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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Menstrual disorders in women with epilepsy

From the Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Wellesley, Massachusetts.

Address correspondence and reprint requests to Dr. Andrew G. Herzog, Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, 422 Worcester Street, Suite 303, Wellesley MA 02481; email: aherzog{at}bidmc.harvard.edu

Women with epilepsy are more likely to have menstrual disorders than women in the general population. Estimates vary because of different definitions of menstrual disorder. Our best estimate is that perhaps one of every three women with epilepsy may be affected compared with one of seven in the general population. Menstrual disorders are significant because they are associated with anovulatory cycles that may increase the risks for infertility, migraine, emotional disorders, and female cancers. They are neurologically important because they are associated with greater seizure frequency. Increasing evidence implicates both epilepsy itself and antiepileptic drug (AED) use as causal or contributory factors. These factors can alter reproductive hormone levels and promote the development of reproductive endocrine disorders, especially polycystic ovarian syndrome (PCOS). Among AEDs, valproate has been associated with the development of characteristic PCOS features. The risk appears to be particularly high when valproate use is started in childhood or adolescence. Menopause tends to occur earlier in women with epilepsy, especially in the setting of a high lifetime number of seizures and lifetime use of multiple enzyme-inducing AEDs. The intricate relationship between reproductive disorders and epilepsy suggests that reproductive function should be monitored closely as part of the comprehensive care of women with epilepsy.

Publication of this supplement was supported by an educational grant from UCB Pharma Inc. The sponsor has provided the author with an honorarium for his participation in this project.

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