anti-epilepsy medications less effective. If you are using oral contraceptives for birth control, talk with your doctor about possible interactions.
Breastfeeding and Epilepsy
The American Academy of Neurology recommends breastfeeding for women with epilepsy. There are some risks of breastfeeding for infants whose mothers are taking anti-epileptic medication. Despite the possible risks, the proven benefits of breastfeeding, such as reduced risk of autoimmune disorders and enhanced cognitive abilities, are compelling.
Menopause and Epilepsy
In menopause, the levels of estrogen and progesterone both decrease. The result of this decline is unpredictable. Women often report that their seizures improve or stay the same, but a worsening is also possible. If you are considering hormone replacement therapy for symptoms of menopause, discuss the possibility with your neurologist. Including progesterone in hormone replacement therapy may be helpful for seizures.
Menopause is a time of bone density loss for women, and anti-seizure medications for epilepsy can also decrease bone density. Therefore, women with epilepsy in menopause should consider getting screened for bone density loss. Exercise, particularly weight bearing, and certain medications can help prevent bone loss.
Sexual Dysfunction and Epilepsy
The epilepsy itself and possibly the anti-seizure medications can affect a patient’s sexual functioning. Commonly reported problems include vaginal dryness, a lack of desire to have sex, and problems with orgasm. Certain anti-seizure medications have been more commonly linked to loss of sexual desire. Anxiety and depression in people with epilepsy can also affect sexual dysfunction.
If you are a woman diagnosed with epilepsy, you may have questions. Here are answers to some of the questions we are most often asked.
I always get a cluster of seizures the day before my period. Is this normal? I take medication every day and it does not seem to control this. Is there anything else I could do?
The first step is to understand your seizure pattern. This requires charting your menstrual cycle and seizures for a few months. After this, your physician can help you start an individualized treatment strategy. There are a number of options, including changing daily medication, taking extra medications prior to menstruation, or considering hormonal intervention.
I just found out I am pregnant! Should I stop my epilepsy medication? I don’t want to hurt the baby.
Congratulations! Please do not stop taking your epilepsy medication. An unwanted seizure can be harmful to you and to your developing baby. It’s important that you talk to your neurologist and your OB/GYN as soon as possible so that you and your baby get the best possible care.