Epilepsy and the 28-Day Cycle

By Sylvia Blair
between us staff
Posted: July 1, 2002

Every month, girlfriends confide in each other about the mood swings, fatigue and acne outbreaks that come with their periods. If only men had to go through this, they say!

Some women with epilepsy may have one more bothersome problem to worry about -- changes in their seizure patterns.

Thirty-eight year old Tricia Dalley, RN, BSN, of Gainesville, Ga., is a wife, mother, nurse and graduate student. She also has epilepsy.

Despite all she juggles, she has learned that the week before her period, she must slow down a little, get plenty of rest, take her medication religiously, and pay extra attention to her health to avoid having breakthrough seizures.

"The week before my period is a vulnerable time for me. I clock my menstrual cycle to the tee. I tune in to my body so I can master my epilepsy," she says.

"I can actually feel the changes in my seizure threshold start at the beginning of my period. I used to anticipate my period each month with dread. I used to fight and deny this. But now I realize that having to manage epilepsy along with my period is just part of the disorder," she says.

Thirty-five year old Melissa Bruesehoff of Warren, Mich., believes her hormones started affecting her epilepsy as a teenager and later in college.

"The later I stayed up and the harder I worked in school, my monthly cycle was affected. I started to see an increase in seizures," she says.

She told her doctor about her concerns, but he told her more research needs to be done in this area. He did not offer any advice about how to handle the monthly effects of her period on her seizures.

About 30 to 50 percent of women with epilepsy experience changes in seizures around the time of their periods. This is also known as catamenial epilepsy.

To better understand why this happens, it's important to understand the 28-day cycle, or menstruation. Every month, the lining of the uterus is shed and bleeding occurs. This begins at puberty and ends at menopause.

The first day of the bleeding is counted as the beginning of each menstrual cycle. The cycle ends just before the next menstrual period. Cycles range from about 21 to 40 days and can be divided into three phases: follicular, ovulatory, and luteal.

The follicular phase extends from the first day of bleeding to right before a surge in the level of a hormone that causes the egg to be released. The ovulatory phase occurs when the egg is released. The luteal phase follows ovulation and during this time, there is a rise in body temperature.

In women with catamenial epilepsy, seizures may occur shortly before menstruation, during and right after menstruation, or at the time of ovulation.

Why is this so?

The hormonal changes associated with the menstrual cycle are the most likely cause of changes in seizure frequency, but other factors may also be involved.

Studies have shown that estrogen can worsen seizures, whereas progesterone tends to act like more an anti-epileptic drug.

When women have regular menstrual cycles, doctors may recommend a slight increase in the dose of the antiepileptic drugs before the time of previously increased seizure frequency. Some physicians are studying the use of hormonal agents such as progesterone to treat women whose seizures appear to be linked to hormonal changes.

Other tips for women with catamenial epilepsy:

• Keep track of your menstrual cycle and of the days you have seizures.
• Keep track of other factors that may affect the menstrual cycle or seizure patterns, such as missed medication, loss of sleep, unusual fatigue, intense physical training, stress or an illness.
• Keep track of your lowest body temperature of the day. This helps to find out if you are ovulating regularly.
• Blood tests of certain hormone levels and of your seizure medication may provide helpful information for your health care team.

If you suspect that hormones play a role in your seizures, talk to your physician or nurse who helps monitor your seizures. It may be that a referral to a neuroendocrinologist will help. A neuroendocrine specialist is a neurologist with training in hormone disorders and their effects on brain function. This specialist is usually found at hospitals or health care centers with programs devoted to epilepsy treatment.