New menopause guidelines “disappointing” for people with epilepsy

The National Institute for Health and Care Excellence (NICE) has published its updated guidelines on menopause today.

However, Epilepsy Action warns that epilepsy has been left behind in the update.

There is a connection between hormonal changes and epilepsy for some people, known as catamenial epilepsy. Perimenopause and menopause occur when hormone levels drop, and the symptoms can be treated with hormone replacement therapy (HRT).

The Epilepsy Action websites says that there have only been a very small number of studies looking at HRT and epilepsy. It says that, at the moment, there’s not enough evidence to say whether HRT could affect seizures.

However, the guidelines don’t mention epilepsy in their ‘key recommendations for research’ section, which Epilepsy Action says is “disappointing”, as this is already an under-researched area.

‘Bridge that gap’

Ann Richardson-Greaves, director of services at Epilepsy Action, says: “While it’s welcome to see HRT as the preferred treatment for the menopause, it’s disappointing to see epilepsy being left behind once again. We know the menopause, especially perimenopause, can affect seizures. We also know that some people with epilepsy may go through the menopause earlier.

“But we still don’t have much research and data about those connections. We still don’t know exactly how the changes in hormones during the menopause affect brain activity and epilepsy. We’ve only scratched the surface when it comes to studying how HRT can affect epilepsy. There’s very little research into the newer types of HRT treatment, too.

“Without more research, people who are navigating both epilepsy and menopause continue to face uncertainty and gaps in their healthcare. It’s time to bridge these gaps and provide the support, guidance, and reassurance that every person with epilepsy deserves.”

Since being first published in 2015, the guidelines have mentioned that St John’s wort, an unregulated complementary therapy, can have “potential serious interactions” with other medicines, including anticonvulsants.

They also mention that menopause can lead to osteoporosis (a thinning and weakening of the bones). This can also affect people taking epilepsy medicines over a period of time. The guideline says that HRT can help protect bones from weakening.