Hormonal replacement therapy (HRT) is used for symptomatic treatment of menopause.
Some evidence suggests a proconvulsant effect of estrogen and an anti-convulsant role
of progesterone. Thus, the use of exogenous sex steroid hormones might influence the
course of epilepsy in peri- and postmenopausal women with epilepsy (WWE). We conducted
a systematic review on the impact of HRT on the frequency of seizures of WWE.PubMed
and Scopus were searched for articles published from inception until August 2022.
Abstracts from the last five years from the European Academy of Neurology and European
Epilepsy Congresses were also reviewed. Article reference lists were screened, and
relevant articles were retrieved for consultation. Interventional and observational
studies on WWE and animal models of estrogen deficiency were included. Critical appraisal
was performed using the Revised Cochrane risk-of-bias tool for randomized trials and
ROBINS-E tools. Results Of 497 manuscripts screened, thirteen studies were included,
including three human studies. One cross-sectional study showed a decrease in seizures'
frequency in WWE using combined HRT, a case-control study showed an increase in comparison
with controls and a Randomized Clinical Trial found a dose-dependent increase in seizures'
frequency in women with focal epilepsy taking combined HRT. Ten studies addressing
the impact of HRT in rat models were also included, which showed conflicting results.
Discussion and Conclusion There is scarce evidence of the impact of HRT in WWE. Further
studies should evaluate the harmful potential and prospective registries are needed
for monitoring in this population.
