Do menopause changes cause seizures in a 44-year-old?

Hello,

Welcome to icliniq.com.

I can understand your concern.

These sound like focal seizures (that odd smell is an aura from the temporal lobe, then blank staring fits). The tricky part is that normal EEGs (echocardiograms) do not rule out epilepsy, and routine EEGs often miss it, especially if the seizures are infrequent.

Video EEG is the right next step, because it catches brain activity during the actual event. About menopause, yes, hormonal fluctuations can absolutely influence seizure threshold. Estrogen tends to be pro-convulsant (makes the brain more excitable), while progesterone is more stabilizing. So in perimenopause, with wild swings in both, some women do see seizures appear for the first time or worsen if they already have epilepsy.

Stress, sleep loss, and hormonal changes together are a known trigger combo.

The medicine side: Phenytoin side effects (weight gain, gums) are common, and Oxcarbazepine can definitely affect memory or words. Other drugs like Levetiracetam or Lamotrigine are sometimes better tolerated, especially in women. But the choice needs her epilepsy specialist’s input, and sometimes balancing hormone therapy with neurology is considered if the pattern is strongly menstrual.

The probable causes:

• Late-onset focal epilepsy, likely triggered and exacerbated by perimenopausal hormone changes.

Investigations to be done:

• Long-term video EEG monitoring.

• Repeat MRI with epilepsy protocol if not already done.

• Hormonal profile (FSH (follicle-stimulating hormone), LH (luteinizing hormone), estradiol, progesterone) around cycle.

• Neuropsychological testing if memory problems persist.

Differential diagnosis:

• Temporal lobe epilepsy unrelated to hormones.

• Psychogenic non-epileptic events (less likely with aura plus blank stare).

• Transient ischemic events (unlikely with normal MRI).

Probable diagnosis:

• Catamenial epilepsy (perimenopause-related seizure onset).

Treatment plan:

• Push for video EEG (echocardiogram) approval, which is crucial.

• Discuss with neurologist about switching to another anti-seizure medication (Lamotrigine, Levetiracetam often easier on cognition/weight.

• Keep a seizure diary in relation to the menstrual cycle.

• Hormone stabilization therapy sometimes helps in catamenial epilepsy but has to be carefully balanced with a gynecologist (risks vs benefits at her age).

• Lifestyle: strict sleep hygiene, stress reduction, and avoiding alcohol.

• Safety measures: no driving until cleared, avoid unsupervised childcare until better control.

Regarding follow-up:

I would like to see the seizure diary, hormone levels, and ideally results of the video EEG when available. Keep both neurology and gynecology teams involved since hormones clearly play a role here. Follow up closely because treatment might need adjusting a few times before stable control.

Preventive measures:

• Track cycle and seizure timing.

• Avoid known triggers (sleep loss, stress).

• Adequate calcium/vitamin D if any hormonal therapy is considered.

• Regular follow-up with both neuro and gynecologist.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.