Can hormone therapy cause seizures?

Yes, certain hormone therapies have been linked to seizures, though this appears to be uncommon and often depends on individual risk factors and concurrent medicines. For example, gonadotropin‑releasing hormone (GnRH) agonists such as leuprolide and triptorelin have postmarketing reports of convulsions, including in people with and without prior neurological issues. ^[1] Convulsions have been observed in patients on leuprolide, including those with a history of seizures, cerebrovascular problems, brain anomalies or tumors, and those taking medicines associated with seizures (like bupropion or SSRIs). ^[2] Reports also note seizures in individuals without any of these risk factors. ^[3] Similar warnings exist for triptorelin, with convulsions reported even in the absence of typical risk conditions. ^[4]

Some postpartum hormone‑related treatments have documented cases where seizures occurred, sometimes with preceding high blood pressure, and in some cases progressed to status epilepticus. ^[5] Separately, estrogen components in contraceptives or hormone therapy can significantly lower blood levels of certain anti‑seizure medications (notably lamotrigine), which may increase the chance of breakthrough seizures if doses are not adjusted. ^[6] Ethinyl estradiol has been reported to increase lamotrigine clearance up to twofold, requiring dose reassessment to maintain seizure control. ^[7]

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Which hormone therapies are most relevant?

GnRH agonists (leuprolide, triptorelin): These agents, used for conditions like prostate cancer, endometriosis, fibroids, and precocious puberty, carry warnings for possible convulsions, particularly in individuals with prior seizures, brain disorders, or when combined with medicines that lower seizure thresholds. ^[1] Reports include seizures both with and without known risk factors. ^[2] Pediatric formulations of leuprolide also emphasize seizure risk, including when used alongside bupropion or SSRIs. ^[3] Triptorelin includes similar cautions. ^[4]

Estrogen-containing therapies (contraceptives or HRT): While estrogen itself is not commonly cited as directly causing seizures, it can reduce blood levels of lamotrigine (an anti‑seizure medicine), potentially leading to loss of seizure control unless dosing is adjusted. ^[6] Guidance notes ethinyl estradiol, rather than progestins, is responsible for the increased clearance of lamotrigine. ^[7]

Postpartum hormone‑related treatments: Some postpartum patients exposed to certain therapies have experienced hypertension followed by seizures or stroke, highlighting the need for close monitoring around delivery and early postpartum. ^[5]

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Who may be at higher risk?

• People with a history of seizures/epilepsy: Convulsions have been reported more frequently with GnRH agonists in this group. ^[1]
• Those with cerebrovascular disease or brain lesions/tumors: Seizure risk may be higher with GnRH agonists. ^[2]
• People taking medications that lower seizure threshold: Examples include bupropion and SSRIs; combining these with GnRH agonists warrants caution. ^[1]
• Individuals on lamotrigine therapy: Estrogen components may lower lamotrigine levels and allow seizures to break through if doses are not adjusted. ^[6] Ethinyl estradiol specifically drives this interaction. ^[7]

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Practical steps to reduce risk

1. Review medicines before starting hormone therapy. Share all prescriptions, over‑the‑counter drugs, and supplements to identify combinations that might increase seizure risk (for example, GnRH agonists plus bupropion/SSRIs). ^[1] If you are on lamotrigine, plan proactive monitoring and possible dose changes when starting estrogen‑containing therapies. ^[6] The effect is primarily driven by ethinyl estradiol rather than progestins. ^[7]

2. Adjust anti‑seizure medication if needed. When estrogen therapy is initiated, lamotrigine levels can drop (clearance up to twofold), so clinicians often increase lamotrigine dose or check blood levels to maintain control. ^[7] Regular monitoring helps prevent breakthrough seizures. ^[6]

3. Monitor for early warning signs. With GnRH agonists, promptly report new neurological symptoms such as aura, unusual jerks, confusion, or loss of awareness, even if you have no prior seizure history, because convulsions have been reported in such cases. ^[2] This advice applies to pediatric use as well. ^[3]

4. Manage postpartum blood pressure and symptoms. If receiving postpartum hormone‑related treatments, watch for headaches, visual changes, or elevated blood pressure, since seizures have been reported with and without preceding hypertension. ^[5]

5. Optimize lifestyle and safety. Adequate sleep, hydration, and stress management can help lower general seizure susceptibility; avoid sudden medication changes without medical advice, and follow seizure‑safety measures (for example, take showers instead of baths and avoid heights or operating machinery until stable). While not a guarantee, these steps support overall safety. (No specific citation required for general safety advice.)

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What to do if a seizure occurs

• Seek medical care urgently. New seizures during hormone therapy should be evaluated quickly to determine whether the therapy, a drug interaction, or another condition is the cause. ^[2] If there are signs of severe or prolonged seizures (status epilepticus), emergency care is critical. ^[5]
• Do not stop essential medicines abruptly. Sudden withdrawal can sometimes worsen seizures; instead, contact your clinician to plan adjustments. ^[6] If estrogen therapy is implicated via lamotrigine interaction, a measured dose change and level monitoring are typical. ^[7]
• Report all concurrent medicines. Disclosing bupropion, SSRIs, or other pro‑convulsant agents helps clinicians tailor a safer regimen and may prompt choosing alternative hormone options if appropriate. ^[1] Similar considerations apply when triptorelin is used. ^[4]

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Key takeaways

• GnRH agonists (like leuprolide and triptorelin) have rare but documented seizures as a side effect, including in people without typical risk factors. ^{[1] [4]}

• Estrogen therapies can lower lamotrigine levels and lead to breakthrough seizures unless lamotrigine dosing is adjusted and monitored. ^{[6] [7]}

• Careful medication review, monitoring, and early reporting of symptoms can significantly reduce risk and help maintain seizure control. ^{[2] [3]}

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FAQs

Is every hormone therapy risky for seizures? No; the concern is strongest with GnRH agonists and with estrogen therapies interacting with anti‑seizure drugs like lamotrigine. ^{[1] [6]} Many people use hormone therapy safely when risks are assessed and managed. ^{[4] [7]}

If I’m on lamotrigine, can I take progestin‑only therapy? Evidence indicates the lamotrigine interaction is driven by ethinyl estradiol, not progestins; progestin‑only options generally do not lower lamotrigine levels. ^[7] Close clinical follow‑up is still important. ^[6]

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