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risk of bone demineralisation, especially if they are receiving a hepatic enzyme-inducing
AED (phenobarbitone, phenytoin, and carbamazepine), which can accelerate vitamin D
metabolism167,168. Both seizures and AEDs affect the hypothalamic-pituitary-adrenal axis,
which can have an adverse impact on bone health. No assessment has been made on the
optimal frequency with which women on long-term AEDs should have bone density
monitored. In the general population, hormone replacement therapy (combined oestrogen and
progesterone) appears to have beneficial effects in postmenopausal women and it should be
offered to postmenopausal women with epilepsy if it is clinically indicated169.

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