Living with epilepsy can pose unique challenges for women. Seizure frequency and severity may change at puberty, over the menstrual cycle, with pregnancy, and at menopause.
Epilepsy and The Menstrual Cycle: There is a type of epilepsy that is specific to women called catamenial epilepsy. For women with catamenial epilepsy, changes in the frequency of seizures follow fluctuations in hormone levels throughout the menstrual cycle.
Seizure frequency can vary in different phases of the menstrual cycle for several reasons. In some cases the reasons are not known or there may be no relationship at all. In other cases, the relationship is based on estrogen's excitatory effect and/or progesterone's inhibitory effect on the brain. As the levels of these and other sex hormones vary, the likelihood of having seizures changes.
Birth Control: Before deciding to use oral contraceptives, women who take seizure medication should consult with their physician. The effectiveness of birth control pills may be impaired when women take certain types of seizure medications. Some oral contraceptives can also affect the efficacy of some seizure medications. However, not all seizure medications interact negatively with birth control pills. Your physician may recommend an oral contraceptive with a lower estrogen content, or suggest alternative birth control methods.
Epilepsy and Pregnancy
Most women with epilepsy have healthy babies and the risks involved in their pregnancies are the same as for any pregnancy. Women with epilepsy, however, should be aware that there are special considerations related to pregnancy. If at all possible, a woman who has epilepsy should consult with her doctor before becoming pregnant to plan for the healthiest possible pregnancy.
Pregnancy can affect the way your body is using your seizure medication and/or it could affect the pattern or frequency of your seizures. There is also a slightly higher risk that having epilepsy and/or taking seizure medication will affect the fetus.
Most women have no change in seizure frequency during pregnancy. However, some women may experience an increase in seizures. A reduction in seizures is also possible. Reasons for these shifts in seizure frequency include dramatic swings in hormone levels during pregnancy, changes in body fluid and salt retention, and alterations in the way the body absorbs, distributes and eliminates seizure medication. Changes in metabolism usually return to normal around three months after delivery.
It is vitally important for women to see their physician regularly during pregnancy and 3-4 months postpartum so that seizure medication levels can be carefully monitored and adjusted as necessary. More frequent blood level measurements may be necessary due to the mother's extra body weight and fluid retention during pregnancy.
Women are naturally concerned about the effect of seizures on the fetus. Most available information indicates that the number of seizures during pregnancy has little effect on the baby, except in the rare case of uncontrolled multiple seizures, known as "status epilepticus". This is a life-threatening condition to the mother and the baby and is considered a medical emergency.
Seizure Medications and Pregnancy: Some types of seizure medication can carry the risk of causing harm to a fetus. Polytherapy, or treatment using more than one seizure medication, has a higher risk of causing harm than does monotherapy, or the use of one seizure medication.
This situation creates a difficult problem for women who have epilepsy. Seizure medication may increase certain risk factors, but the need for the medication continues during pregnancy.
A decision to change or stop seizure medication medication should, therefore, only be made after careful discussion of individual risk factors by a woman, her partner, and the women's physician.
Ideally, discussions of these issues should take place before a woman becomes pregnant so that, if the decision to change or slowly withdraw medication is made, the new treatment plan can be tried out before conception occurs.
A woman who does become pregnant while on seizure medication should not simply stop taking her medication. Such a sudden change in seizure medication therapy can cause severe episodes of multiple seizures that may threaten a woman's pregnancy, or her life. Instead, she should consult her physician as soon as possible.
It is important, however, to remember that the overwhelming majority of women with epilepsy who take seizure medication medication during pregnancy give birth to normal, healthy infants.
Possible Complications During Pregnancy: Complications during pregnancy and labor are slightly higher in women with epilepsy. Both seizure medication and uncontrolled seizures pose risks during pregnancy. The risks associated with uncontrolled seizures are considered to be higher than those associated with taking seizure medication.
While most seizures do not have harmful effects on the fetus, having a tonic clonic seizure can increase the risk of miscarriage, trauma to the abdomen, and/or oxygen deficiency to the fetus. In women with epilepsy, there is also a small increase in the risk of premature labour and delivery, morning sickness, vaginal bleeding, and placental detachment. There is also a slight increase in fetal loss late in the pregnancy, stillbirths, and the need for a caesarean section in women with epilepsy. In general, however, most women with epilepsy will have a normal pregnancy, labor, and delivery.
Epilepsy & Menopause: At menopause, some women experience a change in the patterns of their seizures. As hormonal changes occur, some women experience seizures for the first time in menopause or their seizures change. Other women experience a recurrence of seizures that were previously controlled.