If you are a woman who has epilepsy, there are some important things you should know before using birth control or 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, because anti-seizure medications for epilepsy can increase the risk of birth defects, it's important to plan pregnancy carefully.
Birth Control and Anti-seizure Drugs
If you have epilepsy and take anti-seizure 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 is not as reliable as others. All of these methods are safe for you.
If you are taking anti-seizure medications, some of these drugs can interact with some hormonal types of birth control and make them less effective. In one case, hormonal birth control may reduce the blood concentration levels of lamotrigine (Lamictal), an anti-seizure drug, making it less effective.
"This is the only anti-seizure 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.)
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 anti-seizure medications interact with hormonal birth control in different ways:
- One group of anti-seizure 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), eslicarbazepine acetate (Aptiom), 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. Clobazam, clonazepam, ethosuximide, gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), Lyrica, sodium valproate, tiagabine (Gabitril), and Zonegran, and will not interfere with your birth control.
Reliable Birth Control 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, diaphragms, and new-generation IUDs, 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, professor of neurology at New York University's Langone Medical Center and co-director of Epilepsy Research and Epilepsy Clinical Trials at the NYU Comprehensive Epilepsy Center. "But we have no data to confirm that."
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.
Epilepsy and Planning Ahead for Pregnancy
If you have epilepsy, 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. There are certain medications for epilepsy that doctors may advise you to take a higher dose of folic acid if you are on these, like carbamazepine (Equetro) or valproate. Check with your doctor about this.
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.
