I am 24 years old. How can I manage my catamenial epilepsy?

Question

Hello doctor,

I am 24 years old and have had epilepsy since I was a teen, but my seizures have become much more frequent and severe since I started menstruating regularly. I am experiencing catamenial epilepsy, where my seizures cluster around my period.

I am currently on Lamotrigine, but we have had to increase the dose several times, and I am still having breakthrough seizures. I am also dealing with significant side effects, including hair loss, weight gain, and mood swings that seem to coincide with my menstrual cycle. My boyfriend and I have been together for three years and want to start planning for marriage and children, but I am terrified about how pregnancy might affect my seizures and whether my medications could harm a baby.

I have heard that some seizure medications can interfere with birth control effectiveness, which makes family planning even more complicated.

Why do my seizures get worse around my menstrual period?
How might pregnancy affect my seizure control and frequency?
Are my current seizure medications safe during pregnancy, and do I need to switch?
Can anti-seizure medications interfere with hormonal birth control effectiveness?
What type of contraception is most reliable for women taking seizure medications?
How should I prepare for pregnancy to ensure the best outcomes for me and my baby?
Could hormonal treatments help with my catamenial epilepsy pattern?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Catamenial epilepsy happens because hormonal changes during your cycle, especially the drop in progesterone and relative rise in estrogen before and during your period, can make brain cells more excitable, lowering your seizure threshold. Pregnancy affects seizures differently for each woman: about one-third improve, one-third worsen, and one-third stay the same.

Lamotrigine is generally considered one of the safer anti-seizure medications in pregnancy. Still, its dose often needs adjustment because pregnancy speeds up its breakdown, so levels must be monitored closely. Some anti-seizure drugs like Carbamazepine, Phenytoin, and especially enzyme-inducing drugs such as Phenobarbital and Topiramate can reduce hormonal birth control effectiveness. Still, Lamotrigine primarily interacts with combined pills by slightly lowering hormone levels, and estrogen, in turn, can lower Lamotrigine levels.

For reliable contraception, non-hormonal options like a copper IUD (intrauterine device) or progestin-only IUD are most dependable with epilepsy medications. Preparing for pregnancy means meeting with both a neurologist and an obstetrician and gynecologist (ideally a maternal–fetal medicine specialist) several months beforehand to adjust medications if needed. Start high-dose folic acid at 4 mg daily, and get seizures as controlled as possible before conceiving.

In some women with catamenial patterns, hormonal treatments such as natural progesterone supplementation, certain birth control regimens, or cycle suppression can help reduce seizure clustering, but these need to be balanced carefully with your seizure control goals and family planning timeline.

I hope this answers your query.

Let me know if I need to assist you further.