Menopause and Epilepsy
Perimenopause, changing hormones, seizures, HRT and bone health
Menopause is a normal stage of life, but for someone with epilepsy it can raise additional questions.
Hormones change considerably during the years leading up to menopause. At the same time, symptoms such as poor sleep, anxiety, night sweats and fatigue can overlap with recognised seizure triggers.
Some people notice changes in their seizures. Others notice no change at all.
Hormone replacement therapy, or HRT, can usually still be considered when someone has epilepsy, but treatment needs to take account of their epilepsy medicines and seizure pattern.
What is menopause?
Menopause is reached when someone has gone 12 months without a menstrual period because ovarian hormone production has declined.
In the UK, menopause most commonly occurs between the ages of 45 and 55.
The years leading up to menopause are called perimenopause.
During perimenopause, periods may continue but become:
closer together
further apart
heavier
lighter
longer
shorter
or unpredictable.
Hormone levels can also fluctuate considerably during this time.
Perimenopause can last for years
Menopause does not usually happen overnight.
For many people, the transition begins several years before the final menstrual period.
During this time levels of hormones including:
oestrogen
progesterone
and testosterone
change and may fluctuate unpredictably.
That is different from the more regular hormone pattern usually seen earlier in reproductive life.
What symptoms can happen during perimenopause?
Symptoms vary greatly.
Some people experience very little difficulty, while others have symptoms that significantly affect daily life.
Common symptoms include:
changes in periods
hot flushes
night sweats
difficulty sleeping
tiredness
anxiety
mood changes
low mood
problems with concentration
memory difficulties or “brain fog”
headaches or worsening migraine
palpitations
muscle and joint pain
vaginal dryness
urinary symptoms
changes in sexual desire.
Several of these — particularly poor sleep, tiredness and anxiety — may also act as seizure triggers for some people with epilepsy.
Can perimenopause change seizures?
Possibly.
Research specifically examining menopause and epilepsy is still limited.
Oestrogen and progesterone both interact with brain signalling, and during perimenopause these hormone levels may rise and fall unpredictably.
Some people report:
more seizures
changes in seizure timing
clusters at different points of the month
changes in auras
or previously stable seizures becoming less predictable.
Others experience no noticeable difference.
A change in seizures during perimenopause should therefore be recorded and discussed rather than automatically assumed to be caused by hormones.
Catamenial epilepsy and menopause
People whose seizures have previously shown a strong menstrual relationship may be particularly interested in what happens during menopause.
In catamenial epilepsy, seizure frequency increases repeatedly during particular phases of the menstrual cycle.
Because perimenopause makes reproductive hormone patterns less predictable, some people with catamenial epilepsy may experience increased or less predictable seizures during the transition.
Epilepsy Action notes that some people with catamenial epilepsy report more seizures during the run-up to menopause, followed by fewer seizures once they are postmenopausal.
This is not guaranteed.
Menopause should not be expected to cure epilepsy.
Related Information Hub pages:
Menstruation and Epilepsy
Catamenial Epilepsy
After menopause
Once menopause has occurred, ovarian production of oestrogen and progesterone remains much lower than during reproductive life.
For someone whose seizures were strongly linked to menstrual hormonal fluctuations, removing those monthly fluctuations may change their seizure pattern.
However, epilepsy can continue after menopause and other factors still affect seizure control, including:
antiseizure medicine
sleep
illness
stress
alcohol
ageing
other medicines
and underlying epilepsy type.
Someone should continue taking antiseizure medication as prescribed unless their specialist recommends a change.
Menopause symptoms can sometimes resemble epilepsy-related problems
This can make the transition confusing.
For example:
Brain fog
Perimenopause may cause problems with concentration and memory.
Epilepsy itself and some antiseizure medicines can also affect memory and cognition.
Dizziness
Hot flushes and menopause symptoms can sometimes cause dizziness.
Some focal seizures, medicine side effects and blood-pressure changes can also cause unusual sensations.
Poor sleep
Night sweats can repeatedly wake someone.
Sleep deprivation may then increase seizure susceptibility in people who are sensitive to lack of sleep.
Anxiety and palpitations
Perimenopause can cause anxiety and a racing or pounding heartbeat.
Some focal seizures can also involve sudden fear or autonomic symptoms.
This overlap is one reason new symptoms should not automatically be labelled as either menopause or epilepsy without appropriate assessment.
Keep a record if things begin changing
A diary can help distinguish patterns.
Useful information can include:
seizure date and time
seizure type
duration
recovery
menstrual bleeding
hot flushes
night sweats
sleep
anxiety
missed medication
medicine changes
HRT changes
and other possible seizure triggers.
If HRT is later started, the diary can also show whether seizure frequency changes afterwards.
What is HRT?
Hormone replacement therapy replaces hormones that fall during perimenopause and menopause.
It can help symptoms including:
hot flushes
night sweats
disturbed sleep
mood changes
vaginal dryness
and other menopause symptoms.
HRT may contain:
oestrogen alone
or oestrogen together with a progestogen.
Someone who still has their uterus generally needs a progestogen alongside systemic oestrogen to protect the lining of the womb.
Oestrogen-only HRT is commonly used after hysterectomy.
Does having epilepsy mean HRT cannot be used?
No.
Epilepsy alone is not a reason to automatically rule out HRT.
Epilepsy Action states that HRT should remain an option for many people with epilepsy when menopause symptoms are affecting quality of life.
However, the decision needs to consider:
seizure control
epilepsy type
antiseizure medicines
other health conditions
the type of HRT
and the person's own preferences.
Can HRT make seizures worse?
The answer is not yet completely clear.
Only a small number of studies have specifically examined HRT in women with epilepsy.
An older study using a form of HRT that is not representative of many modern regimens found increased seizure frequency in some participants.
However, there is much less evidence concerning modern preparations, particularly transdermal HRT delivered through patches, gels or sprays.
Epilepsy Action therefore concludes that current evidence is insufficient to say that HRT generally triggers seizures.
If seizures increase after starting HRT, the change should be discussed with the epilepsy and menopause teams.
Oestrogen and seizures are not a simple relationship
Oestrogen is sometimes described as “pro-convulsant”.
That description is too simple when used on its own.
Sex hormones can alter neuronal excitability, but their effects depend on:
hormone concentration
receptors
brain region
epilepsy type
timing
and interaction with other hormones.
The amount and type of oestrogen used in modern HRT also differs from hormonal contraception.
Therefore, someone should not be told they cannot use HRT simply because it contains oestrogen.
HRT and lamotrigine
This interaction deserves particular attention.
Oestrogen can increase the metabolism of lamotrigine, potentially reducing the amount of lamotrigine in the bloodstream.
This interaction is well recognised with combined hormonal contraception, and available evidence suggests HRT may also reduce lamotrigine exposure in some people.
If lamotrigine levels fall sufficiently, seizure control could worsen.
Epilepsy Action recommends additional monitoring or review when HRT is started in someone taking lamotrigine.
A clinician may consider:
seizure monitoring
medicine-level testing where useful
clinical review
or dose adjustment.
Do not adjust lamotrigine independently.
Stopping HRT can matter too
If HRT has reduced lamotrigine levels and the HRT is later stopped, lamotrigine concentrations may rise again.
That could increase the risk of dose-related side effects.
So the epilepsy team should ideally know when someone:
starts HRT
increases it
reduces it
changes preparation
or stops it.
The same principle applies whenever a clinically important interaction is possible.
Some epilepsy medicines can affect HRT
The interaction can also work in the other direction.
Certain antiseizure medicines increase liver-enzyme activity and can make hormone treatments break down faster.
Examples include medicines such as:
carbamazepine
phenytoin
and phenobarbital.
The NHS specifically advises people taking epilepsy medicines such as these to tell the prescriber before using oestrogen-containing HRT.
This does not necessarily mean HRT cannot be used.
The dose, route or preparation may need reviewing.
Are patches or gels different from tablets?
Possibly.
HRT delivered through the skin is called transdermal HRT.
This includes:
patches
gels
and sprays.
Transdermal oestrogen avoids the first-pass liver metabolism that occurs with oral tablets.
The NHS notes that HRT patches are less likely than oral preparations to be affected by some interacting medicines.
However, epilepsy-specific evidence comparing every HRT route remains limited.
The best option should be discussed with a GP, menopause specialist, pharmacist or neurologist.
What about progesterone?
People who still have a uterus usually need a progestogen alongside systemic oestrogen to protect the womb lining.
One commonly prescribed option is micronised progesterone.
The NHS advises that epilepsy medicines such as carbamazepine and phenytoin may interact with micronised progesterone, so the prescriber should know about all antiseizure treatment.
The exact HRT combination should therefore be chosen using the person's complete medicine list.
Sequential and continuous HRT
HRT may be prescribed in different patterns.
Sequential HRT
This is commonly used during perimenopause when periods are still occurring.
Oestrogen is usually taken continuously, while a progestogen is added for part of each month.
This normally produces a regular withdrawal bleed.
Continuous combined HRT
After menopause, oestrogen and progestogen may be taken continuously without a monthly withdrawal bleed.
The appropriate regimen depends on factors including:
whether periods are still occurring
whether the person has a uterus
symptoms
age
health risks
and individual preference.
Epilepsy medicines should be considered whichever regimen is chosen.
Vaginal oestrogen
Some people mainly experience symptoms such as:
vaginal dryness
soreness
pain during sex
or urinary symptoms.
Low-dose vaginal oestrogen can be used specifically for these symptoms.
This delivers much smaller systemic hormone exposure than conventional systemic HRT.
Whether it is appropriate still depends on individual medical history, and medicine interactions should be checked where relevant.
What if someone does not want HRT?
There are other approaches.
Current NICE menopause guidance recommends menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms such as hot flushes and night sweats:
alongside HRT
when HRT is unsuitable
or when someone prefers not to use HRT.
CBT can also help with some:
sleep problems
mood symptoms
and coping with physical menopause symptoms.
Other non-hormonal treatments
Depending on symptoms and medical history, clinicians may discuss other medicines.
Current NHS guidance notes that non-hormonal treatments may be considered when HRT is unsuitable or unwanted.
As of 2026, NICE also recommends fezolinetant as an option for moderate to severe vasomotor symptoms when HRT is unsuitable.
Anyone with epilepsy should still have potential interactions checked before starting another medicine.
Herbal menopause remedies need caution
“Natural” does not automatically mean safe with epilepsy medicines.
Products marketed for menopause may contain substances such as:
St John's wort
black cohosh
red clover
ginseng
or other herbal ingredients.
The NHS warns that herbal menopause products can interact with medicines and specifically notes that St John's wort can reduce the effectiveness of some HRT preparations.
St John's wort can also interact with various prescription medicines.
Tell the pharmacist or doctor about supplements as well as prescribed medicines.
Menopause and bone health
This is particularly important in epilepsy.
Bone density naturally decreases with age, and the fall in oestrogen after menopause increases the risk of osteoporosis.
Some antiseizure medicines can also reduce bone strength when used long term.
This means that someone with both risk factors may need particular attention to bone health.
Which epilepsy medicines are associated with bone problems?
Current Epilepsy Action guidance identifies clearer evidence for long-term bone effects with medicines including:
carbamazepine
phenobarbital
phenytoin
primidone
and sodium valproate.
Topiramate may also affect bone health, although more research is needed.
Evidence concerning newer medicines is less certain.
This does not mean someone should stop these medicines.
Uncontrolled seizures carry their own risks, including falls and fractures.
What is osteoporosis?
Osteoporosis causes bones to become less dense and more fragile.
This makes fractures more likely.
A milder reduction in bone density is called osteopenia.
Risk increases with age and is particularly important after menopause because lower oestrogen levels accelerate bone loss.
Why seizures make bone health even more important
A fracture is more likely to occur if fragile bones are combined with seizures that cause:
collapse
sudden loss of muscle tone
tonic stiffening
uncontrolled movement
or falls.
So bone health is not simply a separate menopause issue.
For some people it can directly affect the consequences of their seizures.
How is bone health assessed?
A clinician may assess factors including:
age
menopause status
previous fractures
family history
antiseizure medicines
duration of treatment
weight
smoking
alcohol
physical activity
diet
vitamin D
and other medical conditions.
Some people may be referred for a DEXA scan, which measures bone mineral density.
Supporting bone health
Measures that can support bone health include:
regular weight-bearing exercise
adequate dietary calcium
maintaining vitamin D
avoiding smoking
limiting excessive alcohol
and assessing osteoporosis risk where appropriate.
Epilepsy Action notes that vitamin D and calcium supplementation may be recommended for some people taking medicines associated with bone loss.
Individual advice is important because supplements are not automatically needed at the same dose for everyone.
HRT and bone health
HRT can help protect bone density during and after menopause.
For someone with epilepsy who already has additional osteoporosis risk from long-term antiseizure treatment, this may form part of the discussion about the potential benefits and risks of HRT.
HRT should not be prescribed solely on the assumption that every person with epilepsy has weak bones.
Risk should be assessed individually.
Memory problems: menopause, epilepsy or both?
“Brain fog” is commonly reported during perimenopause.
Symptoms can include:
difficulty concentrating
losing words
forgetting why someone entered a room
reduced mental sharpness
and difficulty keeping track of tasks.
Epilepsy, poor sleep and some antiseizure medicines can produce similar difficulties.
Several factors may therefore be contributing at the same time.
If memory changes become significant, discuss them rather than automatically assuming they are an unavoidable part of menopause.
Sleep deserves particular attention
Night sweats, hot flushes, anxiety and insomnia can repeatedly interrupt sleep.
For someone whose seizures are triggered by sleep deprivation, treating menopause-related sleep disturbance may indirectly help seizure management.
This does not mean treating menopause is a treatment for epilepsy.
It means that improving a recognised seizure trigger may support overall control.
Mood and anxiety
Perimenopause can cause:
anxiety
irritability
mood changes
and low mood.
Epilepsy can also affect emotional wellbeing, and some antiseizure medicines can influence mood.
Someone experiencing major emotional changes may therefore need both their menopause symptoms and their epilepsy treatment considered.
NICE recommends menopause-specific CBT as one option for menopause-related symptoms, while depression or anxiety may require their own assessment and treatment.
Menopause at work
The combination of epilepsy and menopause may affect work through:
fatigue
poor sleep
memory problems
difficulty concentrating
hot flushes
anxiety
and changes in seizure control.
It may not always be obvious whether a symptom comes from menopause, epilepsy, medication or several factors together.
Keeping a record can help when discussing problems with healthcare professionals or workplace support.
Early menopause
Menopause before the age of 45 is generally described as early menopause.
Loss of ovarian hormones at a younger age has additional implications for long-term bone and cardiovascular health.
NHS guidance states that HRT or, in some circumstances, the combined contraceptive pill is particularly important to consider in people experiencing early or premature menopause, unless there is a medical reason they cannot use it.
For someone with epilepsy, the chosen hormonal treatment also needs to be checked against their antiseizure medicines.
Premature ovarian insufficiency
Menopause-like loss of ovarian function before the age of 40 is generally described as premature ovarian insufficiency, or POI.
This requires medical assessment rather than being assumed to be normal variation.
Treatment is often recommended until around the average natural menopause age to protect areas such as bone health, unless there is a contraindication.
Epilepsy and medication interactions still need to be considered when choosing treatment.
Contraception during perimenopause
Irregular periods do not necessarily mean pregnancy is no longer possible.
Ovulation may still occur unpredictably during perimenopause.
Someone who does not want to become pregnant may therefore still need contraception until menopause has been established according to appropriate clinical guidance.
For people taking antiseizure medicines, contraceptive interactions continue to matter during this period.
Related Information Hub page:
Contraception and Epilepsy
A seizure change should not automatically be blamed on menopause
If seizures suddenly worsen, consider other explanations too.
These may include:
missed medication
poor sleep
illness
new medicines
medicine interactions
alcohol
stress
metabolic problems
or changes in the epilepsy itself.
A new seizure type, prolonged seizure, loss of previously established control or major increase in frequency deserves medical review.
Starting HRT: what should be recorded?
If HRT is started, it may help to note:
HRT name
dose
route
date started
any dose change
seizure frequency before treatment
seizure frequency afterwards
side effects
sleep changes
and menopause symptom changes.
This can help the epilepsy and menopause teams decide whether treatment is helping and whether epilepsy medication needs reviewing.
Questions to ask the GP or epilepsy team
Useful questions include:
Could these symptoms be menopause, epilepsy or medication side effects?
Have my seizures changed in a pattern that suggests hormonal influence?
Is HRT suitable for me?
Would a patch or gel be preferable to tablets?
Does my epilepsy medicine interact with HRT?
Could HRT affect my lamotrigine level?
Should my medicine level be monitored?
What should I do if seizures increase after starting HRT?
What should happen if I later stop HRT?
Am I at increased risk of osteoporosis?
Should I have vitamin D testing?
Do I need a fracture-risk assessment or DEXA scan?
Are there non-hormonal treatments that would suit me?
Taking an up-to-date medication list to the appointment can make these discussions easier.
The most important message
Menopause does not affect every person with epilepsy in the same way.
For some people, the hormonal fluctuations of perimenopause may coincide with changes in seizures.
For others, the more important effects may come indirectly through:
poor sleep
anxiety
exhaustion
or changes in medication.
People with catamenial epilepsy may be more likely to notice seizure changes during the menopause transition, although seizure patterns after menopause still vary between individuals.
Epilepsy is not an automatic reason to refuse HRT.
Modern evidence specifically examining HRT and epilepsy is limited, so treatment should be individualised and seizure control monitored.
Special attention may be needed with lamotrigine and with enzyme-inducing antiseizure medicines because hormone treatment and epilepsy medicines can interact.
Bone health is also particularly important because both menopause and long-term use of some antiseizure medicines can increase osteoporosis risk.
The aim is not to decide whether every new symptom belongs to epilepsy or menopause.
It is to recognise that the two can overlap — and make sure both are properly considered.
Sources and further reading
Epilepsy Action — Epilepsy, the menopause and HRT.
Detailed UK information covering perimenopause symptoms, hormonal changes, seizures, HRT, lamotrigine interactions and bone health.
NICE — Menopause: identification and management (NG23).
Current guidance covering HRT, menopause-specific CBT and other treatment options. The guidance includes 2024 updates and a 2026 recommendation on fezolinetant for moderate to severe vasomotor symptoms when HRT is unsuitable.
NHS — Treatment for menopause and perimenopause.
Current NHS guidance on HRT, non-hormonal treatment and menopause care. Page reviewed May 2026.
NHS — HRT and medicine interactions.
NHS information advises checking HRT with epilepsy medicines and identifies interactions involving medicines including phenytoin, carbamazepine and phenobarbital.
Epilepsy Action — Bone health and epilepsy.
Current information on osteoporosis risk associated with epilepsy medicines, menopause, vitamin D, exercise and bone-density assessment. Updated in 2026.
Epilepsy Society — Menopause and epilepsy.
UK information covering HRT, hormones and possible seizure changes around menopause.
Information reviewed: September 2026.
This page provides general educational information. Menopause treatment and epilepsy-medicine interactions should be considered individually with a GP, neurologist, epilepsy specialist nurse, pharmacist or menopause specialist. Do not change antiseizure medication without medical advice.
