Summary:Purpose: Although important associations between epilepsy and women's hormonal phases are described, the relation of menopause to epilepsy has received little attention.Methods: By using a structured interview, we studied menopausal women with epilepsy seen at the University of Maryland Epilepsy Center over a I-year period from 1994 to 1995. We analyzed the characteristics and temporal relation of the seizures to menopause and compared the frequency and severity of the seizures with those in a similar group of premenopausal women.Results: We identified 61 menopausal women (46 who were postmenopausal and 15 perimenopausal) and compared them with 46 premenopausal women. No statistically significant differences were noted in either the frequency or the severity of seizures comparing all menopausal or only postmenopausal with premenopausal women. However, 12 (20%) of the 61 menopausal women noted that their seizures first began during or after menopause, with eight having no proven cause for their seizures. Many individual women described changes in their seizures with menopause. Among the 61 menopausal women, 49 had established epilepsy before the onset of menopause, and 20 (41%) reported worsening of their seizures with menopause, 13 (27%) noted improvement, and 16 (33%) described no changes. These observations were similar for peri-and postmenopausal women. Of the 15 menopausal women taking hormone replacement therapy, the six taking progestin were significantly less likely to report worsening of their seizures.Conclusions: These findings support the view that hormonal influences are important in women with seizures. Although, in aggregate, menopausal (combined perimenopausal and postmenopausal) and postmenopausal women's seizures were similar in frequency and severity to those of other women, menopause was associated with changes in seizures for some women. Moreover, menopause may be a previously unrecognized factor for some new-onset seizures. The relations between menopause and epilepsy deserve to be more fully investigated. Key Words: Menopause-Epilepsy-SeizuresWomen-Hormones.Women with epilepsy are increasingly recognized to have special problems resulting from the complex and significant effects of reproductive phases on their seizures. The interactions of puberty, menarche, menstruation, and pregnancy with epilepsy have been studied and reviewed by several investigators (1-7). Still, little is known about the associations of epilepsy with another important female hormonal phase, menopause. Understanding this issue will be of increasing importance as the percentage of older individuals in the population increases.Indeed, menopausal women with epilepsy present a potential major public health concern. Menopause genAccepted September 8, 1998. Presented in part at the annual meeting of the American Epilepsy Society, Baltimore, Maryland, 1995. erally occurs in American women between the ages of 48 and 55 years. Current census figures indicate that we now approach a figure of 50 million American women ...

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