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Guide: Epilepsy and Women

Birth Control for Women with Epilepsy

Reviewed by Brunilda Nazario, MD, April 24, 2008

If you are a woman who has epilepsy, there are some important things you should consider about birth control and preparing for pregnancy.

Any birth control that is safe for women in general, is safe for women with epilepsy. However, having epilepsy - and some treatments for the condition - can make some forms of birth control less effective. Also, since antiseizure medications for epilepsy can increase the risk of birth defects, it's important to plan pregnancy carefully.

Birth Control and Antiseizure Drugs

Your birth control options could include hormones such as birth control pills or Depo-Provera injections, barrier methods like condoms or a diaphragm, or an intrauterine device (IUD). Natural family planning such as the rhythm method - abstaining on your fertile days -- can also be used, although this method may not be as reliable as others. All of these methods are safe for you.

If you are taking antiseizure medications, some of these drugs can interact with some hormonal types of birth control and make them less effective. If you understand these interactions, most of the time you can use the pill and other kinds of hormonal birth control effectively.

Different types of antiseizure medications interact with hormonal birth control in different ways.

• One group of antiseizure drugs is known as "liver enzyme-inducing" drugs. They increase the rate at which the liver breaks down the contraceptive hormones that you get from birth control. This means that the contraception medication will leave your body faster. Liver enzyme-inducing drugs include carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), and topiramate (Topamax). If you are taking one of these drugs, it can make your hormonal birth control less effective.
• Two drugs -- valproate (Depakote) and felbamate (Felbatol) -- can even increase hormonal levels. If you are on one of these drugs, your doctor may need to adjust the dosage of your birth control so that you don't have too much of the contraceptive in your body.
• Finally, there are "neutral" drugs which don't have any effect on hormone breakdown. Gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), and tiagabine (Gabitril) will not interfere with your birth control.

Reliable Contraception When You Have Epilepsy

If you are taking a liver enzyme-inducing drug, and you want to use hormonal birth control, you should talk to your neurologist and your gynecologist. It is a good idea to use a second method of birth control as a backup. Barrier methods, like condoms or diaphragms, are good options.

In the past, doctors have sometimes prescribed higher-dose birth control pills to make up for the rapid breakdown of the contraceptive drug. That may work, but there is no clear research to tell us one way or the other. "Doctors used to say that increasing the amount of the estrogen in the pill took care of this problem," says Jacqueline French, MD, co-director of the Epilepsy Center at the University of Pennsylvania in Philadelphia. "But we have no data to confirm that."

In one case, hormonal birth control might make your antiseizure medication less effective. That can happen if you are taking lamotrigine (Lamictal). The body's levels of Lamictal appear to be reduced when a woman takes hormonal birth control. "This is the only antiseizure drug we know of that acts like that," says Mark Yerby, MD, MPH, founder of North Pacific Epilepsy Research in Portland, Oregon. "If Lamictal is controlling a woman's seizures very well, and she begins to take the pill, sometimes the seizure control is not as good." (Lamictal and other seizure medications can also become less effective when a woman is pregnant.)

Hormonal methods like the pill, Depo-Provera, and others are not the only way to prevent pregnancy. Barrier methods are an effective option for many women. They are not affected by the medication that you take to control your seizures. Condoms, diaphragms, and new-generation IUDs are all choices you can consider.

What if you want to use natural family planning to prevent pregnancy? There are a number of natural family planning methods. In general, they work by tracking your menstrual cycle, and that's why you probably want to reconsider using this method. If you have epilepsy, there is more of a chance that your cycles are irregular. That would make natural family planning very unreliable for you.

Planning Ahead for Pregnancy

Keep in mind how important it is for you to plan ahead for a pregnancy. As part of that planning, be sure to start taking folic acid supplements before getting pregnant. It's a good idea for women with epilepsy who are of childbearing age to start taking 0.4 milligrams a day of folic acid just in case they get pregnant. This helps prevent birth defects of the spinal cord and brain.

And as you think about what kind of birth control is right for you and do your planning, it's important to talk with your neurologist and your gynecologist. Both of these doctors should be very involved in your care. Each of them needs to know about the drugs or treatments that the other prescribes.

Next: Pregnancy & Epilepsy

SOURCES: Epilepsy Foundation, Women and Epilepsy Initiative, "Birth Control for Women with Epilepsy. French, Jacqueline, MD, professor of neurology, University of Pennsylvania; co-director, Epilepsy Center. Morrell, M. and Montouris, G., Cleveland Clinic Journal of Medicine, February 2004; vol 7 (supplement 2): pp S19-S24. Penovich, P. et al., Cleveland Clinic Journal of Medicine, February 2004; vol 7 (supplement 2): pp. S49-S57. Yerby, Mark, MD, MPH, associate clinical professor of neurology, public health & preventive medicine, Oregon Health Sciences University; founder, North Pacific Epilepsy Research, Portland, Oregon.