How Hormonal Fluctuations Impact Neurological Health in Women

Hormones & Neurology: Female Life Stages Through a Brain-Healthy Lens

Understanding how fluctuating hormones affect neurological health is especially vital for women. Whether it’s seizures worsening around menstrual cycles, migraines becoming more frequent during perimenopause, or seizure management during pregnancy and lactation, hormonal dynamics profoundly influence the brain.

The Dance of Estrogen and Progesterone: Catamenial Epilepsy

• Catamenial epilepsy refers to seizure patterns that worsen during specific menstrual phases. It affects roughly one-third of women with epilepsy (Epilepsy Society, 2023) Epilepsy Society.
• Estrogen is generally pro-convulsant—it tends to increase neuronal excitability—while progesterone has the opposite, anti-convulsant effect Minnesota Epilepsy GroupScienceDirectEpilepsy FoundationWikipedia.
• Seizures most frequently worsen:
  • Around ovulation (mid-cycle), when estrogen peaks
  • Perimenstrually, when both estrogen and progesterone levels drop dramatically (C1 pattern) Epilepsy FoundationWikipedia.
• Clinical tracking through seizure diaries linked to menstrual cycles aids diagnosis and tailored treatment Epilepsy SocietyEpilepsy Foundation.
• Treatment strategies may include:
  • Non-hormonal options, such as adjusting antiseizure medications around risk periods
  • Hormonal interventions (e.g., progesterone therapy, contraceptives like Depo-Provera or levonorgestrel IUD) with attention to interactions and individual fertility plans CochraneNeurology AdvisorIJMSRI.

From Perimenopause to Menopause

• During perimenopause, irregular hormone fluctuations—especially declining estrogen and progesterone—can lead to “brain fog,” migraines, and worsening seizure control Alan R. Jacobs MD PC.
• Once in menopause, many women experience stabilization or even improvement in seizure patterns, particularly those with catamenial epilepsy, since hormone cycles end WikipediaWinona Wellness.
• However, those using hormone replacement therapy (HRT) may see increased seizure frequency and severity, necessitating vigilant monitoring Wikipedia.

Migraines & Other Hormone-Sensitive Neurological Conditions

• Migraines, particularly menstrual migraines, are also hormone-sensitive. Estrogen withdrawal often triggers migraine episodes, highlighting the tie between reproductive hormones and neural vascular regulation SpringerLink.
• Other neurological conditions—such as multiple sclerosis, Parkinson’s disease, and stroke—are shown to be influenced by menstrual cycle hormone fluctuations, underscoring the broader neuroendocrine connection SpringerLink.

Reproductive Considerations: Fertility, Pregnancy & Beyond

• Fertility issues are more common in women on certain antiseizure medications (ASMs), including valproate, which is also linked to polycystic ovary syndrome (PCOS) Epilepsy SocietyVerywell Health.
• During pregnancy, ASMs may require frequent dose adjustments because of changes in metabolism and drug clearance. Careful tracking and folic acid supplementation are essential to minimize risks to both mother and baby Wikipedia+1.
• Lactation further demands attention, as many ASMs pass into breast milk; however, breastfeeding is generally encouraged, with thoughtful monitoring Wikipedia.

Why a Multidisciplinary Approach Is Essential

Given the complexity of hormone-brain interactions across life stages, optimal care requires collaborative teams:

• Neurologists to titrate medications and recognize hormone-related patterns.
• Gynecologists/endocrinologists to manage hormonal therapies and contraceptive strategies.
• Reproductive medicine specialists for fertility planning and pregnancy management.
• Psychologists/psychiatrists to address mood disorders like PMS/ PMDD, which often co-occur in these contexts arXiv.
• Primary care providers to lead holistic continuity of care across life transitions.

Action Step for Women with Neurological Conditions

Track and Connect

• Keep a 3-month seizure and symptom diary alongside menstrual cycle dates.
• Note triggers like migraines, mood changes, or cognitive shifts.
• Share patterns with your healthcare team to inform care decisions.

References

Epilepsy Society. (2023). Women and girls September 2023. Epilepsy Society

Effects of the menstrual cycle on neurological disorders. (Current Neurology and Neuroscience Reports, 21, 34). (2021). SpringerLink

Hormonal therapies & catamenial epilepsy. (Cochrane Review, CD013225). Cochrane

Catamenial epilepsy treatment approaches. (Neurology Advisor, 2021). Neurology Advisor

Hormonal vs. non-hormonal treatment review. (IJMSRI, 2025). IJMSRI

Pathophysiology: estrogen ≥ pro-convulsant; progesterone ≥ anticonvulsant. (Minnesota Epilepsy Group). Minnesota Epilepsy Group

Effects of estrogen/progesterone on seizure threshold. (Cleveland Clinic Journal of Medicine, 2004). Cleveland Clinic Journal of Medicine

Catamenial epilepsy overview and hormone mechanisms. (Wikipedia; pathophysiology & menopause). Wikipedia

Menopause’s impact on epilepsy. (ByWinona, 2025). Winona Wellness

Menopause-related brain and mood changes. (Neuroendocrinology.org). Alan R. Jacobs MD PC

Migraines and menstrual cycle-related neurological shifts. (Current Neurology and Neuroscience Reports, 2021). SpringerLink

Fertility, AEDs, and reproductive health. (Verywell Health, 2023). Verywell Health

Pregnancy seizure management in epilepsy. (Wikipedia – Epilepsy; Epilepsy and Pregnancy). Wikipedia+1

PMS/PMDD and brain imaging. (Aoki et al., 2024, arXiv preprint).