The menopause and HRT

What is the menopause?

The menopause, also called the change of life, is defined as the end of your last menstrual period. Every woman goes through the menopause.

The menopause happens when your ovaries stop releasing eggs. This means that your fertility comes to an end. There is also a drop in the levels of oestrogen and progesterone in your body (the two female sex hormones produced by the ovaries).

The menopause usually begins between 47 and 52 years of age, but can begin outside this age range. It occurs at an average age of about 50.

What are the symptoms of the menopause?

The most common and easy to recognise symptoms of the menopause are hot flushes and sudden sweats. Other symptoms may include night sweats, insomnia, headaches, poor concentration and general irritability.

What do we know about epilepsy and the menopause?

There is very little research specifically looking at women with epilepsy and the menopause. The information we can provide in this leaflet is taken from just a few studies that have been carried out on small numbers of women. If you would like to find out more about the studies that are mentioned, please contact Epilepsy Action.

Will the menopause cause my seizures to change?

We know that the levels of oestrogen and progesterone in our body can have an effect on seizures. Generally speaking, oestrogen can increase seizure activity, but progesterone can reduce it. When levels of both hormones decrease during the menopause, it is difficult to predict how this may affect seizures. However, it is possible that changes in a woman’s seizure pattern may occur.

A group of women with epilepsy who were going through the menopause took part in a study. Four out of 10 of these women reported more seizures at this time, three out of 10 had fewer seizures and three out of 10 had no change in their seizure pattern.

Will my catamenial epilepsy disappear?

One small study found that women who had a pattern of catamenial epilepsy (that is, seizures related to their menstrual cycle) were more likely to have fewer seizures after the menopause, but more seizures during the time leading up to the menopause.

Will my anti-epileptic drugs (AEDs) be affected by the menopause?

Some women may gain weight during the menopause and some women may lose weight. Sometimes, a change in weight can cause your AEDs to work less effectively and you may experience an increase in the number of seizures or side effects from your drugs. Therefore, when you are going through the menopause, it is a good time to ask your doctor to review your epilepsy and anti-epileptic drugs, to make sure that you are still getting the best possible treatment for your epilepsy.

Can epilepsy cause an early menopause?

In one study of 50 women with epilepsy, only seven women experienced an early menopause. This study therefore suggests that the majority of women with epilepsy do not start their menopause early.

Further research suggests that if you have frequent, uncontrolled seizures, you may start your menopause earlier than a woman who does not have seizures.

Can the menopause cause epilepsy?

There is no strong evidence to suggest that the menopause can cause epilepsy, but the lack of research into this area makes it difficult to give a clear answer.

In one study of 61 menopausal women with epilepsy, 12 had their first seizure during the menopause. However in four of these women, their epilepsy was not caused by the menopause but by something else, such as a stroke.

Hormone replacement therapy (HRT)

What is HRT?

HRT is the use of oestrogen, and progestogen (an artificial form of the hormone progesterone), to treat the discomforts of the menopause (such as hot flushes and insomnia) or to replace hormones (especially oestrogen) that are lost after the menopause. Sometimes the hormone testosterone is also given.

If you still have your womb, you need to take oestrogen and progestogen. The progestogen prevents overgrowth and abnormalities in the lining of the womb that would happen if you took oestrogen on its own. The progestogen can be taken for half of the month, which will cause you to have a period every month. Alternatively, the progestogen can be taken every day so that you don’t have a period at all. This is called the “no bleed HRT”.

Most women who no longer have a womb only need to take oestrogen. However, if you also have epilepsy, there is some research that suggests that oestrogen and a natural progesterone would be more beneficial for you. This is because progesterone is thought to lower the risk of seizures.

Will HRT increase my seizures?

There is very little information available about the effects of HRT on women with epilepsy. This is because there have been just a few detailed studies carried out on small numbers of women, and some of these studies give different results. For example, in one study of 16 women taking HRT, 10 reported an increase in seizures. However, in another study of 31 women taking HRT, only four reported an increase in their seizures.

Many women in several studies reported that there was no change in their number of seizures and a few women reported a decrease in seizures.

One study looked specifically at the type of HRT that women with epilepsy were taking. In six women who took oestrogen and progesterone, three noticed a decrease in their seizures and three reported no change. In nine women who took oestrogen on its own, one noticed an increase in their seizures and eight reported no change. These results support the opinion of some doctors that it may be more beneficial for women with epilepsy to take oestrogen with progesterone rather than oestrogen on its own.

Testosterone used in HRT is not thought to affect epilepsy in women.

If you have a history of catamenial epilepsy, some studies suggest that you have a higher risk of experiencing an increase in seizures if you take HRT.

So, can I take HRT?

The lack of research into HRT and epilepsy means that it is not possible to give a clear idea about how HRT may affect you individually. What we can tell you is that some women with epilepsy have taken HRT in the past without experiencing an increase in their seizures.

If you have epilepsy, you may wish to consider taking HRT as a treatment for symptoms associated with the menopause. Your own doctor will be able to talk to you more about the benefits and disadvantages and how this treatment may affect you. They will also be able to tell you about other ways that your symptoms could be treated.

Will HRT affect my anti-epileptic drugs (AEDs)?

There is very little information available about this. However, it is known that HRT can interact with lamotrigine and lower the levels of this anti-epileptic drug in your blood.

Before you start taking HRT, you should always tell your doctor about any AEDs that you are taking, so they can check to see if other women taking the same drugs have reported any interactions.

If you start HRT and you notice a change in your seizures, or you suspect that you are experiencing side effects from your AEDs, it is advisable to talk to your doctor about this.

Further information about the menopause and HRT

You can obtain more information from your doctor or from the following organisations:

• NHS Direct
  Tel. 0845 46 47
• Menopause Matters

Bone health and epilepsy

Osteoporosis is a condition caused by loss of calcium in the bones. Calcium helps to make bones strong and when it is lost, bones become thinner, more brittle and can break more easily.

Osteoporosis can happen to anyone but it is more common in women than men, particularly after the menopause. Some anti-epileptic drugs (AEDs) can cause bone loss. You can find more information about this on the osteoporosis fact sheet available from Epilepsy Action.

If you are a woman with epilepsy, it is particularly helpful to be aware of the risks of osteoporosis, because seizures can increase the risk of falling and breaking weakened bones.

Hormone replacement therapy (HRT) may offer some protection against osteoporosis. If you do not take HRT, you may wish to talk to your doctor about other forms of treatment to keep your bones strong.

Further information about bone health

You can obtain more information from the following organisations:

• NHS Direct Helpline
  Tel. 0845 46 47
• National Osteoporosis Society helpline
  Tel. 0845 450 0230

How can you help Epilepsy Action?

Nicole Crosby, Development Officer for Women at Epilepsy Action, is interested in hearing from women with epilepsy, living in the UK, who are willing to share their experience of how their epilepsy may have been affected by the menopause or hormone replacement therapy.

Your experiences help to make our campaigns successful, by helping people and health professionals to better understand the lives of women with epilepsy.

If you would like to help, please contact Nicole Crosby, Tel. 0113 210 8800 or email ncrosby@epilepsy.org.uk

Acknowledgement

Epilepsy Action wishes to thank Dr Michael Marsh, Consultant Obstetrician and Gynaecologist at King’s College Hospital, for his help in producing this information

Last updated November 2007