EPILEPSY AND YOUR LIFESTAGE
Women and Epilepsy
For women with epilepsy, many issues arise over their lifespan.
Young woman may have concerns regarding menstruation and seizure control and as you discover your sexuality there may be concerns about forming relationships and whether your epilepsy will affect sexual function and your ability to have children. As the prospect of being a parent approaches you may have concerns about passing your epilepsy on to your future children, being a mother with epilepsy and caring for your child. And as your biological clock ticks over and menopause approaches you may have concerns about the effect it may have on your epilepsy.
Many of these concerns are dealt with here, however, it is important that at all stages of your life you discuss emerging issues with your neurologist, gynaecologist or obstetrician.
You can also find assistance and guidance at the Epilepsy Foundation of Victoria.
Menstruation
Menstruation usually begins between the ages of 8 and 18. Physical changes occur within our body throughout our life. There is no evidence that epilepsy interferes with the onset of menstruation.
At the onset of menstruation seizures in some girls may increase. However, in both sexes epilepsy can disappear at puberty. There are no clear reasons why this happens. Other people develop epilepsy in adolescence. Some women find that their seizures seem to occur just before their period or during it.
Seizure patterns that are linked to the menstrual cycle are known as catamenial epilepsy. Those women who experience catamenial epilepsy also find they experience seizures at any time but their seizures are more likely to occur around the time of menstruation. There is still no clear explanation of why this happens. It may be due to changes in hormone levels and antiepileptic medication levels, fluid retention and possible premenstrual tension. Premenstrual Syndrome (PMS) occurs in some women with symptoms such as irritability, tiredness, depression, hostility and aches and pains.
Keeping a record of your seizures may help identify a relationship between seizure frequency and menstruation and assist your neurologist in formulating a suitable treatment plan. Some women may benefit from taking additional medication in the week before their menstrual period and this option should be discussed.
Intimate relationships and sex
Epilepsy should not stop a person from having an intimate relationship and enjoying sexual intercourse. There is some evidence to suggest that the sex drive (libido) is reduced in a minority of people with epilepsy and also that some medications reduce sex drive.
If you are concerned about reduced libido or are experiencing sexual difficulties talk to your doctor. An epilepsy counsellor at the Epilepsy Foundation of Victoria can also help, or get you the help that you could need.
Can sexual activity provoke seizures?
The answer is that it is unlikely to do so, yet feeling anxious during such intimate moments is understandable. Seizures often involve the same areas of the brain that are important to maintaining healthy sexual function and some of the sensations felt during lovemaking can be similar to those experienced during auras or simple partial seizures.
Confide in your partner how you feel and why you may seem apprehensive about taking the relationship to a more intimate level. An understanding partner will reassure you that everything will be okay. An active and fulfilling sex life is an important part of all loving relationships.
Contraception and AEDs
Women with epilepsy may use all the usual methods of contraception. Your neurologist, gynaecologist or general practitioner can help you decide what is the best form of contraception for you. The most popular form of contraception is the contraceptive pill.
Some antiepileptic medication can affect the metabolism of the pill and make it less effective. These drugs are known as 'enzyme inducers'. Antiepileptic Drugs that are enzyme-inducers include: carbamazepine (Tegretol), phenobarbitone, phenytoin (Dilantin), primidone (Mysoline) and topiramate (Topamax). For women who are taking any of these antiepileptic medications and wish to use the pill, it is recommended that they start on a pill that contains 50 micrograms of oestrogen.
Antiepileptic Drugs, which are not enzyme-inducers, include: clobazam (Frisium), ethosuximide (Zarontin, gabapentin (Neurontin), lamotrigine (Lamictal), sodium valproate (Epilim), tiagabine (Gabitril) and vigabatrin (Sabril). A low dose pill may be effectively used with these drugs.
Breakthrough bleeding between periods may occur in women who are taking enzyme-inducing drugs. This may indicate that the oestrogen dose is not high enough. Other contraceptive precautions should be used and your neurologist notified, as he may need to increase your oestrogen dose. As your body eliminates the pill quickly, there will be no increased risk of side-effects from the higher dose. Your neurologist will also take into account other factors that may influence you taking the pill such as age, obesity and the heavy use of tobacco products.
The oral contraceptive pill will be suitable for most women with epilepsy. In a very small minority of women, however, it may make seizures worse. Remember you have a wide range of options available to you. Please discuss these with your neurologist.
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Menopause
Menopause generally has little influence on seizure frequency. Some women may experience an increase in seizure frequency due to hormonal changes. Others may find that their seizures improve or disappear at this time, particularly if their seizures coincided with the premenstrual period and sometimes with pregnancy. Epilepsy can develop at any stage of life and some women will develop epilepsy at this time.
Natural menopause occurs most commonly between the ages of 45 and 55 years but it may occur earlier or later. The most common symptoms associated with menopause are hot flushes, sweating, palpitations, depression, fatigue, headache and sleeping difficulties.
Hormone Therapy (HT) containing the sex hormone oestrogen may be recommended to relieve some of these symptoms. For most women with epilepsy HRT may be very beneficial. It can, however, make seizures worse for a small minority of people. If this occurs contact your doctor for advice.
Supplementary oestrogen may also be prescribed to prevent loss of calcium, which causes thinning of the bones and, if severe, is called osteoporosis. The bones become increasingly brittle and liable to break more easily. If seizures are a problem this can then be a hazard.
Contact your neurologist, gynaecologist or general practitioner for further information to help you through this time.
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Support Nyah and families just like hers by donating to our Christmas Appeal. We need to raise $181,000 to support programs like our emergency medication training.
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