Approximately 25% of female patients with their first seizure are seen during menarche About 2/3 of female patients with epilepsy before menarche have an increase in seizure frequency, worsening symptoms, or new forms of seizures during menarche. Seizures that occur only during or around menstruation are called menstrual epilepsy, and a possible mechanism is thought to be related to changes in female hormone levels during the menstrual cycle. In patients with menstrual epilepsy, the frequency of seizures decreases during the progesterone phase of the menstrual cycle and increases during the menstrual phase. The reason for this may be related to the increased activity of estrogen during menstruation. Estrogen affects seizures mainly through membrane effects and genetic effects. The membrane effect is mediated through gamma-aminobutyric acid A (GABA-A) receptors and N-methyl-D-aspartate (NMDA) receptors. Increased estrogen activity during menstruation occupies recognition sites on the GABA-A receptor, thereby decreasing GABA-A receptor-mediated inhibitory function and inhibiting GABA synthesis. Estrogen also acts on NMDA receptor-mediated excitability of hippocampal neurons, resulting in increased neuronal excitability. Genetic effects mainly affect glutamic acid decarboxylase gene expression and decrease the rate and amount of GABA-A receptor subunits and GABA synthesis, which leads to increased issuance of epileptiform discharges in EEG and worsening of menstrual seizures in menstrual epilepsy patients. Progesterone (progesterone) has an inhibitory effect on epilepsy during the menstrual cycle, and its mechanism of action is opposite to that of estrogen. In conclusion, estrogen has a seizure-causing effect, while progesterone has the opposite effect. The decrease in progesterone secretion around menstruation and the change in the ratio of estrogen to progesterone may be the cause of menstrual epilepsy.