Epilepsy at Menopause and Osteoporosis
In general, we need more information to determine how seizures are affected by the changes in women's bodies during puberty and menopause. Currently, little is known about how physical changes associated with these periods of life cause increases or decreases in seizures or what precise relationship exists, if any. There are, however, a few indicators that may aid in prediction and there are some studies that measure how commonly women experience seizure onset, exacerbation or diminishment during these phases.
Menopause
Although it has been suggested that women with epilepsy experience menopause earlier than on average, the relationship has not been established. Many women report that their seizure frequency reduces or does not change during and after menopause. In a minority of cases, women with epilepsy report that their seizures increase during menopause. The reasons for these changes are not clear.
Everything has been reported to happen during menopause: no change in seizures; recurrence of previously well-controlled seizures; worsening of seizures; first-time appearance of seizures; and improvement of seizures.
Most studies show that hormones influence seizures in women. Therefore, menopause has been associated with changes in seizures in many individual women. Menopause may be an unrecognized factor for some new-onset seizures. More research needs to be done for this life-stage and its relationship to seizure disorders or epilepsy.
There have been documented patterns of seizure changes in women during menopause. It is even suggested that women with epilepsy who are menopausal should be considered in 2 separate groups: perimenopausal (the early stages of menopause) and postmenopausal (having had no periods for years).
Studies show that seizures are less likely to improve noticeably if:
- seizures begin early in your life;
- seizures have never been well-controlled;
- you have tonic-clonic, or complex partial seizures.
- you are early in your menopausal stage. This is for hormonal reasons. There may be altered estrogen:progesterone ratios at the beginning of menopause. When a woman moves into the perimenopausal period, there may be an exacerbation of seizures. When you reach menopause itself (at least 1 year of not having periods), the seizures may improve, because estrogen production may be extremely low or undetectable.
Anecdotal reports suggest seizures that are most likely to improve are:
- seizures that occur later in life, prior to menopause (therefore in a catamenial pattern);
- seizures that have been well-controlled throughout life.
If you have been prescribed hormone replacement therapy you may want to find out if or how it might affect your seizures. Some antiepileptic drugs may interact with hormone replacement therapy. Although it does not appear to be the case for the majority of women, some experience an increase in seizures due to hormone replacement therapy. It is important to ask your health practitioner for this information.
Osteoporosis
Antiepileptic drugs are a risk factor for osteoporosis. Women with epilepsy who are taking antiepileptic drugs should ask their health care practitioners about this risk and should take preventative measures. These might involve changes to diet, the use of vitamins and/or exercise programs. If you are taking antiepileptic drugs you should be evaluated for osteoporosis as you mature.
