Menstrual epilepsy Menstrual epilepsy is defined as epilepsy in women who experience at least a 75% increase in seizure frequency during the 4 days before and 6 days after menstruation. The phenomenon of increased seizure frequency during menstruation was first described by Gowers in 1885, whereas the cyclic variation in seizure frequency has been identified in ancient times and attributed to the role of the moon. The exacerbation of epilepsy during menstruation may be related to changes in the concentration of sex hormones during menstruation. Estrogens are epileptogenic and lower seizure thresholds in the hippocampus and amygdala, and conversely, progestins have antiepileptic effects. In the past, hormonal therapy or oophorectomy was applied to treat menstrual epilepsy, but the results were not satisfactory. In some patients, diuretics, clonidine, and vincristine have been applied during menstruation with effective treatment. The current widely used approach is to increase the dose of antiepileptic drugs during menstruation. Fertility and epilepsy Epilepsy is not a contraindication to pregnancy. About 90% of women with epilepsy can have a normal pregnancy, so it is very important to go to a regular hospital for preconception counseling before pregnancy. Visit the hospital and have an EEG or video-EEG test to further determine if you have epilepsy? Do you need to take antiepileptic drugs? What is the minimum dose of medication that will control the epilepsy? If the epilepsy is well controlled, it is recommended that the anti-seizure medication be tapered until it has stopped for 6 months before considering pregnancy. If the antiepileptic drugs cannot be stopped, always choose the smallest and most effective dose to control the epilepsy. Sodium valproate is not recommended because it has a high teratogenic rate and can cause fetal malformations (e.g., anencephaly, spina bifida, etc.). If there is a family history of congenital neural tube developmental malformations, it is recommended not to use carbamazepine or sodium valproate. Combination of multiple antiepileptic drugs is prohibited. If pregnancy is detected, switching to other antiepileptic drugs is not recommended because the most sensitive period of fetal organ development has passed when pregnancy is detected. In addition, the overlapping application of antiepileptic drugs can aggravate the risk to the fetus. Folic acid should be supplemented before and during pregnancy, especially in women taking antiepileptic drugs with hepatic-inducing enzyme effects.