Treatment guidelines: Women of fertile age

In women, from puberty, during pregnancy and to menopause, epilepsy presents several unique challenges to physicians and other health-care providers. Women with epilepsy have increased risks of sexual dysfunction, menstrual disturbances, premature menopause, and infertility; and seizure activity and severity can be influenced by the cyclic variations of sex hormones. Oral contraceptive efficacy can be affected by antiepileptic drugs and vice versa. Furthermore, the offspring of women receiving antiepileptic drugs are at increased risk for congenital malformations, and this risk is associated with specific drug regimens. Physicians have to understand and respond to these specific issues to ensure sufficient therapeutic decisions throughout the reproductive stages.