Menstruation and epilepsy
Hormonal changes at the start of puberty may affect adolescents with epilepsy. In some cases, seizures may lessen.
Hormones and seizures
A small number of adolescent girls have increased seizures at certain times in their menstrual cycle when their hormones change.
If menstruation is the trigger for changes in seizure frequency, the scientific term used is catamenial epilepsy. This term refers to the timing of the seizure. It does not change the primary epilepsy diagnosis.
Two main hormones relating to menstruation are progesterone and oestrogen. The levels of these hormones change during the menstrual cycle.
- Oestrogen lowers the seizure threshold, making it more likely a seizure will occur in some girls.
- Progesterone increases the seizure threshold, making seizures less likely in some girls.
Managing periods
Treatment approaches:
- Taking progesterone at certain times in the menstrual cycle
- Change the anti-seizure medicine(s)
- Using a medicine such as clobazam (Frisium) just before the seizures are expected to increase and continuing until the seizure pattern returns to normal
- Stopping the menstrual cycle completely using hormones.
If a child has an intellectual disability, many parents worry about their daughter going through puberty and starting menstruation (or periods). Many parents worry whether their child will understand why they are bleeding and be able to cope with changing pads and tampons.
They may also worry about the risk of an unwanted pregnancy. These concerns should be discussed with your GP and paediatrician who can counsel you regarding contraception.
Puberty and developmental disabilities
The Royal Children's Hospital Melbourne talks about puberty-related issues in children with a developmental disability. It also covers common worries about periods. For example, the website advises that it is helpful to explain to your daughter that:
- The blood is normal
- It will happen regularly
- It is part of her body changing
- She is not hurt.
Periods may not be a big problem. They are a normal part of being a girl, and good for bone and heart health.
Read more about periods and puberty from Family Planning Australia.
Painful periods
For girls whose periods are more problematic and experience issues such as severe pain, irregular periods, or excessive bleeding, you could talk to your neurologist, GP or paediatrician about your concerns.
- They can explain the different options or suggest that you see a hormone specialist or paediatric gynaecologist.
- Various options are available for problematic periods. These include hormone treatments (tablets, devices that can be placed into the body, or injections) or intrauterine devices (IUDs).
- These options may help with good menstrual hygiene, decrease the number of periods, and reduce period pain.
- As each girl is different, you can discuss your concerns with your neurologist, who knows your daughter and her medical history.
Your neurologist may be able to give you more information based on your daughter’s particular type of epilepsy and tailor treatment to her particular situation. They can also check that her seizure plan is up to date.
Some treatments are available for girls with changes in their seizure patterns that are related to the menstrual cycle. If your daughter's seizures increase in puberty, your neurologist may change her anti-seizure medicines. This may improve seizure control.