Authors :
Presenting Author: Aisha Abdulrazaq, MD – University of Minnesota
Gloria Ortiz-Guerrero, MD – Mayo Clinic Rochester
Ekta Kapoor, MD – Mayo Clinic
Stephanie Faubion, MD – Mayo Clinic
Kelsey M. Smith, MD – Mayo Clinic, Rochester MN, USA.
Rationale:
Hormonal fluctuations across a woman's reproductive lifespan can significantly influence seizure patterns in women with epilepsy (WWE). While the effects of menarche and pregnancy are well documented, the impact of perimenopause, menopause, and menopausal hormone therapy (MHT) remains underexplored. Given the increasing life expectancy of women, understanding how these mid-life hormone changes affect seizure control is crucial for optimizing care in WWE.Methods:
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched included PubMed and Scopus from inception through December 2024 for English-language studies involving FWE diagnosed prior to menopause and reporting on seizure outcomes during perimenopause, menopause, or MHT. Case reports, animal/basic science studies, reviews, and articles without full text were excluded. Two independent reviewers screened titles, abstracts, and full texts to identify relevant studies.
Results:
Of 372 records, four studies (totalling 369 women) met inclusion criteria: one study (survey) focused on menopause and seizure frequency, one randomized control trial (RCT) analysed MHT use, and two (surveys) examined both menopause and MHT effects on seizure frequency. Findings indicated that 31–64% of WWE reported worsening seizures during perimenopause. Postmenopausal seizure patterns varied, with some women experiencing improvement (up to 41%) and others reporting worsening. Regarding MHT-use, estrogen-only therapy was associated with increased seizure frequency, while combined estrogen-progestogen (E-P) therapy showed neutral or beneficial effects. The randomized controlled trial demonstrated that E-P MHT led to a dose dependent (increases in E-P) seizure increase.
Conclusions:
Perimenopause and menopause are universal experiences for midlife women, with hormonal changes critical periods that may significantly impact seizure control in WWE. There is a paucity of data regarding seizure control during the menopause transitions as well as with MHT use. Given the limited and varied data, further high-quality studies are essential to elucidate the effects of hormone changes and to guide MHT use in this population. Such research will inform clinical decisions and improve management strategies for midlife WWE undergoing menopausal transitions.
Funding: N/A