Microsoft word - contraception for women with epilepsy

Brainwave The Irish Epilepsy Association
249 Crumlin Road
Dublin 12

Tel: 01-4557500 Email: info@epilepsy.ie Web: www.epilepsy.ie


Contraception for women with epilepsy

Of all the individuals diagnosed with epilepsy in Ireland about 25% or 10,000 are
women of childbearing potential. In today’s society choice is of vital importance for
women, especially those affected by epilepsy. This leaflet intends to explain the various
methods of contraception available to women with epilepsy.
Women with epilepsy can choose from the standard methods of contraception. Your
exact choice should depend on your individual needs but you will need to pay particular
attention to some methods more than others.
The Combined Oral Contraceptive Pill (COCP)

There is no evidence to suggest that taking the pill adversely affects epilepsy. However,
it is of vital importance that you tell your GP that you are taking anti-epileptic
medication (AEDs). Some of the anti-epileptic medication can metabolise (break down)
the COCP faster, therefore reducing its effectiveness. These particular medications are
known as enzyme inducing anti-epileptic drugs.
They include: Phenobarbitone, Primidone (Mysoline), Phenytoin (Epanutin),
Carbamazapine (Tegretol), Topirimate (Topamax) and Oxcarbazepine (Trileptal).
If you are taking any of these drugs, you should be on a COCP with a minimum of 50ug
oestrogen content or a combination of the COCP to obtain a minimum dose of 50ug of
oestrogen. Any evidence of breakthrough bleeding would suggest that this method is
not effective and should be reported to your GP immediately: it may be necessary to
increase the dose of the COCP to 75 or 100ug/day. Women need to be advised that
even on the higher dose contraception efficiency cannot be guaranteed.
Anti-epileptic medications, which are non enzyme inducing anti-epileptic drugs
include: Sodium Valporate (Epilim), Vigabatrin (Sabril), Clonazepam (Frisium),
Gabapentin (Neurontin), Tiagabine (Gabatril), Levetiracetam (Keppra), *Lamotrigine
(Lamictal) and Topiramate (Topamax) in doses lower than 200mg daily. The lower
dose pill (25-35ug/day of oestrogen) can be taken as usual if you are taking any of
these drugs. Any evidence of breakthrough bleeding would suggest that this method is
not effective and should be reported to your GP immediately.
*OF NOTE: Some research has suggested that Lamotrigine may interact with the COCP
and reduce its effectiveness. However, other recent studies have shown a 25 to 70%
Brainwave The Irish Epilepsy Association Contraception for women with epilepsy Page 1 of 3 decrease in Lamotrigine trough levels in women taking the COCP. You may wish to
discuss this with your Neurologist/Epilepsy Nurse Specialist.
The Progesterone Only Pill (Mini Pill)

This method of contraception is not recommended as it is less effective, particularly if
enzyme-inducing anti-epileptic drugs are being taken.
Emergency Contraception

There is no evidence to suggest that women with epilepsy should not take emergency
contraception. Some practitioners suggest a higher dose in women taking enzyme
inducing anti-epileptic drugs.
The Depo-Provera

This method of contraception is a single injection into the buttock. It is usually
administered every 12 weeks. For women on enzyme inducing anti-epileptic drugs
it should be given every 10 weeks as these drugs reduce the effectiveness of the
injection.
The Barrier Methods

The male or female “Femidom” condom if used correctly can be as effective for the
woman with epilepsy. There are no large-scale studies but research to date suggests
that the Femidom is as effective as the male condom.
The Implant

The implant is a rod shaped device that is inserted under the skin just above the elbow
for a period of 3 years. This method of contraception is NOT advisable for women on
enzyme inducing anti-epileptic drugs and an alternative method should be
considered.
Mirena Intrauterine System (IUS)

There are contraindications to the Mirena coil in women with epilepsy because
progesterone acts by being released locally into the uterus.
The Persona Device

This method relies on testing your urine for hormonal changes during your menstrual
cycle. As your hormone levels may be affected by your anti-epileptic treatment the
Persona is not a recommended method of contraception.
Brainwave The Irish Epilepsy Association Contraception for women with epilepsy Page 2 of 3 The Rhythm Method

This method also relies on hormonal changes therefore it is NOT recommended to
women on anti-epileptic medication.
The Evra Patch

Evra is a thin square patch worn on the skin to prevent pregnancy. Each patch is worn
for 7 days every week for 3 consecutive weeks and the fourth week is a patch free week
i.e. no patch is required.
The patch is NOT recommended for women on enzyme inducing anti-epileptic
drugs.
Folic Acid

If you are a woman of childbearing potential and have been diagnosed with epilepsy, it
is important to be made aware of the potential benefits of taking folic acid. By taking the
higher dose tablet of folic acid 5mg as prescribed by your doctor (it cannot be acquired
over the counter) prior to conception you may reduce the risks of neural tube defects
such as spina bifida.
Women should be informed that it is not effective in reducing the risk of neural tube
defects when taken after conception.
This leaflet has been designed to answer some of your questions on the various
methods of contraception. Please note that all women are different and may require
individualised care. However, we would advocate the use of a second method of
contraception to reduce the risk of becoming pregnant. The above advice is written as a
guide only. If you are unsure about anything mentioned or have any further questions
please contact the Community Epilepsy Nurse on the Helpline at 01 – 4554 133 or on
087- 7708 702, the Epilepsy & Pregnancy Register at free phone 1800 320 820, the Well
Woman Centre or your local family doctor or nurse.
Brainwave The Irish Epilepsy Association Contraception for women with epilepsy Page 3 of 3

Source: http://www.epilepsyprogramme.ie/leaflets/womens%20issues/Contraception.pdf