Menopause, or “the change of life,” is the period in a woman’s life when the ovaries stop releasing eggs and menstruation ends. This is associated with declining levels of the major female hormones estrogen and progesterone. Just as menstruation can be associated with an exacerbation of seizures due to fluctuating (particulary increased) levels of estrogen, menopause is often associated with an improvement in seizures. As a matter of fact, approximately 40% of women with epilepsy experience a reduction in seizures as they enter menopause, and those with catamenial epilepsy (increased seizures during a woman’s period) often experience a significant reduction. Unfortunately, up to 30% of women may experience worsening of seizures at menopause, and another 30% experience no definite change in seizure frequency.
Some women are recommended to undergo hormone replacement therapy (HRT) by their primary care physicians or obstetrician/gynecologists. In a woman with epilepsy, this decision needs to be made carefully. Since HRT is comprised of estrogen, progesterone, and sometimes testosterone, seizure frequency can be affected. You should include your neurologist or epileptologist in this decision.