Perimenopausal Symptoms in Women with Epilepsy

A 47-year-old woman with Juvenile Myoclonic Epilepsy is treated with levetiracetam and experiencing irregular menstrual cycles and severe symptoms of intermittent hot flushes. She is prescribed estrogen replacement therapy (ERT) and topical estrogen by her gynecologist. She made an appointment with me as her epileptologist and has several questions regarding the safety of using the ERT/topical estrogen and whether her epilepsy will be exacerbated by using the prescribed hormonal therapies.