EMAS position statement: managing the menopause in women with epilepsy.

Introduction: Epilepsy is a major public health problem worldwide which is clinically characterized by recurrent seizures.

Aim: The aim of this position statement is to provide evidence-based advice on management of the menopause in postmenopausal women derived from the limited data available.

Materials And Methods: Literature review and consensus of expert opinion.

Results And Conclusions: Women with epilepsy may undergo an earlier natural menopause, between 3 and 5 years depending on seizure frequency, but the data are limited. Data regarding the effects of the perimenopause and menopause on epilepsy are conflicting: some studies show an increased risk of seizures but others do not. With regard to hormone therapy (HT) one study has shown an increase in seizures with oral therapy with conjugated equine estrogens and medroxyprogesterone acetate, but no data are available for other regimens. Women starting HT should be closely monitored as their antiepileptic drug (AED) needs may change. As vitamin D and calcium metabolism can be affected by AEDS, supplements should be considered. Herbal preparations should be avoided as their efficacy is uncertain and they may interact with AEDs.