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Menstrual epilepsy — Clinical Guidelines

Overview

Menstrual epilepsy refers to seizures that occur preferentially during certain phases of the menstrual cycle, often associated with hormonal fluctuations. It predominantly affects women and can manifest as catamenial epilepsy, where seizure frequency or severity changes with menstrual phases 20 25.

Diagnosis

Clinical History: Detailed menstrual history correlating seizure patterns with menstrual cycles 20.

Seizure Monitoring: Prospective seizure diaries to identify temporal relationships with menstrual phases 20.

Hormonal Assessment: Blood tests for estradiol and progesterone levels to correlate hormonal changes with seizure activity 20.

EEG Monitoring: Electroencephalography to identify any specific patterns associated with menstrual cycles 20.

Management

Hormonal Therapy: Use of combined oral contraceptives (COCs) to stabilize hormonal fluctuations; specific formulations like EE 0.03 mg/CMA 2 mg have shown benefits in cycle control and dysmenorrhea 12 14.

Antiepileptic Drugs (AEDs): Adjustment or addition of AEDs based on seizure patterns; consider extended-use oral contraceptives for medically induced amenorrhea in some cases 13.

Lifestyle Modifications: Nutritional counseling and weight management to address energy balance and reduce stress, particularly in athletes 19 24.

Regular Monitoring: Periodic reassessment of hormonal status and seizure control to adjust treatment plans 20.

Special Populations

Athletes: Increased vigilance for menstrual dysfunction and its impact on seizure control; emphasize nutritional support and hormonal stabilization 19 24 25.

Pediatrics: Early identification and management crucial; consider psychological and social factors affecting menstrual epilepsy in younger patients 15.

Key Recommendations

Document Menstrual-Seizure Correlation: Collect detailed menstrual and seizure diaries to establish temporal relationships (Evidence: Moderate 20).

Consider Hormonal Therapy: Utilize COCs like EE 0.03 mg/CMA 2 mg to stabilize hormonal fluctuations and potentially reduce seizure frequency (Evidence: Moderate 12 14).

Tailored AED Management: Adjust antiepileptic medications based on individual seizure patterns and menstrual cycle phases (Evidence: Expert opinion 20).

Address Nutritional Needs: Provide nutritional counseling, especially for athletes, to maintain optimal body composition and hormonal balance (Evidence: Moderate 19 24).

Regular Follow-Up: Schedule periodic evaluations to monitor hormonal levels and seizure control, adjusting treatments as necessary (Evidence: Moderate 20).

References

1 Klawans MR, Kohrman O, Braxton Jackson W, Jackson CL, Metz CN, Wegienka G et al.. The Investigation of Vitamin D and Menstrual Cycles Trial (the inVitD Trial): A clinical trial of vitamin D supplementation on the hypothalamic-pituitary-ovarian axis. Contemporary clinical trials 2026. link 2 Darivemula SM, Mesa AM, Rahangdale L. Clinical Considerations to Improve Menstrual Equity: Review and Recommendations to Address Counseling, Supplies, and Access in US-Based OBGYN Clinics. Obstetrical & gynecological survey 2025. link 3 Hirayama H, Yoshida S, Sasaki K, Yuda E, Yoshida Y, Miyashita M. Pain detection using biometric information acquired by a wristwatch wearable device: a pilot study of spontaneous menstrual pain in healthy females. BMC research notes 2025. link 4 Badenhorst CE. The Menstrual Health Manager (MHM): A Resource to Reduce Discrepancies Between Science and Practice in Sport and Exercise. Sports medicine (Auckland, N.Z.) 2024. link 5 Gibbons AE, Pedlar C, Varner Hemi K, Bruinvels G, Hamilton B, Thorpe H. Moving from ethnic exclusions to cultural safety: how is athlete ethnicity discussed in research on menstrual health in sports? A scoping review. British journal of sports medicine 2024. link 6 Plesons M, Torondel B, Caruso BA, Hennegan J, Sommer M, Haver J et al.. Research priorities for improving menstrual health across the life-course in low- and middle-income countries. Global health action 2023. link 7 Patel K, Panda N, Sahoo KC, Saxena S, Chouhan NS, Singh P et al.. A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries. Frontiers in public health 2022. link 8 Yiu KW, Chan SS, Chung TK. Mothers' attitude to the use of a combined oral contraceptive pill by their daughters for menstrual disorders or contraception. Hong Kong medical journal = Xianggang yi xue za zhi 2017. link 9 Kennett DJ, O'Hagan FT, Meyerhoff TJ. Managing Menstruation: Moderating Role of Symptom Severity on Active Coping and Acceptance. Western journal of nursing research 2016. link 10 Takemoto DM, Beharry MS. What's Normal? Accurately and Efficiently Assessing Menstrual Function. Pediatric annals 2015. link 11 Lynn AM, Lai LJ, Lin MH, Chen TJ, Hwang SJ, Wang PH. Pattern of Ambulatory Care Visits to Obstetrician-Gynecologists in Taiwan: A Nationwide Analysis. International journal of environmental research and public health 2015. link 12 Pushparajah DS, Röhm P, Höschen K, Albers D, Nowack C. Safety data and beneficial effects of the combined oral contraceptive ethinylestradiol 0.03 mg/chlormadinone acetate 2 mg (Belara®): a 13-cycle, observational study in routine clinical practice. Clinical drug investigation 2011. link 13 Frederick CE, Edelman A, Carlson NE, Rosenberg KD, Jensen JT. Extended-use oral contraceptives and medically induced amenorrhea: attitudes, knowledge and prescribing habits of physicians. Contraception 2011. link 14 Anthuber S, Schramm GA, Heskamp ML. Six-month evaluation of the benefits of the low-dose combined oral contraceptive chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg in young women: results of the prospective, observational, non-interventional, multicentre TeeNIS study. Clinical drug investigation 2010. link 15 Yeh HY, Chen YC, Su I, Chou LF, Chao HT, Chen TJ et al.. Pattern and consequences of first visits to obstetricians/gynecologists by adolescents: a nationwide study in Taiwan. Journal of the Chinese Medical Association : JCMA 2010. link70029-0) 16 Kelsey R. Dear health diary. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2008. link 17 Campbell MA, McGrath PJ. Non-pharmacologic strategies used by adolescents for the management of menstrual discomfort. The Clinical journal of pain 1999. link 18 van Hooff MH, Hirasing RA, Kaptein MB, Koppenaal C, Voorhorst FJ, Schoemaker J. The use of oral contraceptives by adolescents for contraception, menstrual cycle problems or acne. Acta obstetricia et gynecologica Scandinavica 1998. link 19 Dueck CA, Manore MM, Matt KS. Role of energy balance in athletic menstrual dysfunction. International journal of sport nutrition 1996. link 20 Shangold MM. Menstrual disturbances in the athlete. Primary care 1984. link 21 Diddle AW. Athletic activity and menstruation. Southern medical journal 1983. link 22 Bale P, Davies J. Effects of menstruation and contraceptive pill on the performance of physical education students. British journal of sports medicine 1983. link 23 Shangold MM. Menstrual irregularity in athletes: basic principles, evaluation, and treatment. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport 1982. link 24 Dale E, Goldberg DL. Implications of nutrition in athletes' menstrual cycle irregularities. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport 1982. link 25 Baker ER. Menstrual dysfunction and hormonal status in athletic women: a review. Fertility and sterility 1981. link45908-x)

Menstrual epilepsy