The Menopause Transition and Epilepsy: A Focus on Therapeutics

Perimenopause and menopause are reproductive stages marked by fluctuating and subsequent permanent loss of ovarian estrogen and progesterone production. There are important considerations in these life stages for people with epilepsy including the influence of hormonal changes and use of menopausal hormone therapy (HT) on seizure control and on antiseizure medication (ASM) metabolism. This narrative review summarizes the currently available information about this topic to increase provider awareness and identify gaps in knowledge for future research.

Menopause is associated with symptoms that can negatively affect quality of life, including vasomotor and genitourinary symptoms, mood and sleep disturbances, and cognitive changes. HT is the most effective treatment for menopause symptoms, but data on HT use in women with epilepsy are limited. HT may influence seizure control and the metabolism of some ASMs, such as lamotrigine. These observations and the limited available data may be a deterrent to the use of HT in women with epilepsy.

Data are largely lacking to guide the management of epilepsy during perimenopause and menopause. This review summarizes existing data and discusses HT and nonhormone therapies for management of menopause symptoms, highlighting unique considerations for those with epilepsy during the menopause transition.