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The menopause and hormone replacement therapy

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 is the time of the last ever period and is sometimes called ‘the change of life.’ Before the menopause your periods often happen less often. Around the time of the menopause you may have hot flushes, night sweats, and trouble sleeping. Poor quality sleep can cause poor concentration and make you feel irritable.

When the menopause happens

In the UK, most women reach the menopause around the age of 51. If you have frequent seizures with your epilepsy, you may have the menopause a few years earlier than this.

More information about the menopause is available from NHS Choices.

The menopause and seizures

You may notice a change in your seizures pattern around the time of the menopause. It is often difficult to predict how seizures will change. Some women have more seizures, and some women have fewer seizures. Catamenial (cyclical) epilepsy is when seizures follow a pattern that is related to the cycle of your periods. Women 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.

About hormone replacement therapy (HRT)

HRT involves taking hormone supplements to control the hot flushes and night sweats of the menopause. Many women don’t have severe menopausal symptoms, so don’t choose to take HRT. HRT is helpful for women who find that the symptoms of the menopause are worsening their quality of life.

HRT comes in many different forms. Oestrogen alone is used in women who have had a hysterectomy (operation to remove their womb). In women who have not had a hysterectomy, a synthetic progestogen hormone, or natural progesterone is added to protect the lining of the womb from overgrowing. Oestrogens sometimes increase seizures. Natural progesterone generally reduces seizures.

HRT - the evidence

There are not many studies looking at HRT and epilepsy, and all of the studies have very small numbers of women. This means there is still not enough information about the risk of seizures when taking HRT. More research is needed.

HRT and epilepsy medicines

In some women, some types of HRT can cause them to have more seizures than usual. There may be effects of HRT on your epilepsy medicine. For example, HRT containing oestrogen can lower the levels of lamotrigine in the blood and increase the risk of seizures. If you take lamotrigine and want to take HRT, your doctor should discuss these risks with you.

If you decide to try HRT, your doctor may help you consider the best type for you, or they may refer you to a specialist for advice.

Further information about the menopause and HRT

For more information about HRT and the menopause, see the British Menopause Society's website and Menopause Matters.

If you would like to see this information with references, visit the Advice and Information references section of our website. If you are unable to access the internet, please contact our Epilepsy Action Helpline freephone on 0808 800 5050. 

Code: 
B017.05

Epilepsy Action would like to thank Penny Burt, Nurse Specialist (Epilepsy), Dr Yvonne Hart, Consultant Neurologist, Newcastle Upon Tyne Hospitals NHS Foundation Trust, and Michael Marsh, Consultant Obstetrician and Gynaecologist, King’s College Hospital, for their contributions to this booklet.

The following interests have been declared:

Penny Burt has received sponsorship to attend epilepsy conferences from UCB Pharma, GlaxoSmithKline, Desitin and Eisai.

Yvonne Hart has received payments for lectures given, advisory work and/or sponsorship to attend epilepsy conferences from UCB Pharma, GlaxoSmithKline, Bial, Desitin and Eisai.

Epilepsy Action does not believe these interests have influenced the content of this information in any way.

Michael Marsh has declared no conflict of interest.

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

  • Updated February 2017
    To be reviewed February 2020

Comments: read the 7 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

You can try the coil as a form of contraception, instead of the pill or injection that might counteract with the anti epileptic drugs.

Submitted by Caroline Jenkins 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

Hi there. I am 54 years old and was diagnosed with absence seizures which thankfully are under control. I am now going through the menopause but some nights find it very hard to sleep and then am exhausted next day. It can be hard to plan ahead cause I can get very "tired" days. You don't see too much about epilepsy and menopause and how hard it can be. C

Submitted by Cathy O'Rourke on