The Unique Health Difficulties Faced by Women with Epilepsy
Author: Angélique Erry, BSc Student, University of Toronto | Editors: Tashi Stampp and Romina Garcia de leon (Blog Coordinators) Reviewer: Lindsey Thurston
Published: November 28th, 2025
Women’s specific health concerns are often the victim of public stigma. This has ultimately reduced the research focus on these topics. Many women are not fully knowledgeable of their own unique physiology, which could potentially affect other areas of their health. Epilepsy is one of the most common neurological disorders among women, yet research and knowledge on their unique health challenges remains limited.
Women with epilepsy face unique health challenges due to concerns such as hormonal shifts and anti-seizure medication side effects. Epilepsy is a neurological disorder that causes recurrent seizures. Women’s-specific health issues associated with epilepsy are under-discussed by health professionals. In fact, a study conducted in 2011 showed that many neurologist and neurology residents had poor knowledge or understanding of the health risks associated with pregnancy and epilepsy. As a woman with epilepsy myself, this lack of knowledge warrants serious attention. Women with epilepsy should have access to helpful and comprehensive knowledge on how our condition will affect us at different stages of life. The lack of understanding on the intersection between epilepsy and women’s physiology may lead to misinformed treatment decisions and poorer health outcomes for women.
Understanding the Overlooked Risks of Epilepsy in Women
Professionals agree that an increase in women’s specialized neurology care services and societal awareness played a key role in addressing this issue. How can we prevent women with epilepsy from facing unexpected adverse outcomes? The simple answer is education and awareness. There are multiple health concerns specific to women that may affect their experience with epilepsy. Here are some that should be considered.
Menstruation and pregnancy can contribute to seizure frequency due to hormone dysregulation. Oestrogen and progesterone are the two main sex hormones in a female body. During a women’s menstrual cycle and pregnancy, progesterone levels decrease and oestrogen levels increase. A rise in oestrogen can increase the chances of neurons in the brain misfiring or excess neuron stimulation. Progesterone has the opposite effect and reduces this. This menstrual hormone shift can trigger more frequent seizures for women. Women who are not aware of this relationship may experience unexpected seizures of higher frequency and intensity.
This is often the case in women with catamenial epilepsy, where seizures are directly caused by changes in hormone level during the menstrual cycle. Catamenial seizures have been reported to affect 40% of women with epilepsy. Treating Catamenial epilepsy can be difficult because it does not have a specific proven drug treatment and has been found to be resistant to standard therapies. The non-hormonal or hormonal therapies that are recommended have limited strong evidence to support their effectiveness. Additionally, Catamenial seizures require unique treatment for each patient since the seizures are cycle dependent. Similar to most health concerns, individual differences play a huge role in treatment effectiveness. Determining the right treatment can be challenging as hormone shifts are different for every woman and each requires a unique plan.
Why Birth Control Decisions Are More Complicated for Women with Epilepsy
Choosing the right contraceptive medication can be complicated for women with epilepsy. Hormonal contraceptives contain synthetic oestrogen and progesterone which prevents ovulation and conception. However, many anti-seizure medications promote oestrogen metabolism in the body which reduce seizure frequency but also the efficacy of the contraceptive. More women with epilepsy also tend to report overall changes in seizure frequency (i.e., rise in frequency) while on hormonal contraceptives, compared to those on non-hormonal contraceptives. The medicative interactions are a serious concern for women who take birth control and anti-epileptic medication. Anti-seizure medications can interfere with the effectiveness of these hormonal medications impacting its effect. Navigating these interactions requires careful consultation with a physician to develop a treatment plan that balances seizure control with birth control needs. It is suggested that women with epilepsy can rely on non-hormonal contraceptives instead such as condoms. However, barrier methods are less effective at preventing pregnancy than hormonal medications. If research stops here, we will lose important insights into how medications interact with women’s physiology. .
Breaking the Silence on Epilepsy and Menopause
Menopause remains to be the most stigmatized health concern for women. Many believe that after a woman’s period ends, so do any unique health concerns, this is however false. During perimenopause, oestrogen levels can rise unpredictably, which again potentially increases seizure frequency. During and after menopause, oestrogen and progesterone levels fall, which can not only affect seizure activity, but also introduce diverse health challenges. Some studies suggest that women with epilepsy may experience earlier onset menopause. This is possibly due to the long-term effects of their seizures or medication. The effect of menopause on a woman’s seizure frequency is particularly under-researched, which makes for an unclear treatment plan. More research is required to confirm these findings and prepare treatment.
Closing the Gap in Women’s Epilepsy Care
Women with epilepsy should have informed and personalized care to reduce seizure frequency or other health risks. The stigma surrounding conversations on women’s health has led to less prioritization of research and education on these topics. It overlooks the reality that women’s physiology presents unique health considerations. More research and clinical awareness are key to addressing these health concerns. Understanding women’s specific physiology allows women to make informed decisions about their care.
