Epilepsy & Women’s Health: Expert Insights on Fertility, Pregnancy & Beyond
- Women with epilepsy can face unique clinical considerations related to interactions among reproductive hormones, seizure activity, and antiseizure medications (ASMs) across the lifespan.
- In recognition of National Women Physicians Day, held today, February 3, 2026, NeurologyLive® spoke with Page B.
- Epilepsy, a neurological disorder characterized by unprovoked seizures, significantly impacts the quality of life of those affected and can dramatically affect reproductive health issues, including fertility, contraception, pregnancy,...
Women with epilepsy can face unique clinical considerations related to interactions among reproductive hormones, seizure activity, and antiseizure medications (ASMs) across the lifespan. Advances in understanding these relationships have informed best practices for managing fertility, pregnancy, and menopause, although ASM use during pregnancy has been associated with an increased risk of major congenital malformations. Care for women with epilepsy may require a comprehensive approach that accounts for sex- and gender-related influences throughout life.
In recognition of National Women Physicians Day, held today, , NeurologyLive® spoke with Page B. Pennell, MD, FAES, FAAN, FANA, the Henry B. Higman Professor of Neurology at the University of Pittsburgh School of Medicine, to further explore the clinical importance of integrating sex-specific factors into epilepsy care. The discussion covered how reproductive hormone fluctuations influence seizure patterns across life stages such as puberty, the reproductive years, perimenopause, and pregnancy, including the clinical relevance of catamenial epilepsy. Pennell, who previously served as the president for the American Epilepsy Society, explored how reproductive hormone changes affect seizure patterns across life stages, including catamenial epilepsy, and addressed key considerations around contraception, pregnancy planning, and ASM–hormonal interactions.
Understanding Epilepsy and Reproductive Health
Epilepsy, a neurological disorder characterized by unprovoked seizures, significantly impacts the quality of life of those affected and can dramatically affect reproductive health issues, including fertility, contraception, pregnancy, and childbirth.
Hormonal Influences and Seizure Patterns
As Dr. Pennell explained, seizures may vary with changes in women’s reproductive sex steroid hormones, leading to potential instability during puberty and perimenopause, times marked by irregular hormone cycling. During the reproductive years, approximately one-third of women with uncontrolled seizures notice a catamenial pattern – an increase in seizures synchronized with their menstrual cycles. The most common pattern is increased seizures around the time of menstruation.
Planning for Pregnancy and Contraception
Care for women with epilepsy should include strategies and discussions to decrease the likelihood of unplanned pregnancies. Planned pregnancies are associated with better maternal and child outcomes, particularly in the context of epilepsy and the use of ASMs. Neurologists should consider potential interactions between systemic hormonal contraceptives (like birth control pills) and prescribed ASMs. Enzyme-inducing ASMs can reduce the effectiveness of hormonal contraceptives, while estrogen-containing contraceptives can alter the blood levels of some ASMs, including lamotrigine, oxcarbazepine, and valproic acid.
Antiseizure Medications and Fetal Safety
Currently, limited ASMs have adequate data demonstrating fetal safety when used during pregnancy – lamotrigine and levetiracetam are among those with more supporting evidence. Conversely, some ASMs, such as valproate and phenobarbital, carry a particularly high risk of teratogenic effects, leading to major congenital malformations and adverse neurodevelopmental outcomes, including autism. For many ASMs, sufficient data to quantify fetal risk remains lacking. Balancing the need for optimal maternal seizure control with the safest possible ASM choice is crucial when planning a pregnancy.
Recent Advances in Maternal and Child Outcomes
Research, including data from pregnancy registries, has improved our understanding of the teratogenic profiles of certain ASMs. Pharmacokinetic studies have identified how ASM clearance changes during pregnancy, allowing for evidence-based guidance on adjusting doses to maintain stable blood levels and prevent seizure worsening. Recent literature also supports the benefits of breastfeeding while taking ASMs, outweighing potential risks to the nursing baby.
Remaining Gaps and Future Research
Despite progress, significant gaps remain in women’s health and epilepsy research. Further investigation is needed to establish optimal vitamin supplementation regimens before and during pregnancy, including the appropriate dosage of folic acid. More research is also needed to determine maternal mortality and obstetrical complications during pregnancy in women with epilepsy, and to identify interventions that can improve outcomes. Additional studies should explore the course of epilepsy during the perimenopausal transition, the impact of hormone replacement therapy on seizure control, and the effects of systemic hormonal contraception on seizure activity.
Dr. Pennell also highlighted the need for further research into the role of sex steroid hormones and their neuroactive metabolites on seizure activity, mood, and anxiety during pregnancy, postpartum, and outside of pregnancy.
Transcript edited for clarity. Click here for more of our coverage on epilepsy.