BACKGROUND: Women with epilepsy tend to have hormonal and metabolic disturbances. This study was performed to investigate whether epileptic women with specific epileptic syndromes or antiepileptic drugs (AEDs) are at risk for metabolic and/or menstrual abnormalities. METHODS: Women with epilepsy aged 15 to 50 years old, currently on AED medications for more than 6 months, were recruited for this study. Subjects checked their oral temperature each morning. Serum tests for lipid profiles, insulin, glucose, and leptin were performed on menstrual cycle days 2 to 3. HOMA-index, as a marker of insulin resistance, was calculated. RESULTS: In total 57 patients, 19 women were diagnosed as primary generalized epilepsy (PGE) and the other 38 as localization-related epilepsy (LRE). Among them, 42 patients were on monotherapy; 19 women on carbamazepine (CBZ), 12 on valproate (VPA), and 11 on lamotrigine (LTG). Body mass index increased in VPA group (24.43+/-3.61) compared to CBZ (22.03+/-2.45) or LTG (21.68+/-2.14) group (p=0.046), and metabolic syndrome was more commonly associated in VPA group (5/12, 41.7%) than in CBZ (1/19, 5.3%) or LTG (0%) group (p=0.005). Epileptic women on VPA experienced menstrual irregularity (7/12, 58.8%) more frequently, compared to CBZ (4/19, 21.1%) or LTG (3/11, 27.3%) group (p=0.089). No differences were observed between PGE and LRE groups. CONCLUSIONS: Women with epilepsy on VPA tend to be more obese, and more frequently have metabolic and/or menstrual abnormalities than epileptic women on CBZ or LTG..