Epilepsy in girls

As girls with epilepsy approach adolescence, their care may need to evolve. Hormonal changes, mental health and future reproductive health can all play a role. Understanding and preparing for these factors can help families feel more prepared and supported.

Somewhere between 10-40% of girls with epilepsy will experience catamenial epilepsy, which are seizures triggered or worsened by hormonal changes tied to the menstrual cycle.

“We follow adolescent girls to help identify seizure patterns related to hormones early and adjust medications if needed,” says Nayana Prabhu, M.D., Pediatric Neurologist and Epileptologist at Children’s Health℠ and Assistant Professor at UT Southwestern. “We also routinely screen for anxiety and depression, which are more common during the teen years – especially for girls with epilepsy.”

Dr. Prabhu shares guidance and treatment options for hormone-related seizures and addresses common concerns about mental health, birth control and future pregnancy.

How hormones can affect epilepsy in girls

Some girls experience their first seizures around the time they begin menstruating. Others notice that seizures become more frequent around the time of their cycles.

These changes are related to normal hormonal shifts of both estrogen and progesterone during the menstrual cycle.

• Estrogen can increase brain excitability, making a seizure more likely.

• Progesterone helps protect the brain and reduces the likelihood of seizures.

Identifying hormone-related seizures in girls

Parents may notice a consistent pattern of increased seizure frequency during specific phases of their daughter's menstrual cycle. Identifying a pattern around when those happen can take at least three months.

Hormone-related seizures may occur:

• Just before or during a period

• Around ovulation (mid-cycle)

• Between menstruation and ovulation

Knowing when a girl’s seizures occur in relation to their menstrual cycle can help doctors diagnose catamenial epilepsy and help determine the most effective treatment approach.

Treating hormone-related seizures

Once a pattern is identified, an epileptologist can consider certain options to manage seizures.

1. Hormonal treatments. Your child’s epileptologist can work closely with a gynecologist or adolescent medicine specialist to consider hormonal treatment like progesterone-only pills to target the hormonal imbalance that causes worsening seizures. “These treatments are effective in girls who experience a rise in seizures around the time of their period,” says Dr. Prabhu.

2. Non-hormonal treatments. In some cases, it can work well to adjust a girl’s anti-seizure medication around her cycle – or consider a different seizure medication altogether.

Epilepsy and birth control

Girls with epilepsy can safely use birth control. But there are some important additional considerations.

• Some anti-seizure medications (enzyme-inducing medications) can lower the effectiveness of oral hormonal birth control. This can increase the risk of an unplanned pregnancy.

• Intrauterine devices, Depo-Provera shots and progesterone implants are often considered the most effective birth-control options for girls with epilepsy because they are not affected by anti-seizure medications.

• Birth control that includes estrogen may lower the level of certain antiseizure medications like lamotrigine. If the dose of the antiseizure medication is not adjusted, the medicine may not work as well, which could lead to more seizures.

Self-esteem or mental health concerns

About 1 in 3 adolescent girls with epilepsy experience anxiety or depression. Some contributing factors may include:

• Worrying about having a seizure in public

• Feeling different from peers

• Concerns about sleepovers, travel or independence

• Driving restrictions

• Medication side effects such as weight changes, acne or hair thinning

• Uncertainty about the future

Epilepsy can affect how a teenage girl feels about herself, both emotionally and physically. Regular behavioral and mental health screenings during clinic visits can help identify concerns early and provide timely support from a team of psychologists and psychiatrists.

Strong family support, encouraging independence and normalcy in girls with epilepsy, also helps protect self-esteem and promote emotional well-being.

Concerns for the future

Many families wonder what epilepsy may mean for pregnancy and family planning later in life.

“I reassure families that having a family is absolutely possible,” says Dr. Prabhu. “It just requires planning and the right medical support.”

Some seizure medications can affect menstrual cycles, fertility or pregnancy safety. That’s why early conversations and careful medication planning are important.

By working closely with an epileptologist and an OB/GYN, women with epilepsy can safely transition to medications that support both seizure control and healthy pregnancies.

Asking questions to feel empowered

Open communication with your child’s care team can help you support your child – now and in the future. Consider asking:

• What should we know about epilepsy and reproductive health?

• How can I support my child’s mental health?

• Are there epilepsy support groups for kids or teens?

• How do treatment options vary by epilepsy type?

• How can we prepare for the transition to adult epilepsy care?

“I remind parents that epilepsy is a medical diagnosis – not a limitation,” says Dr. Prabhu. “With the right, individualized care, many kids with epilepsy grow up to pursue their education, careers, relationships and independence.”

Epilepsy 101 (for parents and caregivers)

Explore resources to help you support your child with epilepsy and tune in to the Children's Health Checkup podcast for a three-part series focused on understanding and managing epilepsy in children (available in English and Spanish).

Learn more

Children's Health provides comprehensive, expert and compassionate epilepsy care, close to home for families in Dallas and Plano. Learn more about our Pediatric Epilepsy Program.