Many seizures can be traced to certain triggers. In the case of catamenial epilepsy in women, the trigger is their menstrual cycle. It is estimated that approximately 10-12% of women who suffer from epilepsy experience catamenial epilepsy around the time of the menstrual cycle. Women with epilepsy who are sensitive to hormonal changes may experience this subset of epilepsy. The seizures tend to increase during ovulation and one week before menstruation begins.
The Epilepsy Foundation explains it is likely that catamenial epilepsy occurs from the rise and fall of certain hormones like estrogen and progesterone. These fluctuations affect the brain and higher levels of estrogen can cause a sense of “excitability” in the cells. High doses of estrogen have been seen to cause seizures in animals during research studies. Progesterone, an “inhibitor” hormone helps to calm these cells down. Progesterone should keep seizures from occurring, but the patient may be suffering from low levels of the hormone or has an imbalance of the two. Hormones do not cause the seizures, but they do influence them.
Many seizures start in the temporal lobe of the brain, which also is close to the area that regulates hormones. Physicians are unsure what the direct correlation may be, however hormones do elicit changes in brain cells.
Sex Hormones Estrogen and Progesterone Stabilize Brain Cells
The two sex hormones in women that affect brain cells are estrogen and progesterone. When in equal amounts in the body, the hormones balance each other out and the system works in harmony. However, when estrogen is too high, progesterone has dropped too low, or some type of imbalance has occurred, the brain cells will receive different signals. When the cells become over stimulated, a seizure may occur.
Estrogen is the female sex hormone that influences puberty, monthly menstruation, lactation, mood and the aging process. The levels of estrogen decrease with age.
Progesterone is another sex hormone that prepares the uterus to receive and support fertilized eggs. At a normal level, progesterone will keep seizures at bay by stabilizing brain cells.
Managing Catamenial Seizures
You may be able to help decrease the risk of a having a catamenial seizure by adding or altering medications. Do not add or make any of these changes without your doctor’s recommendation:
- Your neurologist may recommend an increase in anti-seizure medications before menstruation begins.
- Alternately or additionally, your doctor may prescribe an additional anti-seizure medication (like lorazepam) to add to your regime. It should be taken only taken a few days before and during menstruation as prescribed.
- Some physicians advocate taking progesterone or birth control pills. Studies have been inconsistent about whether adding birth control pills can actually help decrease catamenial seizures.
In addition, these measures can be taken without any harm.
- Decrease water retention during the cycle by drinking plenty of water to flush out any toxins.
- Women should consider tracking their menstruation cycle, noting the days when the additional medication is taken (if prescribed) and noting any additional triggers.
- It is important to be diligent about consistently taking your medication.
- Avoid any known triggers.
Consult your neurologist if the you suspect you are experiencing catamenial epilepsy. If your doctors prescribes additional medications, follow the advice above and avoid any triggers as much as possible during the menstrual cycle.
Keep track of your menstrual cycles and seizure activity on our Seizure Tracking Sheet. Your doctor may see patterns that can be treated.
Epilepsy Foundation http://www.epilepsy.com/learn/triggers-seizures/menstruation