Birth Control for Women With Epilepsy
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."
In one case, hormonal birth control might make your anti-seizure drug 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 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.)
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.
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.