Women & epilepsy

Women and girls with epilepsy have some health needs that are different from men's, because hormones, seizures, and anti-seizure medications (ASMs) can all affect one another. The Epilepsy Foundation's checklist for women covers the whole span of life: the pre-teen and teen years, the childbearing years, pregnancy, and the years beyond childbearing — including perimenopause and menopause.

One big theme is the possible link between hormones and seizures. The checklist encourages tracking your seizures alongside your menstrual cycle to spot any relationship, tracking other possible triggers like missed sleep or illness, and asking your care team about how hormones and epilepsy may affect each other. It also notes that hormone shifts during perimenopause and menopause can affect seizures and medications, which is why regular check-ins with your epilepsy team matter at every age.

Birth control deserves special attention. The Epilepsy Foundation notes that some ASMs — including phenytoin, carbamazepine, oxcarbazepine, and perampanel — can make hormonal birth control less effective, raising the risk of an unplanned pregnancy, and that birth control with estrogen can lower the level of lamotrigine in the body. None of this means good options don't exist — the checklist notes that long-acting methods like an IUD may be an option if your ASM interacts with hormonal birth control — but it does mean your neurologist should always know what birth control you use, and vice versa.

Many women with epilepsy plan for and have healthy pregnancies — the checklist focuses on lowering risks to mother and baby through preparation. It emphasizes getting the best possible seizure control before pregnancy, taking folate (folic acid) as your care team directs, never stopping or changing medication on your own, and telling your epilepsy team right away when you become pregnant so medication levels can be monitored. It also covers what comes after: the Epilepsy Foundation notes that breastfeeding is safe for women taking most ASMs, and there are practical tips for caring for a newborn safely.

Bone health is the other lifelong thread. Some seizure medications can affect bones over time, so the checklist recommends talking with your care team about diet, exercise, and — later in life — bone density monitoring and vitamin D or calcium if needed. The materials below are educational, not medical advice; use them as a starting point for conversations with your neurologist and, when relevant, your obstetrician.