What should you know about catamenial epilepsy?

Some people with epilepsy notice that seizures cluster around menstruation, ovulation, or the days before a period. Changing levels of oestrogen and progesterone may alter brain excitability and the effect of existing seizure triggers. The pattern can differ between people and may not occur in every cycle.

A diary can help show whether events follow a repeating cycle. Record seizure dates, bleeding days, sleep, illness, missed doses, alcohol, and any medicine changes. A seizure pattern around periods does not replace an epilepsy diagnosis; it is information that can help a clinician review the diagnosis and treatment plan.

Continue prescribed anti-seizure medicine exactly as directed, including during bleeding days, and do not change the dose without medical advice. Keep a combined seizure and menstrual diary for several cycles if it is safe to do so. Protect sleep, take regular meals, and plan for known triggers such as missed medication or illness.

Arrange a GP or neurology review if the pattern is new, seizures are changing, or rescue medicine is being used more often. Treatment may involve checking adherence, reviewing interactions, considering hormonal factors, and discussing contraception or pregnancy plans. Share the full list of medicines and supplements.

Seek emergency help for a seizure lasting longer than your clinician’s advised limit, repeated seizures without recovery, serious injury, breathing difficulty, or a first seizure. Follow your personal seizure action plan if you have one. Do not put anything in the person’s mouth or restrain their movements; clear nearby hazards and place them on their side after the movements stop.

Ask: Does my seizure diary suggest a menstrual-cycle pattern? Should my medicines or rescue plan be reviewed? Could contraception, pregnancy, sleep, or another medicine affect seizure control? When should I contact the epilepsy team after a seizure change?