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Women, Epilepsy, and Sexuality

New knowledge, new drugs open new doors for people with seizure disorders.

Readdressing Reproductive Health continued...

And the list doesn't end there: "Women taking valproate also report excess weight gain and hair growth," Pack says. Also, a recent study at Columbia University showed that women who took valproate at any time during the past three months were at increased risk of developing cysts in their ovaries.

"The bottom line," Pack says, "is that I tend not to prescribe valproate as a first-line drug for most women with epilepsy who are in their reproductive years. That's not to say that valproate is not a good drug, but with so many other choices available, [for these women] I tend to pick something that won't have these side effects."

While a variety of factors need to be considered when choosing a medication to control seizures in women with epilepsy, Pack says many neurologists have indicated a preference for Lamictal due to its relatively safe side-effect profile.

According to the Epilepsy Foundation, Lamictal neither increases the breakdown of female hormones nor interferes with the effectiveness of hormonal birth control, unlike other seizure medications.

But for women with epilepsy who also suffer from migraine headaches, Topamax is usually considered the drug of choice because of its headache-relieving properties, Pack says.

Epilepsy and Birth Control

Given the complex interactions between hormones and seizures, it's not surprising that certain seizure medications can prevent birth control pills from working effectively, experts note. These medications can affect a system in the liver that breaks down medications. According to the Epilepsy Foundation, the so-called "liver enzyme-inducing" drugs -- Tegretol, Dilantin, phenobarbital (Luminal), Mysoline, and Topamax -- increase the breakdown of contraceptive hormones in the body, making them less effective in preventing pregnancy. Valproate and Felbatol, on the other hand, can actually raise hormonal levels, which may require an adjustment in dose.

Like Lamictal, Neurontin has no effect on hormonal balance and thus does not interfere with the effectiveness of birth control pills.

No matter what seizure medication you are on, it's important to realize that the popular "mini-pill" has too little estrogen -- less than 35 micrograms -- to protect women with epilepsy from becoming pregnant. The reason: Many of the commonly prescribed seizure medications reduce the amount of time that hormones are in your bloodstream, Shafer says.

Her advice: "Talk to your doctor about what type of contraception is best for you." In many cases, a combination of a pill and a barrier method may be the best option.

Sexual Dysfunction

Problems with low sexual desire, difficulty with arousal, and painful intercourse are not uncommon among women with epilepsy. According to Pack, there are a variety of reasons for such problems, many of which can be helped by a doctor or therapist. Some women may experience feelings of low self-esteem, for example, while others may have vaginal dryness caused by the disease itself.

"As embarrassing as it may be, it is important to speak openly with a health-care professional you trust as many of these problems can be solved," Pack says.

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