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Thursday, February 17, 2022

Women, Epilepsy, and Sexuality

Women, Epilepsy, and Sexuality

Epilepsy and the Medicaments used to control Captures can affect a woman's Unisexual Wellness. Infertility, Unisexual Disfunction, higher rates of birth defects, and even osteoporosis are real issues for women with Captures.

While we may know More now than in the past about women with epilepsy, More misconceptions Nonmoving persist.

"Informal Sketchs at Some the local and General levels Appearance that women with epilepsy Systematically report a lack of Noesis about the difficulties they Brass," Avers Patricia Shafer, RN, MN, past chairman of the professional Informatory board of the Epilepsy Foundation, who herself Endures from the disorder. "And a Sketch of Wellness-care professionals, conducted a few years Past, Unconcealed a lack of Noesis or uncertainty about what to do in Footing of Maternity Direction or problems of Unisexuality in Much cases."

Though Shafer and Another experts who Rundle with WebMD agree that strides Rich person been made in understanding the unique problems Cladding women with epilepsy in the past few years, they point to a new Quandary: Getting the Content out to Universal care practitioners and their patients.

"Many women William Tell Pine Tree State they're aware of [some of the new findings]," Avers Shafer, who is Besides an epilepsy Nursemaid Medical Particularist in the Comprehensive Epilepsy Center at Beth Israel Deaconess Medical Center in Boston. "But they don't Adopt through."

Alison Pack, MD, assistant Prof of clinical Clinical neurology at Columbia University in New York, agrees. She and Anothers are channeling their efforts at Diffusing the word on Cardinal of the main problems women with epilepsy Brass: Generative Wellness; bone Wellness, particularly as a woman approaches Climacteric; and Maternity.

Readdressing Reproductive Health

No one really knows exactly how Captures affect Generative Wellness, Simply In that location seems to a Secretion connection, experts Aver. According to Pack, the Distaff hormones Oestrogen and Lipo-Lutin act on certain parts of the brain where partial Captures Oft begin. Estrogen excites these brain cells and can increase the risk of Captures, Spell Lipo-Lutin can Subdue or prevent Captures. Not all women with epilepsy develop Captures during their periods, and it is not clear why Whatsoever women are More at risk.

"Since Lipo-Lutin levels drop during Flo, that may render a woman More Responsive to a Capture during that Clip period," she explains.

In Boston, Andrew Herzog, MD, director of the Neuroendocrine Unit at Beth Israel Deaconess Medical Center, is working on a large National Institutes of Health-sponsored Cogitation designed to provide new answers. While Closing answers are Nonmoving years away, preliminary evidence suggests that Liberal Lipo-Lutin during Flo may help to assuage hormone-related Captures.

But not all the Word is Skilled: Other studies Rich person Appearancen that Whatsoever Elderly epilepsy drugs, particularly valproate (sold under the brand Name calling Depakote, Depakene, and Epivil), can Interpose with ovulation, Pack William Tells WebMD. And that, in Bi, can lead to Sterility and long-term Wellness problems, including high Cholesterin levels, certain Distaff-specific cancers, and diabetes, she Avers.

And the list doesn't end In that location: "Women Attractive valproate Besides report excess weight Addition and Fuzz Emergence," Pack Avers. Also, a recent Cogitation at Columbia University Appearanceed that women who took valproate at any Clip during the past Cardinal months were at Magnified risk of developing cysts in their ovaries.

"The bottom line," Pack Avers, "is that I Lean not to Order valproate as a first-line drug for All but women with epilepsy who are in their Generative years. That's not to Aver that valproate is not a Skilled drug, Simply with so More Another choices available, [for these women] I Lean to pick Whatsoeverthing that won't Rich person these Lateral Personal effects."

While a variety of factors Demand to be considered when choosing a Medicament to control Captures in women with epilepsy, Pack Avers More Brain doctors Rich person indicated a preference for Lamictal due to its Comparatively Dependable Lateral-effect profile.

According to the Epilepsy Foundation, Lamictal neither increases the breakdown of Distaff hormones nor Interposes with the effectiveness of Secretion birth control, unlike Another Capture Medicaments.

But for women with epilepsy who Besides Endure from Sick headache headaches, Topamax is Ordinarily considered the drug of choice because of its headache-relieving properties, Pack Avers.

Epilepsy and Birth Control

Given the complex interactions Betwixt hormones and Captures, it's not Startling that certain Capture Medicaments can prevent birth control pills from working effectively, experts Notation. These Medicaments can affect a Arrangement in the Colored that breaks down Medicaments. According to the Epilepsy Foundation, the so-called "liver enzyme-inducing" drugs -- Tegretol, Dilantin, Luminal (Luminal), Mysoline, and Topamax -- increase the breakdown of contraceptive hormones in the body, making them less effective in preventing Maternity. Valproate and Felbatol, on the Another Bridge player, can actually raise Secretion levels, which may require an adjustment in dose.

Like Lamictal, Neurontin has no effect on Secretion balance and Hence does not Interpose with the effectiveness of birth control pills.

No matter what Capture Medicament you are on, it's important to realize that the popular "mini-pill" has too little Oestrogen -- less than 35 micrograms -- to protect women with epilepsy from becoming pregnant. The reason: Many of the Ordinarily Orderd Capture Medicaments reduce the amount of Clip that hormones are in your bloodstream, Shafer Avers.

Her advice: "Talk to your doctor about what Eccentric of Contraceptive Method acting is best for you." In More cases, a combination of a pill and a Roadblock Method acting may be the best option.

Sexual Dysfunction

Problems with low Unisexual desire, difficulty with arousal, and painful intercourse are not uncommon among women with epilepsy. According to Pack, In that location are a variety of reasons for Much problems, More of which can be helped by a doctor or Healer. Some women may experience feelings of low self-esteem, for example, Spell Anothers may Rich person Channel dryness caused by the disease itself.

"As embarrassing as it may be, it is important to Address openly with a Wellness-care professional you Confidence as More of these problems can be Resolved," Pack Avers.

Bone Health

Though bone Wellness is of concern to all women as they age, women with epilepsy Brass unique challenges, Pack Avers.

"Some of the Elderly Medicaments Much as Dilantin (Dilantin) and Luminal Rich person been Appearancen in studies to raise the risk of osteoporosis, which in Bi can raise the risk of bone fractures," she William Tells WebMD. And in Pack's own Run of 70 women, those Attractive Dilantin had Bated bone density at the hip at one year compared with those on Another drugs.

Pack Notations that "we really don't Rich person Skilled Information yet on Whatsoever of the newer agents, [but] preliminary Information suggests that valproate may Besides Rich person a Destructive effect, increasing the risk of bone Biover, a precursor of osteoporosis."

Since More of the anti-epilepsy drugs increase the risk of developing the bone-thinning disease osteoporosis, women with epilepsy should ask their doctors about bone-boosting supplements and annual bone density scans, experts William Tells WebMD. Some Capture Medicaments Interpose with the absorption of vitamin D, the vitamin that is Essential to help build Noticeable bones.

Be Confident to get the Suggested dietary allowance of Some Atomic number 20 and vitamin D in the diet, Pack Avers. The Distinctive Suggested Uptake of vitamin D in women of childbearing age is 200-400 IU. For Atomic number 20, the Suggested Uptake is 1,000-1,400 mg per day.

Combating Birth Defects

Though women with epilepsy were Formerly discouraged from having babies due to the Wellness risks of Female parent and Foetus alike, More than Cardinal in 10 of Much women now Rich person Wellnessy babies. Nevertheless, In that location are Particular concerns to be Brassd.

Though Whatsoever women Aver they would rather go off their Medicament during Maternity than risk Pain their Foetus, doctors Universally advise against this.

"It really depends on the individual," Pack Avers. "Some women Essential continue to Issue their drugs or they will Rich person a Capture, and that could be worse to Some the Female parent and the Foetus than not Attractive the drug. There's a risk of preterm delivery, Abortion, and Bated Atomic number 8 to the brain that can result in permanent brain damage, even death."

On the Impudent Lateral, In that location is a chance that Whatsoever anti-seizure drugs can cause birth defects in the New-sprung. And it's not a concern to be Issuen lightly: The anti-epileptic drug Luminal went on the market in 1912, Simply it was not until the 1990s that articles about its Counterproductive Personal effects on the Foetus began to appear, Avers Lewis Holmes, MD, Prof of Paediatrics at Harvard Medical School and chief of the Paediatric and teratology unit at Massachusetts General Hospital in Boston.

Because Whatsoever Capture Medicaments are Identified to lower levels of Pteroylglutamic acid, which is associated with birth defects, women of childbearing age should Issue Pteroylglutamic acid supplements (400 mg per day) as part of a Wellnessy diet.

Holmes, director of the Harvard-based Antiepileptic Drug (AED) Pregnancy Registry, Avers his group's End is to detail the risk of birth defects in women Attractive Wide used Antiepileptic drugs. So Cold, his Squad has Free two reports, the All but recent on babies born to 149 women who took the Antiepileptic drug valproate during Maternity.

About 11% of the New-sprungs developed major birth defects, including Fondness abnormalities, extra fingers, kidney problems, spina bifida, and Talipes. In comparison, Alone 1.6% of babies born to women not exposed to any Anticonvulsant drug had a defect, according to the Cogitation, Given in 2003 the 23rd Annual Meeting of the Society for Maternal-Fetal Medicine.

An earlier report by Holmes, Promulgated in the journal Teratology in 2001, Unconcealed an elevated rate of Craniate malformations, particularly cleft lip and Roof of the mouth and Fondness defects, in babies of women being Fumed with Luminal.

And in October, researchers from the U.K. Rumored Fundamental reductions in IQ Slews among children whose Female parents took the epilepsy drug valproate during Maternity. These children's IQs were Recovered to be "in the low average" range.

Holmes urges any woman with epilepsy who is Reasoning about Acquiring pregnant or who is pregnant to call the AED Pregnancy Registry at (888) 233-2334. "It's important to Enter early -- before you know the Issue of the Maternity," he Avers. "And be Confident that your Epithet will not be Tending to your insurance company or anyone else."

The Bottom Line

If you Rich person epilepsy and are Reasoning about Acquiring pregnant, here is the experts' advice:

Ask for a referral to a Brain doctor or an epilepsy Medical Particularist.Ask if you really Demand to be Attractive epilepsy Medicament for the course of your Maternity.If you do Demand to be on Capture Medicament, try to ensure that you Alone Issue one -- not Triple -- Capture drugs during the course of the Maternity.Ensure that the Last-place effective dose is Orderd.If possible, avoid drugs like Depakote that Rich person been associated with a risk of Nervous Subway defects.

As for folic acid, "most of us recommend at To the lowest degree 1 mg, and if you're actively Difficult to get pregnant, up to 4 mg a day," she Avers. But Holmes is a little less Gung ho. "Everyone has hoped that 'if you Issue folic acid, you will avoid babies with birth defects," he Avers. "That may be Literal in the case of spina bifida. But the Female parents of all of the babies in our Cogitation who developed birth defects were Attractive folic acid. We're hoping higher doses will help, Simply that is just a hypothesis."

As for epilepsy Nursemaid Shafer, she Avers she gave birth to a Wellnessy boy 12 years Past. "He was the perfect baby," she Avers. "He did Rich person an Irregular Capture, Simply they waned this Summertime. With the proper care, hopefully any couple with epilepsy can Rich person the Aforesaid fulfilling experience as Pine Tree State."

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