Epilepsy is a complex condition, and as a woman, it may affect you differently at various stages of your life. Epilepsy and its management can also affect female health in several ways.

Hormones and seizures
There are a number of different hormones within a woman’s body that control things such as bone and muscle growth, heart rate, hunger, emotions and the menstrual cycle. The hormones associated with the menstrual cycle, oestrogen and progesterone, have a clearly established connection with seizures.

Oestrogen and progesterone act on certain brain cells. Oestrogen excites the brain cells and can make seizures more likely to occur, whereas progesterone may inhibit the brain cells preventing seizures in some women. Although hormones generally do not cause seizures, they can influence their occurrence. This is why some women have seizures or experience changes in seizure patterns more frequently at times of hormonal fluctuations such as: puberty, ovulation, menstruation, pregnancy and menopause.

Keeping a diary is a good way of determining whether hormones affect your seizures.

Seizures exacerbated or occurring exclusively during ovulation or just prior to or during menstruation is called Catamenial epilepsy.

Puberty
Fluctuating hormone levels during puberty can affect seizure control. Puberty is a time of complex physical and emotional changes. The physical changes can happen so quickly that the dose of anti-epileptic medication(s) that worked previously may no longer do so. This is a good time to have the anti-epileptic medication blood levels checked to determine if the dosage needs to be increased or changed.

Menstruation
Women with epilepsy may have a tendency to have more seizures at certain times of the menstrual cycle. This is due to:

• Hormonal fluctuations
• Fluid retention
• Reduced blood levels of anti-epileptic medications pre-menstrually
• Sleep disruption

Menstrual changes have been identified in 30- 50% of women with temporal lobe epilepsy as compared to 7% of women without epilepsy. These can include irregular menstrual cycles ranging from several months without menstruation to prolonged or shortened menstrual cycles.

Fertility
Fertility can be reduced in women with epilepsy. This means that women with epilepsy may find it more difficult to become pregnant, are more likely to have difficulties during pregnancy and to miscarry. One of the reasons for this may be polycystic ovarian disease.

Polycystic Ovaries
Polycystic ovaries affect 6% of women of reproductive age. There is evidence to suggest that polycystic ovaries are more common in women with epilepsy. No definitive reason has been established for the higher incidence of polycystic ovaries in women with epilepsy. However, possible reasons may be that epileptic discharges in the brain interfere with pituitary hormones. Anti-epileptic medications may also have an effect.
It is important for women with epilepsy to be aware of the indications for polycystic ovaries.
These include:

• A menstrual cycle length that is shorter than 23 days or longer than 35 days.
• Mid-cycle menstrual spotting/bleeding.
• Weight gain.
• Increase in body hair or thinning of scalp hair.
• Acne.
• Reduced sexual interest or difficulty in becoming aroused.
  

If you have these signs and symptoms, discuss them with your doctor.

Contraception
Even if contraception or fertility is not top of your list now, it's a good idea to think ahead and discuss these matters with your doctor or epilepsy nurse. Your teens are a good time to review your epilepsy and find the right treatment for your life ahead as a woman. This will help you to avoid treatment changes later on when it may be more difficult e.g. once you have passed your driving test or are living away from home or planning to have a family.

Oral contraception (contraceptive pill).
There have been some non-scientific reports that suggest that hormonal contraception (the Pill) can reduce or increase seizures in women with epilepsy. The Pill regulates the oestrogen levels and the menstrual cycle and therefore may influence seizure frequency in some women.
Some anti-epileptic medications interfere with the metabolism of the oral contraceptive pill, making it less effective. This can lead to possible “pill failure” and pregnancy. This does not mean that women with epilepsy cannot use the pill for contraception but they may need a higher dose pill.

The decision to take the contraceptive pill should be discussed with the doctor, as additional contraceptive precautions may be necessary. For women taking an anti- epileptic medication that does not interfere with the contraceptive pill’s metabolism, a low dose oral contraceptive pill, or mini pill (progestogen only) can be considered.

Reference: MIMS 2002
Antiepileptic drugs, which can interfere with oral contraception (the Pill), are:
Tegretol (Carbamazepine), Dilantin (Phenytoin), Phenobarbitone, Mysoline (Primidone), Topamax (Topiramate), Trileptal (Oxcarbazepine), Rivotril (Clonazepam) & Frisium (Clobazam).

Antiepileptic drugs that do not interfere with the oral contraceptive (the Pill) are:
Epilim (Sodium Valproate), Neurontin (Gabapentin), Lamictal (Lamotrigine), Gabitril (Tiagabine), Keppra (Levetiracetam), Zarontin (Ethosuximide) & Sabril (Vigabatrin).

The morning after pill
Women who are taking anti-epileptic medications may require a higher dose of the morning after pill. It is advisable to discuss the dose with the doctor.

Non hormonal contraception
Epilepsy and anti-epileptic medications do not hinder the effectiveness of the intrauterine contraceptive device (IUD), cervical cap, diaphragm or condom. The persona/rhythm method relies on testing urine for hormonal changes indicating ovulation. The rhythm method depends on identifying hormonal changes. As hormones can be affected by both epilepsy and anti-epileptic medications, this method of contraception can be more unreliable.

Cosmetic side effects and medications

As with many drug treatments, epilepsy medications also have side effects.

Weight gain can occur when taking sodium valproate, and also gabapentin and vigabatrin. Because being overweight can affect your health in the long run, you and your doctor should review your diet, monitor your weight and consider changing your epilepsy treatment if you are unhappy.

Acne and hirsutism (thicker, darker hair growth), and gum disease are side-effects which can occur with the medication phenytoin. Do talk them through with your doctor if you are unhappy about them.

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