Neurologic Complications of Pregnancy and Menopause

This article reviews neurologic complications associated with pregnancy and menopause, the influence of pregnancy and menopause on preexisting neurologic disorders, and the management of neurologic disorders during pregnancy and menopause.

Pregnancy and menopause can significantly impact neurologic health. Neurologic consultation regarding mode of delivery and anesthesia in patients with neurologic conditions is common, and very few neurologic conditions warrant cesarean delivery. Pregnancy is not a contraindication to acute ischemic stroke therapies or targeted temperature management after cardiac arrest. Both pregnancy complications and earlier age at menopause are associated with worse cognitive and cerebrovascular outcomes later in life. Hormone therapy is approved by the US Food and Drug Administration (FDA) for the treatment of vasomotor symptoms, osteoporosis prevention, and genitourinary syndrome of menopause, all of which are conditions that may be exacerbated by underlying neurologic conditions or their treatments. The American Academy of Neurology (AAN) Women's Neurology curriculum provides core competencies guiding neurologic care through the lens of sex and gender across the lifespan.

Neurologic care during pregnancy and menopause requires careful attention to the dynamic interplay between hormonal transitions, evolving evidence on diagnostic and treatment safety, and the lifelong neurologic risks associated with neurologic complications of pregnancy.