For Women
Women with epilepsy know that there are many gender specific issues related to epilepsy. Research has shown a direct link between hormones and seizures. A woman's hormone level will change during her periods, pregnancy and throughout menopause. These changes can effect when and how often a women has seizures, they have also been known to effect when a woman stops having seizures.
The Menstral Cycle
One third to one half of women with epilepsy will notice a pattern between their seizure freqency and their menstral cycle. This may well be attributed to changes in hormone levels. Estrogen and Progesterone are two hormones produced in a woman's body. Among many other things these hormones speed up and slow down brain cell activity which in turn changes the number of seizures experienced by some women. When estrogen levels are high and progesterone levels are low, the chances of having a seizure greatly increase.Catamenial Epilepsy
Some women only experience seizures during their menstral cycles, this form of epilepsy is called Catamenial Epilepsy. These seizures can be both embarrassing and hard to control so it is suggested that you speak to your doctor or neurologist about it to receive treatment. Other factors can increase seizure frequency during menstration such as alcohol, stress and lack of sleep. Some women find their seizures often happen just before or during their period and some may experience a higher rate of seizures after their menstral cycle.Oral Contraception
Women have a larger selection of birth control methods than ever before. As a woman living with epilepsy, it is important to choose a birth control method that does not interact with your AED's.The Pill
The Combined Oral Contraceptive Pill or "the pill" is commonly used around the world as the most effective form of birth control. For all women there are risk factors such as age, weight, smoking etc. but women living with epilepsy face other controllable risks. Some anti-epileptic dugs are enzyme-inducing meaning, they speed up the way the liver breaks down the pill. Having the pill broken down faster may reduce its effectiveness. Therefore it is imperative to choose a pill the is not enzyme-inducing. Remember: the pill is never 100% effective so it is always a good idea to use a back-up method such as a condom. The chart below shows which AEDS are enzyme-inducing (should be avoided) and non-enzyme-inducing:
Epilepsy drugs which do reduce the effectiveness of the Pill:
Enzyme-inducing drugs:
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Epilepsy drugs which do not reduce the effectiveness of the Pill:
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*Lamotrigine is a non enzyme-inducing drug but, unlike other enzyme-inducing drugs it can effect how well the contraceptive pill works and vice versa. This means both medications are reduced in effectiveness and should not be used together. Morning After Pill
Women taking enzyme inducing drugs will need to take a higher dosage (approximately 50%) of the morning after pill when compared to the standard dosage. It is advisable to check with you doctor about appropriate dosage levels to counteract the effect of your AED.
Fertility
Some studies have shown a slight decrease in fertility found in women who have epilepsy. Fortunately this effect is most often quite treatable through the use of fertility drugs. Using AED's does not prevent a woman from receiving fertility treatment. A few women will notice a marginal increase in the number of seizures they experince while taking fertility drugs.Pregnancy
There is no reason why a person with epilepsy cannot have a healthy and normal pregnancy. It is a good idea to talk to your doctor before conception to plan for the child and discuss your epilepsy and medications. Pre-conception counselling with your doctor and neurologist can be very helpful as women with epilepsy tend to have a slightly higher incidence of having a baby with a problem, which may be related to either AED's taken or the epilepsy itself.
It is important that you arrange a counseling appointment as soon as you become aware that you are pregnant.
Seizures during pregnancy
Approximately 50% of pregnant women with epilepsy notice an increase in the frequency and severity of their seizures, the other half notice no apparent change. The reasons cited for these changes are a dramatic shift in hormonal levels, changes in body fluid and salt retention and changes in the way the body absorbs, distributes and dilutes anti-convulsant drugs. These bodily changes usually return to normal around 3 months after delivery.As stated above these dramatic changes in metabolism have a great impact on the effectiveness of AED's and therefore, it is vitally important to visit a physician throughout pregnancy and 3 to 4 months postpartum. AED dosage levels must be monitored carefully and adjusted when necessary along with frequent blood level measurements.
Possible complications during pregnancy
Pregnant women with epilepsy that are pregnant are often identified as having "high-risk" pregnancies. Doctors feel that there is a greater chance of complications to both the mother and unborn fetus, therefore extra precautions should be taken throughout the pregnancy. There are several complications that can arise in some women during pregnanacy one of which is called eclampsia.
Placental problems figure more prominently in women with epilepsy. Premature separation of the placenta (abruptio placetae) may occurr, and the accompanying vaginal hemorrhage may severely inhibit the nutrition of the developing fetus.
Anti-Epileptic Drugs and pregnancy
Since all drugs present a possible danger to women during pregnancy, women must be aware of the risks posed by AED's. If you do become pregnant it is important not to discontinue your AED's, as the chances of having a seizure and injuring the baby (perhaps from a fall) will become much higher and out-weigh the risks of the drugs. Pregnant women not taking AED's but who were previously taking AED's for childhood epilepsy (but eventually outgrew it), have a 4 in 100 chance of having a child born with birth defects. Pregnant women controlling seizures through the use of AED's will have a 6 in 100 chance of having a child with a birth defect. In both cases, women with epilepsy have over a 90% chance of producing a perfectly healthy baby.
What is Epilepsy |
Living with Epilepsy |
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