Birth Control for Women with Epilepsy

If you are a woman who has epilepsy, there are some important things you should know before using birth control or before planning a 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), primidone (Mysoline), 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), clobazam, clonazepam, ethosuximide, Lyrica, sodium valproate, Zonegran, 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."