Are anti-seizure medications safe during my pregnancy?

Question

Hello Doctor,

I am a 32-year-old woman living with epilepsy. While my seizures are somewhat controlled with medication, I am struggling with how it affects my overall health as a woman. My menstrual cycles have become irregular, and I have noticed that my seizures sometimes get worse around my period. I read that this could be something called catamenial epilepsy.

I also want to start a family soon, but I am worried about whether my current anti-seizure medicine is safe during pregnancy. I do not know if I will need to switch to a different medication. I have also had problems with hormonal changes, like acne and weight gain, and I am not sure if this is because of the medicine or if I might have a condition like polycystic ovary syndrome.

Lately, I have been feeling more anxious and tired, and I do not know if it is because of my hormones, my epilepsy, or both. I am wondering if I should consult both a neurologist and a gynecologist, and how to ensure they work together to manage my care.

I am also confused about birth control options. Are there certain types that are safe to use with anti-seizure medications?

Overall, I feel overwhelmed trying to manage my seizures along with all these other symptoms. What kind of healthcare plan would give me the best support for both my brain health and my reproductive health?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing epilepsy along with women’s health concerns can feel overwhelming, but with the right healthcare team and a good plan, it is manageable.

It is common for seizures to change during the menstrual cycle because of hormone shifts. This condition is known as catamenial epilepsy. Estrogen can increase seizure activity, while progesterone can have a calming effect on the brain. Tracking your seizures along with your menstrual cycle can help your neurologist adjust your treatment. Sometimes, they may recommend hormonal therapy or changing seizure medications during your period.

Some anti-seizure medications can affect your hormones and metabolism, leading to acne and weight gain. However, polycystic ovary syndrome is also common and can cause similar symptoms such as irregular periods, acne, and weight gain. To find the cause, your doctor may recommend blood tests to check hormone levels, a test for insulin resistance, and an ultrasound to look at your ovaries. Your gynecologist and neurologist need to work together in this case.

If you want to have a baby, it is important to talk to your doctor before you get pregnant. Some anti-seizure medications can increase the risk of birth defects, while others are safer. Your neurologist may want to switch your medication to a safer option before you conceive. Taking Folic acid is very important to help lower the risk of problems in the baby’s brain and spine. You may need care from a neurologist who understands pregnancy and epilepsy, as well as a specialist in high-risk pregnancy.

Tiredness and mood changes can be caused by hormone changes, epilepsy itself, or side effects of medication. These symptoms may also come from anxiety or depression. Getting screened for mental health conditions can help. Talking to a counselor, making changes to your lifestyle, and possibly taking medication or therapy can improve how you feel.

Some seizure medications can make hormonal birth control less effective by changing how your body breaks them down. Non-hormonal methods, like a copper intrauterine device, may be a better option. Some hormonal options, such as the Medroxyprogesterone injection or higher-dose birth control pills, may still be safe. Your gynecologist and neurologist should work together to find a method that is both safe and effective for you.

You will benefit most from a care team that works together. This may include a neurologist who specializes in epilepsy and understands how hormones affect seizures, a gynecologist who is familiar with both epilepsy and women’s health, or a doctor who specializes in hormone-related conditions, and a high-risk pregnancy doctor if you plan to become pregnant. These providers should communicate regularly to make sure your medications, hormone treatments, and health plans work together. If possible, ask if a case manager or nurse coordinator can assist you in organizing your care, especially during pregnancy planning.

Here are some next steps you can take:

Keep a diary to track your seizures and menstrual cycle.
Ask your doctor for hormone and metabolism tests to better understand your symptoms.
Talk to your neurologist about your pregnancy plans, and never stop or change medication without guidance.
Ask about birth control options that are safe with your medication and fit your lifestyle.
Get help for anxiety and fatigue if needed.
Ask your providers if there are clinics that offer coordinated care for both epilepsy and women’s health.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.