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Menopause

These pages are about women and epilepsy in the UK. If you are looking for information about women and epilepsy in another country, please contact your local epilepsy organisation

Menopause
Hormone replacement therapy

About the menopause

Every woman goes through the menopause. It’s sometimes called ‘the change of life’.  Around the time of the menopause, your periods happen less often and eventually stop altogether. Your body stops releasing eggs, which means that you can’t get pregnant naturally. Among other symptoms, you might have hot flushes and night sweats. You might also have trouble sleeping. This can cause you to have poor concentration and feel irritable.

When the menopause happens

In the UK, most women reach the menopause around the age of 52. However, it can happen earlier, or later, than this. If you have epilepsy, there’s a possibility that you may start the menopause earlier than other women. This is more likely if you have frequent seizures.

More information about the menopause is available from NHS Choices.

The menopause and seizures

Many women with epilepsy notice a change in their seizure pattern during or after the menopause. Some women have more seizures and some women have fewer seizures.

Catamenial epilepsy is when your seizures follow a pattern that is connected to your periods. If you have catamenial epilepsy, some research suggests that you might have more seizures than usual in the time leading up to the menopause. After the menopause, you might find that your seizures happen less often.

About hormone replacement therapy

Hormone replacement therapy (HRT) is a treatment that involves taking certain hormone supplements. The aim of HRT is to lessen or stop symptoms of the menopause, such as hot flushes and night sweats. Many women don’t have severe menopause symptoms, so don’t take HRT. But it can be helpful for women who find that the menopause is affecting their quality of life.

HRT is available in many different forms, including oestrogen alone and oestrogen combined with a progestogen hormone. Oestrogen alone may trigger seizures in some women with epilepsy, so it’s not recommended. It’s possible that oestrogen with natural progesterone may help and be less of a risk.

Hormone replacement therapy - the evidence

There are a number of studies looking at HRT and epilepsy. However, all of the studies looked at very small numbers of women with epilepsy, taking HRT. This means there is not enough information about the risk of seizures when taking HRT, and more research is needed.

Hormone replacement therapy and epilepsy medicines

If you decide to try HRT, your doctor will help you consider the best type for you. They will be able to check any interactions between HRT and your epilepsy medicine. It’s known that HRT containing oestrogen can interact with the epilepsy medicine lamotrigine, by lowering the levels of lamotrigine in the blood. This may increase the risk of seizures. If you take lamotrigine and want to take HRT, your doctor should discuss these risks with you.

Hormone replacement therapy and seizures

One small study (21 women) suggests that HRT could cause you to have more seizures than usual. This study goes on to say that this is more likely if you have previously had catamenial epilepsy (when your seizures follow a pattern that is connected to your periods.) And the higher the dose of HRT you take, the more likely you are to have seizures.

If you have epilepsy and are considering taking HRT your doctor may refer you to a specialist for advice.

For more information about HRT and the menopause, see the British Menopause Society's website: thebms.org.uk.

For more information about the menopause generally, see menopausematters.co.uk

If you would like to see this information with references, visit the Advice and Information references section of our website. See Women with epilepsy.

Code: 
B017.04

Epilepsy Action wishes to thank Penny Burt, Nurse Specialist (Epilepsy), Royal Victoria Infirmary,Newcastlefor her contribution to this information. Penny has declared no conflict of interest.

This information has been produced under the terms of The Information Standard.

  • Updated August 2014
    To be reviewed August 2017

Comments: read the 5 comments or add yours

Comments

I never had epilepsy until I was premenopausal. I knew there was something going on with me for over two to three years. I even went in to be tested for seizures. I ended up having a grand mal seizure and was in the hospital. They sent me to the Mayo because they had found a tumor that was benign. After much testing, they found out that I had epilepsy. Even though I am on medication, I continue to have them monthly like a menstrual cycle. I really believe they are tied to my menstrual cycle. The med do not control the seizures. An ideas??

Submitted by Barb Melsha - S... on

Hi Barb
A number of women have seizures which are triggered by hormonal changes. Sometimes a doctor will prescribe a different drug (in the UK clobazam) for you to take at your time of highest risk of seizures. It may be worth discussing this with your specialist. Keeping a seizure diary for a few months first would help show the connection between your menstrual cycle and your seizures. I hope that helps.

Cherry
Epilepsy Action Advice and Information Team

Submitted by Cherry, Epileps... on

We are very concerned about our special needs daughter Toni. She is now 36 years old, has always been small and slim and presents as a non verbal, but aware young lady. She has had congenital cataracts removed and implants put in. She started having seizures from about the time she started periods and usually had a seizure of varying degrees around that time thereafter. She was on tegretol for this up until around the age of 28 when because of having more seizures, this was changed to lamotrogine which worked fine, at first not having any seizures to only having the odd one throughout the year. Toni was never on the depo vera, only the mini pill in order to help her with period pains, but since these increased, we were advised to try the depo which we were reluctant to do, but thought we had better let Toni have the chance of being pain free. She was only on the depovera for a matter of around 4 months when and the staff at her facility noticed changes in our daughter. Her usually thick curly hair became thin dull and brittle, she started to swell, she was dull and dribbly and had no spark at all. She also started to have seizures in clusters which she had never had before. We told them to stop the depo vera as we said it looked as though the amount of medication Toni was having ( both the depo and the lamotrigine ) was having a culmative affect on her. ( The doctor had increased her lamotrigine before putting Toni on the depo as she said that the mini plll was decreasing the affectivness of the pill which was why her seizures had started becoming more frequent ) As said, we noticed a distinct change in Toni after the combination of more lamotrigine and the depo.Toni was taken to see a specialist recently ( about 2 months ago ) and he actually gave her an extra dose of lamotrogine so that she is now getting 100 mor milgrms per day, 400 is far too much for such a small person ( even if levels show up within the "norm" ) she has become increasingly unwell since then. Her sight perception has become bad, she is wobbly on her feet, she looks as though she has headaches, she seems to swell up on occasions. Generally since going of the depo, her hair and skin has improved but she has had no periods at all, her quality of life has been shot for months and she is still getting cluster seizures. Staff are very concerned as are we about continuing to give Toni that much lamotrogine as perscribed by the specialist, I have come to the conclusion that Toni is going through and early menapause, brought on by the depo as she has stopped having periods altogether with no easing down, her doctor has never explained why this has happened even though she said that there are no longer any affects from being on the depo. We also have observed that Toni has had seizures within an hour of taking lamotrigine when home with us. We think that Toni needs to be seen holistically by another specialist and her medication changed or even phased out if she no longer needs it if aligned with her periods.if Toni is indeed going through a very early change with all the accompanying symptoms as well as having an increase in a medication that is counter productive, this could be very harmful to her. We could take Toni back to the same specialist as a private patient, but feel that we should seek another opinion entirely, can you advise please? We are very worried... thanking you Jennifer

Submitted by jennifer russell on

Dear Jennifer
Thank you for your comment. It sounds like your daughter is having a really tough time.

If you haven’t already, you may wish to view the NHS choices information on the Depo-Provera.. it lists possible side-effects such as weight gain, headaches, and mood swings. It also says that the person’s periods may become more irregular or longer, or stop altogether (amenorrhoea).  The NHS website also states side effects will last as long as the injection and for some time afterwards. For example, it can take up to one year for the injection to wear off and fertility to return to normal.  You could discuss these issue further with her doctor.

nhs.uk/conditions/contraception-guide/pages/contraceptive-injection.aspx

Some women may have more seizures than usual at certain times in their menstrual cycle. This could be at the start of their period, when they ovulate (around the middle of their menstrual cycle), or in the week before their period. When this happens one possible treatment is the drug clobazam (Frisium). This would be taken as well as your daughter’s usual epilepsy medicine, but just on the days when she is at a higher risk of having seizures.

We can’t comment on your daughter’s lamotrigine but we can confirm for an adult, the usual maintance dosage is between 100-200mg daily, increasing if necessary up to 500mg daily. We have information on epilepsy treatment on our website.

You have asked for details of a specialist but have not told us where in the UK you live. Please contact our helpline team directly with this information. You can either email helpline@epilepsy.org.uk  or phone the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Friday, 8.30am until 5.30pm.

Regards
Diane Wallace
Epilepsy Action Advice and Information Team

Submitted by Diane, Epilepsy... on

I would suggest seeing an epilogologist, which is a neurologist that specializes only in epilepsy. When I saw mine yesterday, my family had been so upset how my progress was going and I turned to her and I said babe, epilepsy is just like baking without a recipe. You just have to keep trying different ingredients and have the right measurements. My Dr loved that expiation! He asked if he could use it again. Your epilogologist should also know a high risk ob/gyn in your area that knows how to deal with all sorts of high risk patients. Best of luck to all of you ladies from across the pond.

Submitted by Becky Bearden on