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Epilepsy and Women

UW Health's comprehensive epilepsy program at UW Hospital and Clinics in Madison, Wisconsin, offers state-of-the-art care for patients with epilepsy or those suspected of having seizures.

 

Epileptic Seizures and Menstruation

  • Half of the women who suffer epileptic seizures during childbearing years report an increase of seizures during their menstrual cycle. This type of epilepsy is referred to a catamenial epilepsy.
  • These seizures usually occur predictably, just prior to or at the onset of bleeding, at ovulation and during the second half of the cycle.
  • Doctors believe catamenial epilepsy is due to the hormonal changes women experience during and after menstruation. Two primary hormones, estrogen and progesterone, can travel through the brain/blood barrier and affect the brain cells. Estrogen may lower seizure thresholds while progesterone may protect against seizures.
  • Controlling catamenial epilepsy seizures is difficult. Doctors have tried increasing anti-seizure medication prior to menstruation and experimenting with different medications but the results have been disappointing. Hormonal therapy including the use of progesterone and high-progesterone birth control pills have not proven safe and effective.

Epilepsy and Contraception

  • Contraception for epilepsy patients is challenging because many medications, including the following, interact with anti-seizure medication (AEDs): Phenobarbital, Primidone, Phenytoin, Carbamazepine, Oxcarbazepine, Topiramate, Felbamate and Lamotirigine
  • Often times women who take any of the above medications need to increase the estrogen component of their birth control.
  • Many physicians recommend non-hormonal birth control methods be used, including condoms, diaphragm and inter-uterine devices, as they are not affected by AEDs

Epilepsy and Fertility

  • Women with epilepsy have a higher rather of infertility than the general population, due to the use of anti-epileptic drugs and irregular menstrual cycles.
  • Women with temporal lobe epilepsy, in particular, tend to suffer from reproductive dysfunction due to the complex interactions between the temporal lobe and the body's hormone centers.
  • Some women with epilepsy suffer from polycystic ovary syndrome (PCOS), which can decrease fertility and is characterized by elevated testosterone, multiple ovarian cysts, menstrual disorders, hirsutism (increased facial and body hair), obesity, acne, elevated insulin levels and high blood pressure.

Epilepsy and Pregnancy

  • More than 90 percent of pregnant women who have epilepsy give birth to healthy babies.
  • Risks include maternal seizures and fetal malformations but thorough pre-pregnancy planning and communication between the woman and her neurologist and obstetrician can reduce the risk of complications during pregnancy and childbirth.
  • UW Health's epilepsy program recommends all women of childbirthing age and especially those planning to become pregnant take folic acid supplements.
  • Children whose parents have epilepsy have a slightly higher chance of having epilepsy than the general population. There is a 3 percent chance of epilepsy in the general population. Children whose father has epilepsy but whose mother does not have about a 3 percent chance of having epilepsy, as well. If the mother has epilepsy but the father does not, the risk for the child is about 5 percent.
  • Even if both prospective parents have epilepsy, having children should not be discouraged. The chance of the child having epilepsy is still quite low, and if the child does have epilepsy, they can often lead normal lives with medication and even outgrow their seizures.
  • Women with epilepsy have a 4 to 6 percent chance of giving birth to a child with a major birth defect, compared to a 2 to 3 percent chance for the general population.
  • Anti-epileptic drugs taken by the mother shortly before conception and during the first three months of pregnancy, when the baby's major organs develope, present the greatest danger of birth defects. Defects can include cleft lip and palate and structural defects in the heart.
  • Anti-epileptic drugs taken during the second and third trimesters include risks such as widely spaced eyes, a slightly upturned nose and short fingers and toes. These defects may disappear during the first year of the child's life.
  • Pregnant women taking AEDs are strongly encouraged to contact the Anti-epileptic Pregnancy Registry.
  • Absence seizures, simple partial seizures and complex partial seizures pose no danger for the fetus unless the pregnant woman injures herself as a result of the seizure, which is rare. Tonic-clonic seizures, however, can be dangerous, because they may cause abdominal injuries and lead to temporary oxygen-deprivation for the baby.
  • Women with epilepsy are much more likely to have Caesarian deliveries (C-sections) and are much more likely to have labor induced. But having epilepsy does not mean that natural, vaginal delivery is impossible.
  • It is important for women to continue with their anti-epileptic seizure medication as delivery nears, as the frequency of seizures increases slightly during labor, delivery and the first two days after delivery.
  • Breastfeeding is recommended for mothers because of the variety of benefits for the baby. But for mothers who take anti-epileptic seizure medication, the benefits of breastfeeding must be weighed against the risks AEDs present to the baby. Mothers should talk to their doctors about this subject.

Epilepsy Later in Life

  • Forty percent of women with epilepsy experience a reduction in seizures during menopause, and those catamenial epilepsy often experience a significant reduction. Thirty percent of women with epilepsy report increased seizures during menopause, and 30 percent experience no change.
  • Women considering hormone replacement therapy (HRT) should speak with their neurologist. HRT may increase the frequency of seizures.
  • Some anti-epileptic seizure medications increase the risk of osteopenia and osteoporosis. Women (and men, for that matter) who take AEDs that affect bone density should take calcium and vitamin D supplements.