Epilepsy and Birth Control
All available birth control methods (barriers, timing and hormonal contraception) can be used by women with epilepsy but the effectiveness of contraceptives can be influenced by the antiepileptic drugs that you use. In general, the most reliable methods of birth control currently available use hormones to stop conception, but they are less effective when used by women using antiepileptic drugs.
It is important to work with your gynaecologist and/or neurologist to choose the birth control method that is most appropriate for you.
Some antiepileptic drugs increase your body's breakdown of the hormones used in birth control pills making them less effective in preventing pregnancy.
Some of the seizure medications that reduce the effectiveness of "the pill" are:
Conversely,
valproate (Depakote®, Epival®) and
felbamate do not increase the breakdown of these hormones – and may even increase hormonal levels – which might make you require adjustments in the dose of your birth control.
Gabapentin (Neurotin®) and lamotrigine (Lamictal®) do not interfere with the effectiveness of birth control pills.
Women with epilepsy often need contraceptive pills with higher doses of estrogen than is usual. Even then there is a risk of an unwanted pregnancy. It is a good idea to use a barrier method ( diaphragm, spermicidal cream, or condom) in addition to the pill.
Other hormonal birth control methods also have interactions with antiepileptic drugs. For women with epilepsy, Norplant® (hormonal implants) placed under the skin, may not provide effective birth control. Depo-Provera® (medroxy-progesterone) is a hormonal injection given more frequently to women with epilepsy who are using "liver enzyme-inducing" seizure medications such as carbamazepine, phenytoin, primidone, primidone, and topiramate.
It is important to contact your physician if you experience bleeding in the middle of your cycle, while taking a hormonal contraceptive. This breakthrough bleeding may indicate that your level of protection from unwanted pregnancy is less than it should be.
There is consistent evidence indicating that the use of oral contraceptives does not have an bad effect on seizure frequency or severity.
- Take note of the type of antiepileptic drug used. Antiepileptic drug levels should be monitored during the start of any hormone therapy.
- Strength or dosage of the oral contraceptive and the estrogen:progesterone ratio of it should be considered by your health care provider when picking the proper birth control pill.
- Spotting or bleeding between periods is an indication of possible ovulation and low estrogen levels. This indicates that pregnancy can occur. Consult your health care provider immediately if this happens.
Should breakthrough bleeding occur, alternative precautions should be used and the matter looked into. It is likely that the estrogen dose will need to be increased further. The increased risk of side effects from a higher dose estrogen, such as an increase in seizure frequency, does not apply in these circumstances as the pill is being disposed of more quickly by the body.
Other barrier methods should be used in addition to the birth control pill, or alone.
- condoms
- diaphragms
- intra-uterine devices [IUDs]
- contraceptive foams and jellies
This will also lessen some fears about reliability against a pregnancy and lessen the general unhappiness of having to take so many different drugs.
None of these birth control methods will affect your seizures or interfere with your antiepileptic medications.
Problems with birth control pills should not be accepted as an indication that the pill in general is unsuitable for women with epilepsy. There is no evidence to suggest that the pill can influence epilepsy in any way, either beneficially or by making the seizures worse.
Other high risk factors (age, obesity, heavy smoking, etc.) must be taken into account when considering the suitability of the pill for a woman with epilepsy.
