For women with epilepsy, family planning involves some unique issues. Whether a woman wishes to delay pregnancy until the time is right or prevent pregnancy long term, an awareness of these issues will allow informed choices.
Birth Control Pills and Seizure Medications
The first issue is that some seizure medications interact with birth control pills and end up reducing the pills’ effectiveness for pregnancy prevention. Oral contraceptive pills typically consist of the hormones estradiol (the predominant estrogen during reproductive years) and progestin (a synthetic form of progesterone), or progestin alone. The pills work by preventing a woman from releasing an egg each month.
Some seizure medications, called “inducing” medications, help the liver to eliminate the hormonal contraceptive more rapidly from the body. This may make the birth control pills less effective at stopping ovulation, which in turn can lead to unexpected pregnancy.
One way around this issue is to change to a seizure drug that does not interact with birth control pills. But if making such a change won’t work for you, other contraceptive methods can be explored — and some of these options have the added benefit of being longer-lasting. Hormonal injections can last up to 3 months, hormonal implants for up to 3 years, hormone-releasing intrauterine devices for 6 years, and copper IUDs for 10 years.
Another issue is that birth control pills can affect the way the body processes the seizure medication. This comes into play for the many women with epilepsy who take lamotrigine. Estrogen-containing oral contraceptives, patches and rings induce the liver to eliminate lamotrigine more rapidly, causing the amount of lamotrigine in the body to be significantly reduced and increasing the risk for seizure recurrence. Progestin-only birth control pills do not have this effect on lamotrigine and may be an appropriate alternative.
For women taking an inducing seizure medication, the Centers for Disease Control and Prevention provide the following recommendations.
— Hormone injections (depot medroxyprogesterone acetate, or DMPA) and copper or hormonal IUDs (with local intrauterine levonorgestrel) can each be used with no restriction.
— For progestin implants (subdermal etonogestrel) the advantages usually outweigh the risk for unplanned pregnancy.
— For oral birth control pills, hormone patches and vaginal rings, the risk for unplanned pregnancy is higher and usually outweighs any advantages.
— Barrier methods such as condoms may add some additional contraceptive effect when used with other methods and also offer the benefit of protection from sexually transmitted infections.
Incorporating Family Planning
Family planning is especially important for women with epilepsy. The good news is that most women with epilepsy have uncomplicated pregnancies and deliver healthy babies. But some seizure medications can affect a baby’s development.
Certain medications pose more risk than others, and taking multiple medications or high doses can increase the risk. Planning ahead allows time for the prospective mother and her doctor to consider whether any medication changes or adjustments would be appropriate. Another safeguard is to take folic acid, a prenatal vitamin, for at least several months before conceiving.
Steps to Take
If you are a woman with epilepsy, you may wish to consider the following guidelines.
— Speak with your doctor about your reproductive plans. If contraception is in the picture, request a form of birth control that is compatible with your seizure medication.
— If the available contraceptive options do not appeal to you, explore whether your seizure medication could be changed to a drug that agrees with the contraception you prefer.
— Take folic acid every day to lend further protection for a future baby.
— If you decide the time is right to become pregnant, meet with your doctor to consider whether any changes to your seizure medication could be beneficial to you and your future child.
Ensuring that pregnancy occurs only when desired can take some extra planning for women with epilepsy. Equipped with knowledge about the interplay between drugs for contraception and seizure control, a woman and her doctor can ensure that both remain effective.
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