Can Hormonal Changes Cause Seizures in Women with Epilepsy?

Yes, changes in hormones seem to trigger changes in seizures

Young woman receiving EEG exam
Young woman receiving EEG exam. Getty Images/Muammer Mujdat Uzel/E+

Hormonal changes are responsible for many things, but can they be causes of seizures? Even though epilepsy affects equal percentages of men and women, women with epilepsy can experience a higher frequency of seizures at particular points in their lives due to normal hormonal changes.

During a woman's lifetime, her ovaries produce two essential hormones needed for pregnancy and menstruation: estrogen and progesterone.

The balance between these two hormones varies during a woman's reproductive years, which run from puberty through menstruation and pregnancy to menopause.

Although these hormonal fluctuations obviously are important in reproductive health, they can also affect seizure activity. Specifically, physicians believe estrogen may heighten seizure activity, while progesterone seems to have the opposite effect.

Puberty and Menstruation

During puberty, the reproductive system matures — your body makes estrogen and progesterone, which trigger the onset of menstruation along with breast development. Due to this increase in hormones, girls with epilepsy may also see an increase in the frequency of their seizures at this point in their development.

Some women may also experience an increase in the frequency of their seizures around their menstrual period. Known as catamenial epilepsy, seizures occurring around a woman’s menstrual cycle may need additional management.

Doctors believe that the effects of estrogen and progesterone on the brain leads to this increase in seizure frequency.

Contraception and Pregnancy: Management Needed

There are a variety of contraceptives available if you're a woman with epilepsy who wants to avoid pregnancy, but you'll need to take precautions, especially with oral contraceptives.

Some epilepsy medications may counteract the effects of contraceptive pills, meaning you could get pregnant even if you're on the pill.

As with many chronic diseases, you may be able to manage pregnancy and have a healthy baby if you have epilepsy, but it may require careful planning. Epilepsy can create a concern during pregnancy, especially when it comes to uncontrolled seizures and the medications used to control your condition.

Doctors believe that your higher hormone levels in pregnancy (both estrogen and progesterone) can cause an increase in seizure frequency, though this may not be the case with every woman. It is estimated that seizure frequency increases in 20 to 33% of pregnancies, decreases in 7 to 25% of pregnancies, and remains unchanged in the remaining 50 to 83% of women with epilepsy who are pregnant.

Menopause: Changes in Seizures Possible

Menopause occurs when menstruation has ceased and your ovaries stop producing estrogen and progesterone. Due the effect of these hormones on the brain, some women may experience changes in the number and frequency of their seizures during menopause.

Sources:

Braunwald E, Fauci ES, et al. Harrison’s Principles of Internal Medicine. 16th ed. 2005.

Morrell M. Epilepsy in women. Am Fam Physician 2002; 66:1489-94.

Pennell PB. "Pregnancy in Women Who Have Epilepsy." Neurol Clin. 2004 Nov;22(4):799-820.

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