Sexual and reproductive dysfunction in women with epilepsy in the aspect of current anti-epileptic pharmacotherapy

Abstract

Based on current literature analysis this review provides information on various issues of a woman’s reproductive system functioning under altered conditions of a pathologically functioning brain during epilepsy, outlines possible pathogenetic mechanisms of hormonal imbalance and its effect on epileptogenesis. There are complex multidirectional interactions between female sex hormones and epileptic pathological process. Any changes in the concentrations of endogenous or exogenous hormones can affect the occurrence of epileptic seizures directly or by pharmacokinetic interactions through the modification of antiepileptic drugs level in plasma. These effects are realized by acting on various links of the hypothalamic-pituitary-ovarian axis. Special catamenial epilepsy when hormonal imbalance determines the epileptic process, mechanisms of its formation and therapeutic approaches to treatment are also considered. The questions of reproductive dysfunctions typical for women with epilepsy are described, such as hyperandrogenism, high luteinizing hormone levels, irregular menstruation, hyperprolactinemia, polycystic ovary syndrome, infertility, premature menopause. The result of these dysfunctions is that 30–60% of patients with epilepsy have a low pregnancy and childbirth rate. Worsening of life quality in women with epilepsy results in approximately five-fold increase in the risk of sexual dysfunction compared with the general population, which is manifested by a decrease of sexual contacts quantity, libido problems, decreased lubrication, dyspareunia, vaginismus, problems with arousal and orgasm dissatisfaction despite a normal attraction. It needs consider the effects of epilepsy pharmacotherapy and drugs interaction with hormonal contraception, that reduces its effectiveness. The possibilities of this problem solution and hormone replacement therapy in menopausal patients with epilepsy are reviewed. Information is presented on the current pharmacotherapy of epilepsy in the aspect of antiepileptic drugs as the causes of sexual and reproductive dysfunctions, primarily valproate and anticonvulsant inducers of cytochrome P450, as well as other drugs of this group.