Reproductive dysfunction in women with epilepsy: Menstrual cycle abnormalities, fertility, and polycystic ovary syndrome

Epilepsy can be associated with reproductive endocrine disorders. In women these include polycystic ovary syndrome (PCOS), isolated components of this syndrome such as polycystic ovaries or hyperandrogenemia, hypothalamic amenorrhea (HA), or functional hyperprolactinerma (HPRL). The most likely explanations for endocrine disorders related to epilepsy are a direct influence on the endocrine control centers in the brain (the hypothalamic-pituitary axis) or are effects of antiepileptic drugs (AEDs) on peripheral endocrine glands. Furthermore, the effects of AEDs on the metabolism of hormones and binding proteins and secondary endocrine complications of AED-related weight changes or changes of insulin sensitivity must be considered. Therefore, regular monitoring of reproductive function at visits, including questioning about menstrual disorders, fertility, weight, hirsutism and galactorrhea are recommended. Single abnormal laboratory or imaging findings without symptoms may not constitute a clinically relevant endocrine disorder. However, patients with these kinds of abnormalities should be monitored in order to detect the possible development of a symptomatic disorder associated with, for example, menstrual disorders or fertility problems. If a reproductive endocrine disorder is subsequently found, AEDs should be reviewed in terms of their indication for the particular seizure type and their tolerability vis-a-vis their potential for contributing to the endocrine problem.