What is Epilepsy?
Epilepsy is a neurological condition where electrical impulses to the brain become mixed up and can lead to seizures, blank episodes, stiffness and rigidity; strange sensations, smells or tastes. It is a chronic condition that is usually managed with medication.
Epilepsy in Women
Epilepsy can be cyclical in some women meaning throughout their lives from puberty onwards, their seizures may be triggered or exacerbated by hormonal changes during their menstrual cycles. Oestrogen is known to induce seizures in these individuals, and they may have been unable to use some methods of hormone-based contraception as a result. These individuals may experience peri/menopause earlier than those without Epilepsy.
Like many things associated with menopause the effect on epilepsy is under-researched and more is needed to help individuals through this major life event. Given that Oestrogen is known to induce seizures some experts believe HRT should not be used as may worsen the condition. However, others believe the dose of Oestrogen in HRT is too low to be a problem!
This conflicting advice makes it very hard to advise individuals living with epilepsy when they begin to experience symptoms relating to perimenopause. The British National Formulary for pharmaceuticals in use in the UK lists most anti-epileptic drugs as either reducing or increasing the effect of HRT although even this advice is only theoretical.
Advice for individuals with epilepsy going through menopause
At this point in time, the best advice for individuals first experiencing menopause is for a referral to a menopause specialist who will work closely with the neurologist to ensure adequate treatment for both conditions.
As with every individual, the treatment should be individualised and when prescribing HRT, the benefits of treatment should outweigh any risks. For example, one benefit of HRT is the protection of bone health in the prevention of Osteoporosis often seen in menopause. Anti-epilepsy medication is also a risk factor for Osteoporosis; therefore, HRT is beneficial to these individuals.
It is essential an individual regularly attends appointments with their specialists and report any drug side effects, increase in seizures and ongoing symptoms. It may take some time to develop a regime that suits the individual and it may feel like things are getting worse instead of better but with time and perseverance relief should be achieved.
More research is needed to look at the relationship between menopause and epilepsy which can help with the ongoing treatment and management of both conditions for the benefit of the individuals' experiencing difficulties because of the change in hormone levels. Until then patient and prescribers should work together to improve quality of life and ensure a smooth transition to the rest of their life.
If you have access to myTamarin virtual support with your employer and would like to discuss any concerns around Menopause book a 1-1 appointment with a specialist at myTamarin via your company-specific landing page or app.
Epilepsy Action, (2023) The Menopause and HRT. www.epilepsy.org.uk
NHS, (2020) Epilepsy – Living with. www.nhs.uk
Epilepsy Society, (2020) Menopause and Epilepsy. www.epilepsysociety.org.uk
Svalheim, S. et al, (2015) Interactions Between Antiepileptic Drugs and HRT. www.pubmed.ncbi.nlm.nih.gov
NICE, (2023) Hormone Replacement Therapy – Interactions. www.bnf.nice.org.uk
Newson Health, (2023) Epilepsy and the Perimenopause and Menopause. www.balance-menopause.com
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