Contraception and Epilepsy

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Research has indicated that some hormonal contraceptive methods can interact with certain anti-epileptic drugs (AEDs) which may increase the likelihood of unplanned pregnancy in women living with epilepsy.

Having a conversation with your doctor or neurologist about the appropriate contraceptive method for you is vital to prevent unplanned pregnancy, and maintain seizure control.

In the 1970s, some women taking anti-epileptic drugs (AEDs) and using hormonal contraception reported more frequent occurrences of unplanned pregnancy than the general population.

Research has indicated that a number of AEDs and types of contraception can interfere with one another to increase the risk of unplanned pregnancy. Having access to the right  contraception method for you can help you maintain control over your reproductive health. Some commonly used methods include hormonal contraceptive methods like the combined
oral contraceptive pill and the progestin only pill, implants such as the Implanon and intra-uterine devices, barrier methods such as male and female condoms, and natural methods such as the rhythm method.

Each type of contraception has different levels of effectiveness in preventing pregnancy, however, the effectiveness of the rhythm method is uncertain.

AEDs and hormonal contraceptive methods

Certain AEDs can induce the body’s production of certain enzymes, which can interact with the hormones in some types of contraception. This can reduce the effectiveness of some contraceptive medications that contain hormones such as oestrogen and progestin. There is some of evidence to suggest that these interactions can, in some cases, increase the frequency of seizures.

Contraceptives that can interact with AEDs

Some hormonal contraceptives lose some of their effectiveness when taken alongside some AEDs, but this may depend on the dose and type of AED. Some of these hormonal contraceptives include:

  • The combined oral contraceptive pill (“the pill”)
  • The progestin-only pill (known as “the mini pill”)
  • Transdermal contraceptive implants such as the Implanon
  • Emergency contraception (known as the “morning after” pill)
  • The contraceptive injection

Enzyme-inducing AEDs such as those in the following list may interact with hormonal contraceptives :

  • Phenytoin (Dilantin)
  • Carbamazepine (Tegretol)
  • Oxcarbazepine (Trileptal)
  • Topiramate (Topamax, Tamat, Epiramax)
  • Lamotrigine (Lamictal)

Taking lamotrigine and hormonal contraception may reduce the amount of lamotrigine in your blood stream, which can impact seizure control.

Managing your contraception

If you are using AEDs, discussing your contraceptive options with your doctor or neurologist is the first step in preventing an unplanned pregnancy. Ensure that your doctor knows what
dosage and type of AED you are taking before prescribing hormonal contraceptive methods. This is important because only specific AEDs interfere with hormonal contraception.

A certain dose and type of hormonal contraception may be effective in pregnancy prevention even if you are using AEDs. Some important points to consider in consultation
with your doctor when choosing the right contraception for you include:

  • What types of hormonal contraception could interact with the AEDs I take?
  • Is there a risk that taking hormonal contraception will influence my seizure control?
  • Which of the following types of contraception would best suit my lifestyle?
  • A daily medication such as the combined oral contraceptive pill?
  • A long-lasting method such as an IUD or implant?
  • Barrier methods such as condoms?
  • Do I require a higher dose of hormonal contraceptives such as the combined oral contraceptive pill for it to be effective?
  • How effective is my contraceptive choice?
  • Do I need to consider an extra method such as condoms?

Other resources

For more information about contraceptive choices, visit the Family Planning Victoria website http://www.fpv.org.au/for-you/contraception 
For more information and advice contact our
Information Line on 1300 761 387.

 

 

© Epilepsy Foundation August 2017. The information contained on this page provides general information about epilepsy. It does not provide specific advice.
Specific health and medical advice should always be obtained from a qualified health professional.

Reviewed by: Professor Patrick Kwan FRACP, PhD, Chair of Neurology, Department of Medicine, The University of Melbourne