Epilepsy affects 1 in 10 people during their lifetime and is characterized by seizures. Seizures are the tip of the iceberg in terms of quality of life for people with epilepsy. There is a complex interplay between epilepsy, neuro-endocrine disruption and anti-seizure medications in the management of women with epilepsy. Menopause adds another layer of complexity to this network.

To manage women with epilepsy, an understanding of the neuro-endrocine system as well as the esotrogen:progesterone ratio, and how they influence seizure control, is critical to  the understanding of catamenial epilepsy and hormonal impacts in pregnancy and menopause. Epilepsy itself is an endocrine disruptor adding more complexity to the equation. Finally, enzyme-inducing anti-seizure medications play a role in altering hormonal levels as well as direct impacts on vitamin D and bone turnover.

There is a multi-factorial increase in the risk of fractures in epilepsy, which is additive to the risks that menopause poses on bone health.

For optimal management of epilepsy and menopause, a holistic approach is required with balancing of risks and benefits of treatment for the individual patient. Management includes discussion on menopause-specific treatment in women with epilepsy, control of seizures, bone health, osteoporosis and fracture prevention.

There is an imperative need for longitudinal studies, to enable development of evidence-based preventive and treatment guidelines.