Both men and women can suffer from epilepsy. However, this condition can affect women in particular ways which are beyond the scope of the condition itself.
What’s epilepsy?
Epilepsy is a disorder of the brain that causes seizures. Such a brain disorder can arise from various reasons, such as a stroke, brain tumor, head injury and infection in the brain or spine. There are many different kinds of seizures. The way a seizure looks depends on the type of seizure a person is experiencing. Some seizures can look like staring spells (called absence seizure). Other seizures can cause a person to collapse and shake (called tonic-clonic seizure); some people experience seizure while being aware of it, others don’t.
We wrote an article previously on what to do when someone has a seizure, read here.
How epilepsy and its treatment affects women?
Some issues around epilepsy and its treatment are specific to women and do not apply in the same way to men. These include the following:
Menstruation and fertility
Around 40% of women with epilepsy have reported worsening of seizures in relation to their periods. This is known as catamenial (menstrual) epilepsy. There are specific times within the menstrual cycle when women are more likely to develop seizure: in the days leading up to a menstrual period and during a menstrual period (perimenstrual or catamenial type 1 pattern); at the time of ovulation (catamenial type 2 pattern); and in the second half of their cycle (luteal phase, or catamenial type 3 pattern). On the other hand, some women with epilepsy find that their periods don’t follow a regular pattern, or happen very rarely.
The reason for such menstrual disturbance may relate to changes in the levels of progesterone (a hormone released by the ovaries) around the time of a menstrual period and oestrogen (a female sex hormone) surge around ovulation.
The abnormal menstrual cycle length among women with epilepsy gives rise to another issue: infertility. Epilepsy leads to disturbances of hormones such as luteinizing hormone while also disrupting the function of the ovary, leading to a reduced fertility rate among women with epilepsy. Sodium valproate, an anti-epileptic medication, is also known to contribute to dysfunctional ovarian hormone release and increases risk of polycystic ovaries, a condition that reduces fertility. With that being said, we shall not ignore the other social factors to this observation: lower birth rates may reflect some of the social and psychological pressures experienced by women with epilepsy. Misinformation about epilepsy (e.g. epilepsy can be transmitted to children) also fuels many of these fears.
Contraception
On the other hand, women with epilepsy who are receiving both anti-epileptic and oral hormonal contraceptive treatments may experience a higher failure rate in preventing pregnancy. This is because many types of anti-epileptic medications can affect the metabolism of oral contraceptives in the liver by inducing metabolizing enzymes, thus reducing the effectiveness of oral contraceptive pills and may lead to unwanted pregnancy.
This type of anti-epileptic medications is known to be enzyme-inducing. Here are some examples of enzyme-inducing anti-epileptic medications (may reduce efficacy of oral contraceptive pill):
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Carbamazepine (Tegretol)
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Phenytoin (Dilantin)
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Phenobarbital
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Primidone (Mysoline)
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Oxcarbazepine (Trileptal)
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Topiramate (Topamax)
Such reduction in the effectiveness of contraception also applies to other forms of hormonal contraception, such as subdermal levonorgestrel implants (an implant that is placed under the skin of a woman’s arm to release the hormone at a constant rate). As a result, the general consensus is that women taking enzyme-inducing antiepileptic drugs should use non-hormonal methods of contraception (such as condom) or receive hormonal contraceptives containing higher doses (50 mcg or more) of the estrogenic component. However, higher doses of estrogenic oral contraceptive pills may carry higher rates of side effects and other health risks.
There are other types of non-enzyme-inducing anti-epileptic medications (do not reduce oral contraceptive pill efficacy):
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Gabapentin (Neurontin)
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Levetiracetam (Keppra)
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Lamotrigine (Lamictal)
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Tiagabine (Gabitril)
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Valproate (Depakote)
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Zonisamide (Zonegran)
Do not change your antiepileptic medications without consulting your doctor first.
For part 2 of this article, we will cover how epilepsy affects women who wish to plan for pregnancy, pregnant and breastfeeding women.
Stay tuned!
A word from DOC2US
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References
Cover image credit: Image by Gerd Altmann from Pixabay
