21 October 2020 Authors : Ana Catarina Franco e Carla Bentes There are several issues related to epilepsy and its treatment that are particular to women . These questions are related to: Sex hormones (estrogen and progesterone); Contraception; Pregnancy and breastfeeding; Menopause Sex hormones In some women with epilepsy there may be a greater influence of sex hormones on epileptic seizures. The main natural hormones produced in a woman's body are estrogens and progesterone. The levels of these hormones vary throughout the menstrual cycle. Certain women have epileptic seizures only or more frequently during menstruation. Thus, in women it is important to keep a crisis diary so that the neurologist can better understand the variations present and that can influence the treatment to be performed. Contraception There is currently a wide variety of contraceptive methods. Hormonal contraceptive methods, such as the contraceptive pill, may have interactions with some antiepileptic drugs, namely: Levels of anti-epileptic drugs in the blood may increase or decrease, which may decrease their effectiveness or increase adverse effects; The effectiveness of contraception may be less and an unplanned pregnancy may occur A woman taking anti-epileptic drugs should always do family planning and consult her doctor about the best contraceptive method to use. Barrier methods, such as condoms, do not interact with antiepileptic drugs and their effectiveness remains. Pregnancy In women with epilepsy, pregnancy should always be planned . The influence that epileptic seizures and anti-epileptic drugs can have on pregnancy varies from woman to woman. Therefore, women who have epilepsy and are planning to become pregnant should consult their neurologist so that, if necessary: Adjust the medication; Know and understand the possible effects of medication on pregnancy; Are referred to an obstetrics consultation. Breast-feeding Some antiepileptic drugs may be present in breast milk. However, for many antiepileptic drugs, this does not mean that there may be harmful effects for babies. A woman with epilepsy who intends to breastfeed should discuss this issue with her neurologist so that he can inform her and clarify all her doubts. Menopause During menopause, estrogen and progesterone levels change. However, the relationship between these changes and the frequency of epileptic seizures is not linear. Globally, postmenopausal women have the same frequency and severity of epileptic seizures as younger women. However, at the individual level, the evolution of epilepsy with menopause is difficult to predict. There is evidence indicating that women with epilepsy whose seizures occur at the time of menstruation may have fewer seizures after menopause, but more seizures near the time of menopause. For most women with epilepsy, only time (wait-and-see) can show how the epilepsy will develop. Monitoring by a neurologist is important to clarify all your doubts and adjust your medication, if necessary. Meet the neurology team of Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
