Women and Epilepsy
Women with epilepsy face many unique changes and challenges throughout their life.
Changes may occur in seizure severity and frequency during the reproductive cycle: at puberty, throughout the menstrual cycle, during pregnancy and at menopause.
These changes are due to varying levels of the female hormones oestrogen and progesterone. Oestrogen is known to excite brain cells, lowering the seizure threshold and therefore causing seizures. Progesterone has an inhibitory effect which raises the threshold and reduces seizures.
The onset of epilepsy often happens around puberty and for girls who already have epilepsy, seizures may increase. As well as the hormonal changes taking place, seizures may be attributable to social and psychological factors that are impacting on the adolescent.
This refers to an increase of seizures related to the menstrual cycle. Seizures are commonly found to increase in the three days before or at the onset of menstruation. Contributing factors include:
- The influence of hormones progesterone and oestrogen
- Pre menstrual tension
- Fluid retention.
Oral contraception is not 100% effective in women taking certain antiepileptic medications. This arises from an interaction between the antiepileptic medication and the oestrogen and progesterone in the contraceptive pill. If pregnancy is not wanted, additional contraceptive measures may need to be taken.
While women with epilepsy have a greater than 90% chance of a normal pregnancy and delivery, there is a risk of 4 to 6% of women taking antiepileptic medication having a child with malformations compared with 2 to 3% of the general population. Most malformations are minor but some more significant conditions canoccur (spina bifida, cleft palate and heart defects).
To minimise the risks, good medical management from pre conception to post delivery is paramount along with strict adherence to medical advice and the medication regime.
Folic acid taken prior to conception and continuing for the first three months of pregnancy is recommended.
Depending on seizure frequency and severity, it may be possible with medical advice to reduce medication in the first three months when antiepileptic medication has its greatest influence on the developing foetus. Medication requires careful monitoring especially in the last three months of pregnancy when the foetus is at risk during delivery or from a seizure.
A third of women have more seizures during pregnancy. This is caused by sleep deprivation, weight gain, metabolic changes or morning sickness, but the greatest cause is the failure to take medication for fear of harming the foetus.
For most women with epilepsy, breast feeding is a safe option. The antiepileptic medications will be found in breast milk in small amounts but this usually does not affect the baby.
Most women are likely to experience no change in the incidence of seizures at menopause. Some however will experience a marked reduction in seizures or a cessation, particularly in those whose seizures tend to occur pre menstrually.
Some women with poorly controlled seizures may experience early menopause.
Hormone replacement therapy is sometimes recommended for women at menopause. This is intended to combat the effects of the reduction in hormones (hot flushes and mood changes), to combat osteoporosis (a degenerative bone disorder), or for cardio protection. Because of the possible influence of the replacement hormones on the incidence of seizures, particular regard to the situation of women with epilepsy is required.
Reproductive disorders such as irregular ovulation and polycystic ovarian syndrome can occur.