EMAS position statement: managing the menopause in women with epilepsy.
BACKGROUND
Epilepsy is a major public health problem worldwide which is clinically characterized by recurrent seizures.


OBJECTIVE
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.


METHODS
Literature review and consensus of expert opinion.


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.
Erel
C Tamer
CT
Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa School of Medicine, Valikonagi Cad. No: 93/4, Nisantasi 34365, Istanbul, Turkey. tamererel@superonline.com
Brincat
Marc
M
Gambacciani
Marco
M
Lambrinoudaki
Irene
I
Moen
Mette H
MH
Schenck-Gustafsson
Karin
K
Tremollieres
Florence
F
Vujovic
Svetlana
S
Rozenberg
Serge
S
Rees
Margaret
M
D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects*; D002118:Calcium / Q000378:metabolism; D019587:Dietary Supplements; D004347:Drug Interactions; D004827:Epilepsy / Q000188:drug therapy*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006736:Horses; D006801:Humans; D008593:Menopause; D012640:Seizures / Q000139:chemically induced*; D012955:Societies, Medical; D014807:Vitamin D / Q000378:metabolism
D000927:Anticonvulsants; D014807:Vitamin D; D002118:Calcium