How Epilepsy affects Women and Girls
Living with epilepsy can present additional challenges for women and girls. Hormonal changes, pregnancy, and menopause can all impact the frequency and severity of seizures.
Understanding how epilepsy specifically affects women and girls is important for effective management and treatment.
Hormones and the Menstrual Cycle
The menstrual cycle is regulated by luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestrogen, and progesterone. Of those hormones, oestrogen and progesterone are most linked to epilepsy because they directly influence the nerve cells in the brain.
Progesterone, a hormone that increases after ovulation, has natural anticonvulsant effects. Oestrogen is the primary hormone responsible for reproductive functions in females, and it differs from progesterone in that it has proconvulsant effects.
At different points in a woman’s menstrual cycle, progesterone and oestrogen levels rise and fall. These fluctuations can affect the frequency of seizures and the effectiveness of anti-seizure medication. When seizures increase because of hormonal changes, it is known as Catamenial epilepsy.
Catamenial epilepsy
Catamenial epilepsy is when seizures get worse or become more frequent during the menstrual cycle. This can also happen during puberty, pregnancy, and menopause. Studies suggest that around 40% of women with epilepsy are affected by catamenial epilepsy.
How can you manage epilepsy during hormonal changes?
Track your cycle
Keeping track of your cycle can give your doctor valuable insights into your health. If you also make a note of when your seizures occur, you can pinpoint which stages of the menstrual cycle most affect your epilepsy. The more information you give your doctor, the better they can help you treat and manage your seizures.
Avoid triggers
Avoiding things that may trigger your seizures is always important in managing epilepsy, especially during hormonal changes. Common triggers include missed medication, inadequate sleep, stress and dehydration.
Take anti-seizure medication
Most of the time, epilepsy symptoms are managed with anti-seizure medication as prescribed by a healthcare professional. If you are diagnosed with catamenial epilepsy, your doctor may prescribe additional medication on the days you are more likely to have a seizure.
Invest in an epilepsy alarm
An epilepsy alarm is a great tool for managing epilepsy and reducing the risks involved. It detects seizures and alerts your selected caregivers that you need assistance.
Maintain a healthy diet
Specific diets, such as the ketogenic diet*, have been shown to help manage epilepsy in people with poorly controlled seizures. A key part of the keto diet is cutting back on carbohydrates and increasing your intake of healthy fats, such as avocados, nuts, olive oil, full-fat yoghurts and more.
* You should consult with a healthcare professional before making any big changes to your diet.
Contraception and ASM’s
Hormonal contraception may be less effective for women taking enzyme-inducing anti-seizure medication (ASMs), as these medications increase the speed at which hormones are broken down in the body. Speak to your doctor to ensure you are using the correct combination of ASMs and contraception for your needs.
Planning for Pregnancy
Having epilepsy does not affect your chances of getting pregnant and delivering a healthy baby. However, you may need to make adjustments to your medication to ensure a healthy pregnancy. Some women experience an increase in seizures during their pregnancy, so you may need to make some small lifestyle adjustments to prepare for this.
If you have epilepsy and are planning on having a baby, or you are already pregnant, please take a look at our article Navigating Pregnancy With Epilepsy: What You Need To Know.
The Menopause and Epilepsy
During menopause, the body produces fewer hormones, resulting in the stopping of menstrual cycles. As mentioned earlier, any fluctuations in hormone levels could affect the frequency and severity of seizures.
Menopause can cause a wide range of symptoms, some of which may trigger seizures. Stress, dehydration and sweating are among the list of common seizure triggers. Therefore, menopausal symptoms such as mood swings, night sweats and hot flushes, could trigger seizures in women with epilepsy.
Most often, the symptoms of menopause are treated with hormone replacement therapy (HRT). HRT works by replacing the oestrogen and progesterone hormones that usually fall to lower levels during menopause. These hormones are important in helping our brains and bodies function properly.
Currently, it is uncertain whether or not HRT can increase the frequency of seizures. Ask your doctor to help you assess the advantages and disadvantages of having hormone replacement therapy (HRT).
If you want to know more about how epilepsy affects women and girls specifically, take a look at some of the following resources: