Catamenial Epilepsy

Women’s epileptic symptoms

When your hormones change during your menstrual cycle, in puberty, pregnancy, or menopause, they can intensify your seizures. The medical name for this epilepsy subtype is catamenial epilepsy. Of all epileptic women, about 40% of you will have the catamenial subtype.

Typical epilepsy symptoms 

• Convulsions
• Loss of awareness, but not always
• Staring blankly
• Loss of consciousness, then falling
• Body stiffening
• Breathing difficulties
• Loss of bladder control
• Confusion, problems understanding
• Feeling of deja vu, dread or fear
• Lip-smacking, chewing
• Abnormal eye movements

How epilepsy symptoms are different for some women

Your reproductive health could be impacting your epilepsy symptoms.

Menstruation

• Seizures can feel worse or happen more often during distinct phases of your monthly cycle, such as during ovulation or menstruation.

Fertility

• Some standard epilepsy medications cause hormonal fluctuations. This can impact your fertility and change the effectiveness of oral contraceptives. If you have catamenial epilepsy, you may have a higher risk of infertility and polycystic ovarian syndrome.

Pregnancy

• Although 20-35% of women have worse seizures during pregnancy, 10% see an improvement. There’s a risk that seizures may injure you or the baby. Some seizure medications may increase the risk of birth defects.
• We offer pre- and postnatal counseling to ensure a safe pregnancy while taking anti-seizure medications.

Perimenopause and menopause

• You may experience a worsening of seizures when you’re pre-menopausal and during menopause. The seizure pattern is unpredictable during menopause because hormone levels fluctuate and decrease. After menopause, you’re at greater risk of bone fractures because of weakened bone density.

When to seek care for epilepsy

It’s important to see your doctor as soon as you have a seizure or if your symptoms get worse. 

Call 911 if your epileptic seizure lasts longer than five minutes. Go to the emergency room if you have trouble breathing, waking up, or get injured while having convulsions. 

Types of epileptic seizures

These conditions are related to catamenial epilepsy:

• Migraine
• Depression

If you have catamenial epilepsy, you are more likely to get catamenial migraine headaches and depression. We can address these and all your associated conditions at the UCI Health Comprehensive Epilepsy Program.

Types of epileptic seizures

Seizures usually fall into one of four categories:

• Focal: Also called partial seizures and they happen in one specific area of your brain. They usually last from a few seconds to two minutes
• Generalized: Involve your entire brain. They may last from one to three minutes or longer
• Focal and generalized
• Unknown: Some seizures cannot be categorized to either focal or generalized types

Catamenial epilepsy diagnosis at UCI Health

For many women, shifts in your estrogen and progesterone levels are likely triggering your intensified seizure symptoms. 

To determine if you have epilepsy, your doctor may run the following tests:

• New patient questionnaire about your seizure history
• Physical exam
• Blood test
• Brain imaging: MRI, PET, CT, MEG or SPECT scan
• Neurological exam
• Neuropsychological test
• Routine EEG
• 24-hour ambulatory EEG

We perform EEG tests to confirm or characterize seizures, to prepare for surgery or before receiving a neurostimulator.

Additional testing for women

To see if your seizures cluster at specific times, your doctor will use details about your menstrual cycle such as:

• Temperature charts
• Ovulation test kits to track ovulation

Catamenial epilepsy treatment at UCI Health

We care for your reproductive health alongside your epilepsy by tailoring your treatment based on your cycles.

Conventional medication

Typically, our doctors prescribe conventional seizure medication. However, we may adjust the dosage at vulnerable periods when seizures may be worse or more frequent.

Additional approaches

Sometimes, catamenial seizures may continue despite medication. If you fall into this category, we use other approaches, including:

• hormonal medications
• non-hormonal medications
• dietary changes
• vitamin D supplements 
• osteoporosis medications to protect bone health

As a multidisciplinary epilepsy program, we can refer you to endocrinologists for bone health assessment and treatment.

If your seizures still don’t lessen in intensity, we may recommend the following treatments:

• neurostimulation 
• epilepsy surgery

How to work with us

If your symptoms worsen, your neurologist or primary care doctor might refer you to us, or you can make an appointment directly to meet with our expert neurologists at the UCI Health Comprehensive Epilepsy Program.

Why choose UCI Health for women’s epilepsy services

Our understanding and specialized training is unique and rare

Led by national expert Mona Sazgar, MD, UCI Health has one of few women’s epilepsy programs in the nation. Many healthcare providers may be unaware of the special care required to control seizures in some women. We have the tools and technology to care for your catamenial epilepsy from puberty and pregnancy through menopause. 

Through our robust research program, you’ll have access to clinical trials

One of the advantages of being an academic hospital is our close affiliation with the UCI School of Medicine. Our doctors are also researchers, and they continuously innovate tools, technologies and medicines for your benefit. 

Our collaborative multidisciplinary approach creates a sense of community

We consult with each other in regular meetings to discuss treatments and your care. When you step into our program, you’re working with a dedicated team and can expect support for all your symptoms. You’re not alone.