The effect of menopause and perimenopause on the course of epilepsy

Purpose: The purpose of this study was to obtain preliminary information ab out the effect of menopause and perimenopause on the course of epilepsy, an d to determine whether seizure type, use of hormone-replacement therapy (HR T), or a history of catamenial seizure pattern would influence this course. Methods: We performed a questionnaire study of women with epilepsy currentl y in menopause and perimenopause, requesting information regarding the cour se of their epilepsy and treatment. Statistical analysis was performed by u sing Pearson chi(2) With 95% confidence limits. Results. Forty-two menopausal women (ages 41-86 years) responded. Twelve su bjects reported no change in seizures at menopause, 17 reported a decrease in seizure frequency, and 13 reported an increase. Sixteen (38%) took synth etic HRT. Sixteen (38%) additional subjects (having some overlap with the H RT group) reported having a catamenial seizure pattern before menopause. HR T was significantly associated with an increase in seizures during perimeno pause (p = 0.001). A history of catamenial seizure pattern was significantl y associated with a decrease in seizures at menopause (p = 0.013). Thirty-n ine perimenopausal women (ages 38-55 years) responded. Nine subjects report ed no change in seizures at perimenopause, five reported a decrease in seiz ure frequency, and 25 reported an increase. Fight (15%) subjects took synth etic HRT, and 28 (72%) reported having a catamenial seizure pattern before menopause, HRT had no significant effect on seizures; however, a history of catamenial seizure pattern was significantly associated with an increase i n seizures at perimenopause (p = 0.02). Conclusions: These pilot data suggest that synthetic HRT may be associated with an increase in seizure frequency in menopausal women with epilepsy. A catamenial seizure pattern may be associated with seizure decrease during m enopause but with an increase during perimenopause.