Epilepsy in women of childbearing age: a focused review

Epilepsy affects over 50 million individuals worldwide, a significant proportion of whom are women with epilepsy (WWE) of childbearing age. This population faces unique challenges related to hormonal fluctuations, e.g., during life stages such as breastfeeding or menopause. Antiseizure medications (ASMs) further complicate reproductive health by influencing menstrual function, contraception, pregnancy outcomes, bone health, and menopausal transition due to their teratogenic potential and hormonal interactive effects. Consequently, treatment strategies for WWE must consider these interactions and the risks associated with ASMs during pregnancy. This review aims to consolidate current data and guidelines for managing WWE throughout their reproductive years. These findings emphasize the importance of preconception counseling to optimize ASM regimens, ensuring both maternal well-being and fetal safety. Key recommendations from major international pregnancy registries are summarized to guide clinicians in selecting ASMs that minimize the risk of congenital malformations while maintaining effective seizure control. Additionally, this review explores the role of folic acid supplementation in preventing neural tube defects and outlines contraceptive options tailored for WWE. In conclusion, comprehensive education on the implications of epilepsy for reproductive health is crucial for WWE. By fostering informed decision-making through personalized counseling and careful medication management before, during, and after pregnancy, healthcare providers can significantly improve outcomes for both mothers and their children.