Women with epilepsy considering HRT have extra factors to consider.
Impact on seizures: One small study suggested that seizure frequency increased in women who used HRT, but another study found that women who used the type of HRT that includes progestin (a form of progesterone) were much less likely to have worsening of their seizures than those who took only estrogen.
Impact on bone health: The role of HRT in preventing osteoporosis can be especially important for women with epilepsy, since seizures can increase the risk of falling and breaking weakened bones. The problem is worsened by the fact that certain seizure medicines can cause bone loss. These medicines include phenytoin (Dilantin or Phenytek), carbamazepine (Tegretol or Carbatrol), phenobarbital, primidone (Mysoline) and valproic acid/valproate (Depakene or Depakote). Women who take these medications should be especially careful to get enough vitamin D and calcium. Exercise is also important to and keep bones strong. If you and your doctor decide against HRT, you can try one of the other medications that can help keep your bones strong.
Impact on hot flashes: If you are troubled by hot flashes, you may be interested in a recent report that the seizure medicine gabapentin (Neurontin) can reduce their frequency and severity. This could be an alternative approach for some women. Talk to both your neurologist and gynecologist about the best way to manage the changes of menopause without upsetting your seizure control or causing other health problems.