This chapter describes how and why women may also be gaining ground on their male counterparts in the consumption of alcohol and illicit substances. Surveys of substance abuse and dependence in the general population fairly consistently show overall rates in females to be lower than those in males. Women with affective and anxiety disorders are more likely to present with alcohol or drug abuse/dependence than are women without such disorders. Antisocial personality disorder (APD) is another psychiatric condition strongly associated with substance abuse and dependence. The impact of substance abuse on reproductive fitness in women is evidenced by higher rates of amenorrhoea and anovulatory cycles. The high rate of treatment dropout for women with drug and alcohol problems is of great concern to clinicians and researchers as there is a powerful association between dropping out and negative outcome.

This chapter discusses some of the reproductive disturbances in women with epilepsy and points out signs and symptoms that women should report to their health-care providers. Reproductive health disturbances described in women with epilepsy include menstrual abnormalities such as amenorrhea (not menstruating), oligomenorrhea (menstrual cycle length greater than 35 days), and metrorrhagia (irregular menstrual cycle with excessive menstrual flow). Menstrual cycle abnormalities, polycystic ovaries, and disruption in pituitary and ovarian hormones may cause infertility. Women with epilepsy appear to be at risk for anovulatory cycles, polycystic ovaries, and disturbance in the hypothalamic, pituitary axis, the system that regulates the menstrual cycle and ovarian production of female sex steroid hormones. Electrical epileptic discharges in the brain may alter pituitary hormones and abnormally stimulate the ovaries. Changes in ovarian hormones caused by antiepileptic drug interactions could also cause anovulatory cycles. Finally, the antiepileptic drug valproate may specifically increase the risk.