How can I manage catamenial epilepsy at 35 during periods?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

What you are describing sounds like catamenial epilepsy, where seizures become more frequent around your period due to hormonal fluctuations, especially estrogen and progesterone shifts. It is more common than most people realize in women with epilepsy. You are also right that Lamotrigine (an antiepileptic drug) levels can drop during certain phases of the menstrual cycle, especially around ovulation and menstruation, which may explain your increased seizure activity.

To manage this, there are a few strategies we can consider:

1. One is adjusting your Lamotrigine dose cyclically. Some women benefit from a temporary increase in dose during the high-risk period of their cycle (usually a few days before and during menstruation), which we would monitor carefully.

2. Another option includes adding a hormonal therapy, like natural progesterone (oral or vaginal) during the second half of your cycle, as progesterone has anti-seizure effects. For some patients, continuous birth control pills to suppress hormonal fluctuations altogether can also help, but since you are concerned about mood and fertility, we would need to tailor that carefully. Levetiracetam (an antiepileptic medication) is another anti-seizure medication sometimes added short-term just around menstruation.

It is important we also keep a seizure diary alongside your menstrual cycle for a couple of months, as this helps us pinpoint patterns and plan treatment precisely.

Regarding your concern about depression, Lamotrigine is generally mood-stabilizing, but some other anti-epileptic drugs can worsen mood, so we would avoid those. And yes, some seizure medications can affect fertility or pregnancy safety, so it’s good we’re thinking long-term too.

I hope this information helps you.

Feel free to ask further queries.

Thank you.