Dr Louise Newson’s 9 July 2026 podcast with menopause specialist nurse Sian Rees says around one in three women with epilepsy experience hormone-related changes in their seizures, and that symptoms can worsen during perimenopause.
Perimenopause can last from a few months to several years, and the hormonal changes linked to menopause can affect physical, emotional, mental and social well-being. In women with epilepsy, that wider symptom burden can overlap with seizure instability, sleep disruption and mood change.
Hormone changes during perimenopause and menopause can affect epilepsy. Perimenopause hormone fluctuation can change seizure frequency, and women with epilepsy going through menopause can see a change in seizure patterns. Epilepsy is not a reason to avoid hormone replacement therapy, but women should be monitored if HRT is started because epilepsy medicine may need adjusting. NICE recommends HRT as a first treatment for vasomotor symptoms and low mood due to menopause.
A 1999 PubMed review found the effect of perimenopause and menopause on epilepsy had received scant attention and that no retrospective or prospective published studies were available at the time. It is not fully understood how menopause affects women with epilepsy, and the impact of HRT on epilepsy is not known. The Health Research Authority’s Epilepsy and Menopause Register is set to examine menopause status, seizure frequency and epilepsy comorbidities including depression, anxiety, cognitive impairment, sleep disturbance, osteoporosis and cardiovascular disease.
Catamenial epilepsy and seizure exacerbation are common in women with epilepsy, and women may not receive appropriate treatment for menstrual-related seizure worsening because of uncertainty about which treatments work best and when they should be taken.