Menopause and Epilepsy

Menopause and Epilepsy

Menopause and epilepsy is an intricate subject. For women with epilepsy, the menopause can pose unique challenges, as the fluctuating levels of hormones, particularly oestrogen, may influence seizure activity. Additionally, the interaction between antiepileptic drugs (AEDs) and hormone therapy warrants careful consideration for effective management.

Understanding Menopause and Epilepsy

During menopause, the ovaries gradually decrease their production of oestrogen and progesterone, leading to the cessation of menstrual periods. These hormonal fluctuations can impact various bodily functions, including neurological processes, potentially affecting seizure thresholds in women with epilepsy.

Dr. Hobson, Clinical Lead Director at The Menopause Consortium, notes that the hormonal changes during menopause can increase the likelihood of seizures. Fluctuating oestrogen levels may destabilise brain activity, triggering epileptic episodes in susceptible individuals. As a result, women with epilepsy may experience more frequent or severe seizures during this transitional phase.

Managing Epilepsy During Menopause

Managing menopause and epilepsy requires a comprehensive approach that considers both hormonal changes and the effects of antiepileptic medications. A key aspect of this management involves understanding how Anti-epileptic drugs (AEDs) interact with hormonal therapies commonly used to alleviate menopausal symptoms.

One such AED is lamotrigine, commonly prescribed to control seizures. Lamotrigine is known to be influenced by hormonal fluctuations, particularly oestrogen levels. During menopause, changes in oestrogen can affect the metabolism of lamotrigine, potentially altering its efficacy. Therefore, it becomes essential to monitor lamotrigine levels closely and adjust dosage as needed to maintain optimal seizure control.

Hormone Therapy and Lamotrigine Interactions

For women experiencing menopausal symptoms such as hot flashes, vaginal dryness, or mood disturbances, menopause hormone therapy (MHT) may be recommended. MHT involves the use of oestrogen, often in combination with progestin, to alleviate these symptoms and improve overall quality of life.

However, the use of MHT in women taking lamotrigine requires careful consideration due to potential drug interactions. Oestrogen can induce the hepatic enzymes responsible for metabolising lamotrigine, leading to increased clearance of the drug from the body. As a result, blood levels of lamotrigine may decrease, compromising seizure control.

Dr. Hobson emphasises the importance of close monitoring when initiating hormone therapy in women with epilepsy. Regular assessment of lamotrigine levels is necessary to ensure that therapeutic concentrations are maintained. Depending on the individual’s response, adjustments to lamotrigine dosage may be needed to offset the effects of oestrogen on drug metabolism.


Menopause presents unique challenges for women with epilepsy, as hormonal fluctuations can influence seizure activity. Understanding the interplay between menopausal hormones, antiepileptic medications, and hormone therapy is crucial for effective management. Close collaboration between patients, neurologists, and menopause specialists is essential to tailor treatment strategies that optimize seizure control while addressing menopausal symptoms. With careful monitoring and personalized care, women with epilepsy can navigate through menopause with confidence and minimal disruption to their overall health and well-being.