Reproductive dysfunction in women with epilepsy: recommendations for evaluation and management

The 2002 document reviews the association between epilepsy, antiepileptic drugs (AEDs), and reproductive endocrine disorders in women, such as polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea, and functional hyperprolactinaemia. It suggests that reproductive dysfunction in women with epilepsy may be caused by the direct effects of epilepsy or AEDs on the brain's endocrine control, peripheral endocrine glands, hormone metabolism, and insulin sensitivity. The document highlights that valproate, in particular, is linked to an increased risk of these disorders and recommends regular monitoring of reproductive function for women with epilepsy, especially those on valproate or experiencing obesity or significant weight gain. If a reproductive endocrine disorder is diagnosed, it is advised to reassess the AED treatment considering the balance between seizure control and the side effects of alternative drugs. The document concludes that reproductive dysfunction is common in women with epilepsy and underscores the importance of clinicians being vigilant about the potential impacts of epilepsy and AEDs on reproductive health.