Epilepsy affects more than 3 million women in the United States, and yet many are unaware that their hormones may be influencing their seizures. From puberty to pregnancy and menopause, a woman’s body goes through major hormonal shifts that can significantly affect epilepsy management.
This Women’s Health Month, experts with Baptist Health Miami Neuroscience Institute highlight what every woman living with epilepsy should know — and how they can take control of their health.
Understanding the Hormone-Epilepsy Connection
For many women with epilepsy, seizure patterns can change during specific phases of their menstrual cycle — a condition known as catamenial epilepsy. This is due to the natural rise and fall of estrogen and progesterone, two hormones that can either lower or raise the brain’s seizure threshold.
“Estrogen can increase brain excitability, which may make seizures more likely by lowering the seizure threshold, while progesterone has the opposite effect,” explains Natalia Rincon Buendia, M.D., MPH, neurologist at Baptist Health Miami Neuroscience Institute. “That’s why some women may notice more frequent seizures around ovulation or around their period.”
Tracking seizure activity in relation to the menstrual cycle can be a powerful tool. Dr. Rincon Buendia recommends that women keep a seizure diary, noting when seizures occur and how they relate to their cycle. “This helps us tailor treatment more precisely,” she says.
Birth Control and Anti-Seizure Medications: What to Know
Some anti-seizure medications can interfere with the effectiveness of hormonal birth control, putting women at risk for unintended pregnancy.
“It’s critical that women understand this interaction,” says Dr. Rincon Buendia. “We always discuss contraceptive planning with our patients to ensure both seizure control and reproductive safety.”
Conversely, some hormonal contraceptives can alter the levels of seizure medications in the bloodstream. The good news? There are multiple options, and a neurologist can work closely with a gynecologist to find the best solution for each woman.
Planning for Pregnancy with Epilepsy
Pregnancy is possible for women with epilepsy. But careful planning is essential.
“We want to make sure that women are on the safest medication at the lowest effective dose before conception as some medications carry a higher risk of congenital defects,” says Dr. Rincon Buendia. “Some anti-seizure medications can carry a higher risk of birth defects, so we work closely with obstetricians to monitor the health of both mother and baby.”
Women with epilepsy are encouraged to take prenatal vitamins with folic acid, even before they start trying to conceive, as it may help reduce the risk of complications.
Menopause and Shifting Seizure Patterns
Later in life, menopause brings another wave of hormonal changes. For some women, seizures may improve after menopause — for others, they may worsen.
“There’s no one-size-fits-all answer,” says Dr. Rincon Buendia. “That’s why ongoing follow-up with your neurologist is so important as adjustments to medications may be needed.”
Neuromodulation for Difficult-to-Control Seizures
For women whose seizures don’t respond well to medication — a condition known as pharmacoresistant epilepsy — new hope exists in the form of neuromodulation therapies, such as vagus nerve stimulation (VNS) or responsive neurostimulation (RNS).
“These therapies don’t cure epilepsy, but they can reduce the frequency and severity of seizures when medications aren’t enough,” explains Dr. Rincon Buendia. These options are particularly valuable for women navigating life stages where medication changes may be complex or risky.
Empowering Women Through Awareness
Too often, women’s unique needs in epilepsy care are overlooked — but that’s changing, thanks to specialists who understand the intricate interplay between neurology and women’s health.
Natalia Rincon Buendia, M.D., MPH, neurologist at Baptist Health Miami Neuroscience Institute
“My passion is helping women live full, empowered lives while managing epilepsy,” says Dr. Rincon Buendia. “With education, planning, and personalized care, we can make that possible.”
