Menopause, HRT and Epilepsy

Many women with epilepsy who undertake hormone replacement therapy (HRT) have reported that seizures have increased. There is a close link between seizures and hormones. Changing hormone levels, which happens during times such as puberty, pregnancy and menopause, can cause changes in seizure activity. 

Hormonal influences 

Hormone levels can change throughout a woman’s life, particularly during puberty, pregnancy, menstrual cycles and menopause. These hormonal changes can affect when epilepsy starts, as well as the frequency and severity of seizures. It can also impact if and when she might stop having seizures. This can also mean that treatment has to be changed periodically. 

Oestrogen and progesterone are two hormones that women naturally produce. Both of these hormones can speed up or slow down brain activity, which can ultimately affect the number of seizures experienced. 

It’s worth noting that epilepsy is so varied and affects everyone differently that some women will not experience changes due to their hormone levels. 

Menopause

Menopause is the period of life whereby a woman ceases to menstruate, often referred to as ‘the change of life’. Most women will experience menopause in their 50’s, although it could start earlier than this. 

As previously stated, many women experience a change in their seizure pattern during menopause. It’s often difficult to predict these changes and they can affect everyone differently. Some women will experience an increased number of seizures and others a decrease, whereas some women will experience no change at all. 

Some women will experience Catamenial epilepsy, which is a medical term for when seizures follow the pattern of the menstrual cycle. Women who experience this type of epilepsy will often find that seizures increase during the period of time leading up to menopause, but then afterwards will often have less than before. 

Hormone replacement therapy (HRT)

HRT is a treatment that is often prescribed to control the symptoms of menopause, which include hot flushes and night sweats. Unfortunately, these symptoms can limit the quality of life for women going through menopause and therefore HRT is helpful to minimise the symptoms. 

HRT comprises a variety of different treatment options. For example, oestrogen may be used for women who have had a hysterectomy (an operation to remove the womb). For women who have not had a hysterectomy, either a synthetic or natural progesterone hormone will likely to be used.

As we know, hormonal changes can have an impact on seizure activity, which is why many women have reported changes in their seizure pattern once they begin HRT. However, to date, the evidence for this is only anecdotal and there aren’t enough studies to definitively claim that HRT triggers seizures. More studies are needed to fully understand the link between HRT and epilepsy. 

If you are a woman with epilepsy who is considering HRT, then your doctor or neurologist should be able to help you choose a treatment course with your epilepsy in mind.