The menopause and HRT

What is menopause?

The menopause is when you stop having periods and have not had a period for 12 months. In the UK, most women reach the menopause between the age of 45 and 55. Some research suggests that people with epilepsy may go through the menopause slightly earlier.

If it happens before the age of 45 it is called early menopause. If it happens before the age of 40, it is called premature ovarian insufficiency (POI). The NHS has more information about this.

What is perimenopause?

For many years before you stop having periods you might have symptoms, and this stage is called perimenopause. This is the time leading up to the menopause when you are still having periods, but different hormones going up and down can cause unpleasant symptoms.

What are the symptoms of perimenopause?

These are different for everyone and some people go through this stage of life very smoothly. But for a lot of people, the symptoms can be lifechanging and hard to cope with.

Some of the symptoms include:

• Changes to your usual pattern of periods – they could be lighter, heavier, further apart or closer together
• Low mood, or mood swings
• Anxiety
• Problems with concentration or memory (brain fog)
• Hot flushes that can also make you feel dizzy
• Night sweats
• Difficulty sleeping
• Fast or strong heart beats (palpitations)
• Headaches and migraines that are worse than usual
• Muscle and joint pains
• Changes in body shape or gaining weight
• Skin changes, including itchy skin
• A low sex drive
• Vaginal dryness
• Urinary tract infections

You may feel that some of these symptoms are affecting your epilepsy. For example, some people find that disturbed sleep, tiredness or anxiety can be seizure triggers.

The Balance website has lots of information and support for people experiencing perimenopause, including an app and a symptom questionnaire. You could use this information to talk to your doctor about your symptoms.

Hormones and seizures

As women get older, the levels of certain hormones in the body gradually falls. These hormones are oestrogen, progesterone and testosterone.

During perimenopause, your oestrogen and progesterone levels may not follow your usual monthly cycle and may go up and down in an unusual pattern. Both of these hormones can have an effect on brain activity and epilepsy, but more research is needed to fully understand this.

If you have seizures that are affected by your monthly periods (catamenial epilepsy), it may mean that you are more likely to have changes to your seizures during perimenopause. Often people with this type of epilepsy may have more seizures in the run up to, and during, their menopause. But after the menopause, they often have less.

Treatment for menopause and perimenopause

The main treatment for menopause and perimenopause symptoms is hormone replacement therapy (HRT).

What is hormone replacement therapy (HRT)

HRT involves using hormone treatment to replace and stabilise the levels in your body. It is helpful for people who find that the symptoms of  perimenopause are affecting their quality of life. HRT can help to improve all of the symptoms listed above, if they are caused by low or changing hormone levels.

HRT comes in different forms, such as gels, patches, sprays, pessaries and tablets. Your doctor will help you choose what’s best for you. Gels, patches and sprays go through the skin into your bloodstream (transdermal).

Oestrogen alone is used if you don’t have a womb (uterus). If you have a womb you will also take progesterone to protect the lining of the womb.

Having your womb removed is called a hysterectomy. If you also have your ovaries taken out, this can cause a sudden or surgical menopause. There’s more information about hysterectomy and surgical menopause on the NHS website.

Newer forms of HRT use ‘body identical’ hormones that more closely match those found naturally in your body. These are different to ‘bioidentical hormones’ which are not regulated, and the NHS warns against using.

If you have a low sex drive because of perimenopause or menopause,  and HRT does not improve it, you may be offered testosterone. It’s not currently licenced for use in women in the UK, although it can be prescribed by a specialist doctor or menopause clinic if they think it might help.

You can find out more about HRT and the menopause from:

• British Menopause Society
• Balance

Will HRT affect my epilepsy?

There have only been a very small number of studies looking at HRT and epilepsy. One study found that a specific, older form of HRT increased the risk of seizures in women with epilepsy. However, there’s not much research into the other types of HRT that are available now, such as transdermal HRT. So, at the moment, there’s not enough evidence to say whether HRT can trigger seizures. More research is needed.

Your doctor should help you consider the possible risks and benefits of taking HRT, so that you can come to an informed decision about your treatment.

Can I take HRT with my epilepsy medicines?

Depending on your type of epilepsy and the medicines you take, HRT could cause your epilepsy medicine to be less effective. For example, some research has suggested this to be the case for lamotrigine. But having epilepsy is not a reason to avoid HRT completely if the symptoms of perimenopause are causing you distress. The amount of eostrogen used for HRT is lower than other hormone treatments, such as the contraceptive pill.

If you decide to try HRT, your doctor should help you consider the best type, or they may refer you to an epilepsy or hormone specialist for advice. You may need extra reviews or monitoring of your epilepsy if you start taking HRT. Your specialist can monitor you and adjust the dose if you both feel that HRT is right for you.

Other treatments

If you choose not to take HRT, there are other options that you can talk to your doctor about. These might include:

• Antidepressants which can help with mood symptoms if you have depression or anxiety. But only if these symptoms are not related to menopause
• Cognitive behavioural therapy (CBT) which is a talking therapy that could help with low mood, sleep problems or physical symptoms
• Oestrogen creams or other creams and tablets that you insert into your vagina (pessaries) to treat dryness and itchiness
• Other medicines that your doctor might be able to prescribe for hot flushes and night sweats
• Alternative or complementary treatments. You should discuss this with your doctor as these can sometimes interact with other medicines

Menopause, epilepsy medicines and bone health

Some people who take epilepsy medicines are at risk of developing osteoporosis. This is a condition that thins and weakens bones, making them more likely to break (fracture). It can happen over a period of time.

People with low levels of oestrogen are also at risk of weaker bones. The combination of taking epilepsy medicines for a long time, and also going through the menopause, could mean you are at an even higher risk. HRT may give your bones some protection.

You can discuss this with your specialist when you are weighing up the risks and benefits of HRT in order to find the right treatment for you.

Your doctor will look at your risk factors, including your age, sex, health, medications and lifestyle. They may refer you for a scan to measure your bone strength. This is called a bone density (DEXA) scan. It is a short, painless procedure.

You can also improve bone health with exercise, healthy eating and safe exposure to sunlight. Some people may also benefit from vitamin D and calcium supplements.

Epilepsy Action has more information about bone health and epilepsy.

Epilepsy and menopause at work

Everyone is likely to have some experience of menopause – whether going through the stages yourself or being around someone else who is. In the past, people have sometimes felt uncomfortable talking about menopause and have found it difficult to ask for support at work.

People with epilepsy who are also going through menopause can find it hard to figure out whether their symptoms are related to menopause, seizures, the side effects of medicines, or something else. The timing can often also be at the same time as other life events, like children leaving home or parents becoming sick. This can all cause extra stress and worry.

Attitudes in some workplaces are changing and some employers are raising awareness about how perimenopause and menopause symptoms can affect people’s lives. More women are working full time and retiring later, so it’s important that workplaces learn about how they can support people at work who have epilepsy and have symptoms of menopause.

Here are some common symptoms that people have said affect their work the most:

• Concentration problems
• Tiredness
• Memory problems
• Feeling low or depressed
• Mood changes or irritability
• Hot flushes

Balance have put together some top tips for menopause in the workplace. Some of these include: finding someone senior at work that you can talk to about your symptoms, asking for adjustments, and what to do if you are not listened to.

Epilepsy Action also have an Employment Toolkit to support people with epilepsy in the workplace.

Support

Epilepsy Action Talk & Support groups

Virtual and in person general groups, plus a virtual group just to talk about epilepsy and menopause. You can find out more and sign up here Talk and support 

Balance
A safe space to learn all things perimenopause and menopause through evidence-based information and knowledge

Women’s Health Concern
Confidential advice, reassurance and education

Menopause Matters

The Royal Osteoporosis Society
Helpline: 0808 800 0035

Sexual Health Helpline
Tel: 0300 123 7123