Women with epilepsy report increased seizure frequency with perimenopause . Thirty-nine women with epilepsy in perimenopause, as manifested by irregular menses and hot flushes, were surveyed regarding change in seizure frequency as they became perimenopausal. Most of the women (63%) reported an increase in seizure frequency as they became perimenopausal, although their medication had not been changed. Women who had a history of a catamenial seizure exacerbation, specifically pre-menstrual increase in seizure frequency, had an even greater risk for increased seizure frequency during perimenopause (Figure 9.1). Conversely, women with a catamenial seizure pattern were more likely to have a decrease in overall seizure frequency when they became postmenopausal, defined as 1 year without menses . This change in seizure frequency during these life changes may be related to hormonal changes during perimenopause and menopause, specifically a relative increase in the oestrogen:progesterone ratio in early perimenopause. These findings indicate that for women with epilepsy, perimenopause is a life epoch that merits careful monitoring for seizure change and, if necessary, medication adjustment. Furthermore, at postmenopause, women with catamenial epilepsy exacerbations may experience a decrease in seizures.
The Women's Health Initiative (WHI) reported in 2002 that hormone replacement therapy (HRT) in the commonly used form of conjugated equine oestrogens and medroxyprogesterone acetate was associated with an increased risk for breast cancer and stroke . These results
No change Catamenial pattern
Figure 9.1 Seizure patterns in perimenopausal women with epilepsy . *Significantly associated with an increase in seizures (P=0.02).
were surprising in the light of the long use of this compound, effective in the treatment of both the vasomotor symptoms ('hot flushes') and vaginal dryness associated with menopause. After a survey in which women with epilepsy reported an increase in seizures with HRT use , a randomized, double-blind, placebo-controlled trial using two dosages of conjugated equine oestrogens and medroxyprogesterone acetate was performed to evaluate the effect of HRT on seizure frequency . This study found a dose-related increase in seizure frequency during the treatment period compared with baseline among women with partial epilepsy. Therefore, women with epilepsy have a risk of increased seizure frequency with the use of this standard HRT regimen. For women with epilepsy experiencing menopausal symptoms, a brief intervention of HRT using estradiol with natural progesterone would be an alternative treatment, although the safety of this alternate regimen has not been specifically evaluated.
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