Feature Article: Special topic on women’s issues: Epilepsy and Menopause
Epilepsy and Menopause
As women approach menopause, they often experience hormonal shifts that can affect many aspects of physical and emotional health. For women living with epilepsy, these changes can also impact seizure frequency and overall seizure control.
Menopause (meno means month or menstrual) is “the permanent cessation of menstruation, occurring 12 consecutive months after the last menstrual period, in the absence of other underlying medical conditions.” Typically, it occurs between ages 45 and 55. In the years leading up to menopause, levels of estrogen and progesterone begin to fluctuate; this is called perimenopause. Menopause, a natural biological process marking the end of a woman's reproductive years, can significantly impact women with epilepsy. These hormonal shifts can trigger novel physical (e.g., hot flashes, thinning hair, vaginal dryness, increased risk of osteoporosis) and psychological symptoms (e.g., mood swings, decreased libido, poor sleep, cognitive problems)— and in some women, changes in seizure activity.
Hormonal Influence on Seizures
Estrogen and progesterone, the primary female sex hormones, play a crucial role in brain excitability. Estrogen is generally considered proconvulsant, meaning it can lower the seizure threshold which can increase seizure risk, while progesterone is often seen as anticonvulsant, which can calm the brain and reduce the risk of seizures. During menopause, estrogen levels decline significantly, and progesterone levels also fluctuate. These shifts can lead to changes in seizure patterns for some women and lead to more unpredictable seizure patterns.
Some women notice increased seizures during perimenopause, while others improve after menopause when hormone levels stabilize.
Impact of Menopause on Epilepsy
Antiepileptic Drug (AED) Metabolism: Hormonal changes can also affect the metabolism of antiepileptic drugs (AEDs), potentially altering their effectiveness. Close monitoring of this may require and lead to adjustments to medication dosages.
Bone Health: Menopause can contribute to reduced bone density and certain anti-epileptic drugs (AEDs) can interfere with calcium and vitamin D metabolism, increasing the risk of osteoporosis. In postmenopausal women this may compound the risk of osteoporosis. Monitoring and testing may be necessary to check for osteoporosis.
Cognitive Function: Epilepsy can increase cognitive problems in all genders. In women, menopause can also affect cognitive function (e.g., memory). The combined impact of epilepsy, AEDs and menopause might exacerbate these difficulties for some.
Mood and Quality of Life: The symptoms of menopause, such as hot flashes, sleep disturbances, and mood changes, can significantly impact quality of life. Common psychiatric comorbidities in epilepsy are depression and anxiety. When epilepsy and menopause are combined, these symptoms can further affect a woman's well-being.
Management Strategies
Managing epilepsy during menopause requires a comprehensive approach, often involving collaboration between an epileptologist and a gynecologist. Some epileptologists specialize in women’s issues in epilepsy.
Hormone Monitoring:
Monitoring hormone levels may help in understanding their correlation with seizure activity.
AED Adjustment: Regular review and potential adjustment of AED dosages by a neurologist can also help maintain seizure control.
Bone Density Screening: Regular bone density screenings and appropriate interventions (e.g., calcium and vitamin D supplementation, lifestyle modifications) are important to mitigate bone health risks.
Symptom Management: Addressing menopausal symptoms through lifestyle changes, non-hormonal therapies, or hormone replacement therapy (HRT) – with careful consideration of its potential impact on seizures – can improve overall well-being.
Lifestyle Modifications: Maintaining a healthy lifestyle, including regular exercise (if you are starting a new exercise or sport, make sure to consider seizure-safety and if in doubt, run it by your doctor), a balanced diet that includes calcium, adequate sleep, and stress management, can be beneficial for both epilepsy and menopausal symptoms.
Open Communication: Open communication with the patient’s healthcare team about all symptoms and concerns is essential for personalized and effective management.
Here are a few ways to take control during this transition:
1. Track symptoms. Keep a diary of seizures, sleep, mood, and menstrual cycles. This helps your doctor spot patterns. If you notice changes in your seizures, worsening menopause symptoms, or emotional health challenges, don’t wait — letting your care team know in a timely manner, can help them adjust your treatment plan.
2. Review medications with your healthcare team. Some seizure medications affect hormones and bone health. Talk to your neurologist about any needed adjustments and encourage your gynecologist to communicate with the neurologist (and vice versa) if any concerns arise. If it has not been brought up, feel free to ask about your bone health and how that is part of your treatment plan.
3. Consider hormone therapy. Hormone replacement therapy (HRT) may help with menopause symptoms but could affect seizures, therefore, your gynecologist and neurologist should discuss this before starting any hormone replacement processes.
4. Prioritize sleep & stress. Stress and poor sleep can increase seizure risk. Perhaps introduce mindfulness strategies to your life (using apps like Calm and Headspace can be helpful), maybe practice yoga or Pilates, take time to enjoy life, get out into nature, build in breaks into your day during which you rest and reset, and if you are feeling especially anxious or moody, consider meeting with a psychotherapist. Final words: Much has changed in recent years. In the past, menopause was not discussed openly. It was considered somewhat shameful because of its association with aging a loss of attractiveness. As a result, its symptoms were often hidden, dismissed or trivialized by the medical community and the general public. Women endured troubling symptoms like hot flashes, anxiety, and brain fog in uncomfortable silence. Presently, women are being much more outspoken about menopause. They are talking about it’s pros and cons. And yes, there are some pros, such as better seizure control in some women, not having to deal with uncomfortable menstrual symptoms such as cramps or pain, or having to use pads or tampons, or having to worry about staining, or having to worry about unintended pregnancies, or having to worry about excess body hair. Also, some scientists have even talked about a brighter outlook on life called the “menopausal zest” and increased self-confidence that accompanies menopause and entering into your 50’s. So, if you are perimenopausal or menopausal, learn more about this natural feminine life stage and whenever necessary, discuss it openly with your healthcare team.
