Reproductive dysfunction in women with epilepsy: recommendations for evaluation and management

Abstract

Background: Epilepsy is commonly associated with reproductive endocrine disorders. These include polycystic ovary syndrome (PCOS), isolated components of this syndrome such as polycystic ovaries, hyperandrogenaemia, hypothalamic amenorrhoea, and functional hyperprolactinaemia. Objective: To summarise the currently known relations between epilepsy and reproductive endocrine disorders. Methods: A review of clinical experience and published reports. Results: The most likely explanations for endocrine disorders related to epilepsy or antiepileptic drugs are: (1) a direct influence of the epileptogenic lesion, epilepsy, or antiepileptic drugs on the endocrine control centres in the brain; (2) the effects of antiepileptic drugs on peripheral endocrine glands; (3) the effects of antiepileptic drugs on the metabolism of hormones and binding proteins; and (4) secondary endocrine complications of antiepileptic drug related weight changes or changes of insulin sensitivity. Regular monitoring of reproductive function at visits is recommended, including questioning about menstrual disorders, fertility, weight, hirsutism, and galactorrhoea. Particular attention should be paid to patients on valproate and obese patients or those experiencing significant weight gain. Single abnormal laboratory or imaging findings without symptoms may not constitute a clinically relevant endocrine disorder. However, patients with these kinds of abnormalities should be monitored to detect the possible development of a symptomatic disorder associated with, for example, menstrual disorders or fertility problems. Conclusions: If a reproductive endocrine disorder is found, antiepileptic drug treatment should be reviewed to ensure that it is correct for the particular seizure type and that it is not contributing to the endocrine problem. The possible benefits of a change in treatment must be balanced against seizure control and the cumulative side effect of alternative agents.

Polycystic Ovarian Syndrome: Diagnosis and Management

“…The reason for this overrepresentation is debatable but likely multifactorial, ranging from the influence of epilepsy itself on the hypothalamic-pituitary axis to various effects of antiepileptic drugs on hormone secretion and action both directly and indirectly through changes in weight and body composition. 115,116 Valproic acid has received particular attention in this regard. Some evidence suggests that some women on this therapy have higher levels of insulin, testosterone, and triglycerides than those on another agent (lamotrigine), although few actually had a clear biochemical suggestion of PCOS.…”

Contraception for Adolescents

“…Adolescents with disabilities may have early or irregular menstrual cycles, 228 and medications such as certain anticonvulsants and antipsychotics may influence the neuroendocrine system, leading to abnormal bleeding. 229 Menstrual hygiene also may present a special problem for adolescents with motility and transfer difficulties, as well as for those with behavioral and developmental disabilities. 230 Menstrual control and suppression is commonly achieved with COCs, transdermal patches, DMPA, and levonorgestrel IUDs.…”

Lamotrigin bei Frauen mit Epilepsie

“…So wird heute empfohlen, während einer antiepileptischen Medikation auf klinische Hinweise einer hormonellen Dysregulation zu achten (Störungen des Menstruationszyklus,Virilisierungszeichen, Galaktorrhö, Infertilität,Gewichtsänderungen).Bei klinischen Verdachtsmomenten sind gezielte Hormonanalysen und eine gynäkolo-gische Ultraschalluntersuchung sowie eine Evaluation des antiepileptischen Regimes indiziert [5].…”