Abstracts

Understanding the menopause is important for healthcare providers assessing risks in patients with chronic diseases. There is growing interest in the interaction between menopause and seizure control. Furthermore, bone health has become a concern for persons with epilepsy maintained on antiepileptic drugs. Menopause increases this risk even more in women with epilepsy (WWE). The mean age of menopause in the general population is approximately 52 and has remained fairly stable over the decades. The effect of epilepsy on age of menopause has not been widely studied. This is a cross-sectional study examining the age of menopause in a group of middle-age WWE at MINCEP[reg] Epilepsy Care.
All women ages 40-60 years seen at MINCEP Epilepsy Care from 5/02 to 3/03 were given a questionnaire about their menstrual history (255). Twelve refused to participate. Others were excluded if they had surgical menopause (47), were on Depo-Provera (9), had a history of non-epileptic events only (10), or answered the questionnaire inadequately (7). Women on hormone replacement therapy or oral contraceptives were included. One hundred seventy women (age 40-60, mean 47.5[plusmn]5.23) were included in the study and were classified as premenopause (PREM, regular monthly menses), early menopause transition (EMT, irregular menses but had 1 in last 3 months), late menopause transition (LMT, irregular menses but had 1 in last 4-12 months), or postmenopause (POSTM, no menses for [ge] 12 months). Age of menopause was determined as age of last menses. Medical records were reviewed for possible contributing factors to early menopause: epilepsy syndrome, age of seizure onset, seizure types, seizure frequency in the last 1 year, and etiology.
Eighty-six women (50.5%) were PREM (mean age 44.6[plusmn]3.4), 16 (9.4%) were in EMT (45.8[plusmn]3.1), eleven (6.5%) were in LMT (mean age 46.8[plusmn]4.2), and 57 (33.5%) were POSTM (mean age 52[plusmn]4.8). Age of menopause ranged from 25-56, mean 45.9 (95% confidence interval 44.3-47.6). Age of menopause among the 57 patients was compared to mean age of menopause (51.3) from a large cohort of women (2750) from Massachusetts (McKinlay, et al., [underline]Maturitas[/underline], 1992:103-115). Using student t-test statistics, menopause was significantly earlier for our patients (p[lt]0.001). Student t-test was used to determine which variables contributed to early menopause. Menopause occurred at a significantly earlier age in patients with generalized tonic-clonic seizures (43.8[plusmn]6.6) than those with other seizure types (48.0[plusmn]4.7), (p=0.011).
This study demonstrates WWE are more likely to experience early menopause than women in the general population, but factors which may affect this are yet to be determined. The association of generalized tonic-clonic seizures with early menopause may suggest effect of seizure severity. A prospective study with larger sample size is much needed to examine other possible contributing factors to early menopause in WWE.
[Supported by: MINCEP[reg] Epilepsy Care]