Effects of menopause on seizures in women with epilepsy

Purpose: Although important associations between epilepsy and women's hormo nal phases are described, the relation of menopause to epilepsy has receive d little attention. Methods: By using a structured interview, we studied menopausal women with epilepsy seen at the University of Maryland Epilepsy Center over a 1-year p eriod from 1994 to 1995. We analyzed the characteristics and temporal relat ion of the seizures to menopause and compared the frequency and severity of the seizures with those in a similar group of premenopausal women. Results: We identified 61 menopausal women (46 who were postmenopausal and 15 perimenopausal) and compared them with 46 premenopausal women. No statis tically significant differences were noted in either the frequency or the s everity of seizures comparing all menopausal or only postmenopausal with pr emenopausal women. However, 12 (20%) of the 61 menopausal women noted that their seizures first began during or after menopause, with eight having no proven cause for their seizures. Many individual women described changes in their seizures with menopause. Among the 61 menopausal women, 49 had estab lished epilepsy before the onset of menopause, and 20 (41%) reported worsen ing of their seizures with menopause, 13 (27%) noted improvement, and 16 (3 3%) described no changes. These observations were similar for peri- and pos tmenopausal women. Of the 15 menopausal women taking hormone replacement th erapy, the six taking progestin were significantly less likely to report wo rsening of their seizures. Conclusions: These findings support the view that hormonal influences are i mportant in women with seizures. Although, in aggregate, menopausal (combin ed perimenopausal and postmenopausal) and postmenopausal women's seizures w ere similar in frequency and severity to those of other women, menopause wa s associated with changes in seizures for some women. Moreover, menopause m ay be a previously unrecognized factor for some new-onset seizures. The rel ations between menopause and epilepsy deserve to be more fully investigated .