Epilepsy and menopause: potential implications for pharmacotherapy

Being a woman with epilepsy is not the same as being a man with the disease. There is a complex multidirectional interaction between sex hormones, seizures and antiepileptic drugs (AEDs) with gender-specific implications. Estrogen can be a potent proconvulsant, whereas progesterone is an anticonvulsant in experimental models. It is well established that women with epilepsy can have changes in seizure propensity related to their menstrual cycle (catamenial epilepsy). There is good evidence that the gonadotropin-releasing hormone cell population in the hypothalamus can be affected by seizures originating in the limbic system, possibly leading to anovulatory menses, possibly contributing to lower fertility, and earlier menopause among women with epilepsy. Data on the effects of menopause on epilepsy are scarce. In general, menopause appears to have limited effects on seizure control, with the possible exception of women with catamenial epilepsy who may experience an increase in seizure frequency during perimenopause and a decrease after menopause. Hormone replacement therapy has the potential to increase seizure frequency and thus cannot be recommended for women with epilepsy. Of particular relevance for menopause is the adverse effect on bone mineral density caused by enzyme inducers and other AEDs. In general, there is a remarkable shortage of studies on the impact of menopause on epilepsy and on its implications for epilepsy treatment.