Epilepsy Program: Catamenial Epilepsy
Many women with epilepsy have challenges and symptom variations that are distinct from men. They require a treatment approach that accounts for the effects of their menstrual, or catamenial, cycle on their disorder.
At the UCI Health Comprehensive Epilepsy Program, our specialists offer unique expertise, tools and technology to care for women with epilepsy from puberty and pregnancy through menopause.
We are one of the few programs in the nation to specialize in the treatment of catamenial epilepsy. We also have a robust research program and offer clinical trials for women with this form of epilepsy.
What is catamenial epilepsy?
Catamenial disorder is a subtype of epilepsy in which seizures are affected by changes in the menstrual cycle and hormonal fluctuations that occur at puberty, pregnancy and menopause. Seizures often worsen or are more frequent during distinct phases of the menstrual cycle, such as during ovulation or menstruation.
About 42 percent of women with epilepsy have the catamenial pattern of the disorder. And among women with refractory epilepsy — whose seizures are uncontrolled, even when taking seizure medication — about one-third has catamenial epilepsy.
Epilepsy specialists have only recently learned more about the causes and management of catamenial epilepsy. Many healthcare providers may be unaware of the special care required to control seizures in these patients.
UCI Health epilepsy experts have developed treatments to carefully target the time of the seizures, using both hormonal and non-hormonal options.
Comprehensive epilepsy care must take into account the distinct hormonal stages in a woman’s life, including puberty, pregnancy and menopause. Some medications used to treat epilepsy can affect hormone levels, impacting fertility and even the effectiveness of oral contraceptives.
Women with catamenial epilepsy also may experience higher rates of reproductive disorders, such as infertility and polycystic ovarian syndrome.
At UCI Health, we help tailor effective contraceptive care and reproductive healthcare throughout their life stages.
About 35 percent of women with catamenial epilepsy experience a worsening of seizures during pregnancy, while about 10 percent see an improvement.
Women with catamenial epilepsy should be closely monitored during pregnancy because seizures can pose a risk of injury to the mother or baby. Moreover, some seizure medications may increase the risk of birth defects.
At UCI Health, we recognize the unique needs of pregnant women with epilepsy and provide treatments that minimize health problems — for mother and child.
Perimenopause and menopause
About a third of women with epilepsy experience a worsening of seizures during the onset of menopausal symptoms, known as perimenopause, as well as during menopause.
The pattern of seizures during menopause is unpredictable because hormone levels fluctuate and decrease. Closer monitoring may be necessary during this period.
Women with epilepsy are at greater risk of bone fractures post-menopause due to weakened bone density. These patients should undergo routine bone health screening and bone-density testing at recommended intervals.
Women may need vitamin D supplements or osteoporosis medications to protect bone health. As a multidisciplinary epilepsy program, we can refer patients to endocrinologists for bone health assessment and treatment.
Diagnosis and treatment
Catamenial epilepsy is diagnosed based on readings from temperature charts that indicate ovulation and with ovulation test kits.
Doctors use detailed information about menstrual cycle fluctuations to tell if seizures cluster around specific times during the cycle. Treatment is tailored to the individual patient and her cycles.
Conventional seizure medications are typically prescribed, although dosages may be adjusted at vulnerable periods, when seizures may be worse or more frequent.
Catamenial seizures may persist despite medications. In these patients, we also use other approaches, such as hormonal and non-hormonal medications and dietary changes, such as avoiding foods that seem to be related to seizure activity.
When seizures are not curtailed by other treatments, neurostimulation or epilepsy surgery may be recommended.
Meet our team
Our catamenial epilepsy team is led by UCI Health clinical professor and epileptologist Dr. Mona Sazgar, a national expert on women with epilepsy and co-editor of a recently published book, book Controversies in Caring for Women With Epilepsy.
To schedule an appointment, call 714-456-6203 or request an appointment online.