Epilepsy affects about 50 million people worldwide, regardless of age, sex, or region. However, women face some specific, important challenges. There are issues tied to hormonal cycles, pregnancy and breastfeeding, medication safety, social stigma, and unequal access to care. All these can change how epilepsy is experienced and treated by women.
Epilepsy & Menstruation
Hormones affect brain excitability. Estrogen tends to be pro-convulsant (increasing seizure likelihood), while progesterone is an anti-convulsant. That hormonal interplay explains why some women experience ‘catamenial epilepsy’. These are seizures that cluster around specific phases of the menstrual cycle, such as ovulation or the pre-menstrual window. Recognising this pattern can guide targeted treatment. If seizure frequency changes with the menstrual cycle, women can track seizures using an app or a paper diary. This data can be used to discuss options with your neurologist.
Pregnancy & Antiseizure Medication (ASM)
A large share of the global epilepsy population are women in reproductive years. Pregnancy brings two major issues. The first is that physiological changes alter blood levels, which can permit more seizures unless doses are monitored and adjusted. The second is that some medicines carry a higher risk of major congenital malformations and neurodevelopmental problems when used in pregnancy. Careful pre-conception counselling, planning, and coordination between neurology and obstetrics are essential.
Recommended Steps
- Planned pregnancies are associated with fewer medication changes and better outcomes.
- Monitor ASM serum concentrations during pregnancy and adjust dosing as needed. Levels typically return to baseline quickly postpartum.
- Avoid or restrict the use of valproates in women of childbearing potential when possible and counsel thoroughly about risks.
Social Stigma
Worldwide, stigma around epilepsy remains a major driver of reduced education, employment and social participation. Women can be particularly affected in cultures where marriage, childbearing, and ‘family reputation’ are tightly linked to health perceptions. Stigma reduces quality of life, increases isolation and can deter women from seeking care or disclosing epilepsy to employers or partners. Access to care is unequal and often insufficient. Women may face additional barriers such as less autonomy, financial dependence, or restrictions on mobility.
Debunking Common Myths
Contrary to belief, women with epilepsy can have children. In fact, most women with epilepsy have healthy pregnancies with planning, medication review and specialist care. Risks exist but are manageable with modern care. Another myth is that epilepsy always means mental disability. This is not true. Epilepsy is a disorder of brain electrical activity. Cognitive outcomes vary widely and many people with well-controlled seizures lead fully independent lives.
Practical Tips To Navigate Work And Family
Disclosure choices: Decide carefully who needs to know at work or school. Disclosure can bring schedule flexibility, extra breaks, and safe travel arrangements. But it also means risk of discrimination. Evidence shows workplace discrimination remains an issue, so weigh the benefits and risks.
Safety at home: If seizures include loss of awareness, adapt the environment. Consider bath and shower safety, stove guards, and discuss childcare safety plans with your family.
Medication: Keep medication on schedule and set reminders. If you’re planning a pregnancy, consult neurology and obstetrics well before conceiving to review medications and folic acid supplementation.
Mental health: Anxiety and depression are more common in people with epilepsy, so seek support early.
Driving: Understand your local regulations and rights while driving or any other safety-sensitive positions.
Consider carrying a card or wearing a medical ID that indicates you have epilepsy and any emergency medications or care plan. Women with epilepsy deserve individualised, evidence-based care that addresses hormones, pregnancy safety, and psychosocial needs.