Epilepsy and Your Changing Hormones

Medically Reviewed by Carol DerSarkissian, MD on July 13, 2023
4 min read

Women with epilepsy face different issues than men with epilepsy. For some women, the pattern of epileptic seizures is directly affected by the normal hormonal cycles they experience throughout their lives.

Two primary sex hormones flow through women's bodies. One is estrogen and the other is progesterone. Most of the time, your body has about the same amount of each.

What does that have to do with epilepsy? Doctors have learned that both of these hormones interact with brain cells. Estrogen is an "excitatory" hormone, which means that it makes brain cells give off more of an electrical discharge. Progesterone, on the other hand, is an "inhibitory" hormone, which means that it calms those cells down.

When the body is making more estrogen than progesterone, it can make the nervous system "excitable." In other words, you could be at greater risk for seizures. The hormones aren't actually causing the seizures, but they can influence when they happen.

Some women with epilepsy have more seizures when their hormones are changing. For example, some young women have their first seizures at puberty. Other women have more seizures around the time of their menstrual periods. This doesn't happen to all women, so doctors are still learning about how hormones and epilepsy interact.

Some women have a form of epilepsy called catamenial epilepsy. This refers to seizures that are affected by a woman's menstrual cycle. Doctors aren't completely sure how many women with epilepsy have this, but they think it's about 10% to 12%.

The exact cause of these seizures is unknown. However, some women have most of their seizures when there is a lot of estrogen in their body, such as during ovulation. Other women have seizures when progesterone levels tend to drop, such as right before or during their period.

If you have seizures that start around the last half of your menstrual cycle and continue through the second half of your cycle, then you might have another type of catamenial epilepsy. This is when a woman has menstrual cycles that do not release an egg. These are called "anovulatory" cycles.

Women with epilepsy have more anovulatory cycles than other women do. Some doctors think that as many as 40% of menstrual cycles in women with epilepsy do not release an egg. It depends on the woman, and it is not always the same every month. Some months a woman will release an egg, and some months they will not. In general, though, women with epilepsy do not ovulate as regularly as women without epilepsy.

Why is that? Doctors do not know for certain. But, some seizures start in the temporal lobes of the brain. This is an area that is very closely connected to the areas regulating hormones. Women who have seizures that start in the temporal lobes may have their hormone production affected by their seizures.

If you can identify the role hormones play in your seizure patterns, it can help with your treatment. Try keeping a calendar of your menstrual cycle, and the days that you have seizures. Include notes about other factors that might be important, such as missed medication, sleep loss, stress, or illness. By sharing these records with your doctor, you can work together to manage your epilepsy more effectively.

As you've already learned, many people develop their first seizures when they enter puberty. This happens to both men and women. Doctors think this is because before puberty we don't have many sex hormones circulating in our body. After puberty there are many more hormones in the body. Hormones have a direct effect on the cells of the brain.

Does that mean that a woman's seizures might go away when they reach menopause? Sometimes, but not always. In some women, seizures do seem to just disappear. This usually happens in women who have catamenial epilepsy. For other women, menopause doesn't seem to make a difference in their seizures. And still other women have worse seizures during menopause.

Most of the time, though, doctors say that seizures become easier to control as you get older. They are not sure if that's because the seizures themselves are decreasing, or because newer medications are now available that control epilepsy better than in the past.

Keep in mind that some types of anti-seizure medications can cause bone loss when taken over a long period of time. Since osteoporosis is a particular problem for women who have reached menopause, this would be a good time to talk with your doctor about your medication and what you can do to help prevent osteoporosis. On the whole, it's best to build strong bones early in life -- in your 20s and 30s -- and not wait till you're close to menopause when some of your bone strength may have already been lost.