Epilepsy and Contraception

If you are in a sexual relationship and want to take precautions against having a baby, there are many different forms of contraception available. If you have epilepsy or take anti-epileptic drugs, there are a few things that you may find helpful to consider before you make the best choice of contraceptive for you. Your local family planning clinic can also offer advice.

There is little research into the possible interactions between lamotrigine and the following forms of contraception. If you take lamotrigine and are considering any of the following, it would be advisable to discuss it with your own family doctor epilepsy specialist.

Barrier Contraceptives

These include condoms (sheaths) and diaphragms (caps). If your epilepsy causes you to have periods of confusion or memory loss, your partner could help you make sure that condoms are used correctly or your diaphragm is in place, before you have sex.

Contraceptive Injections

Depo-Provera injections are contraceptive injections. If you are taking enzyme inducing anti-epileptic drugs (see box below) it is suggested that the injection be repeated every 10 weeks instead of the usual 12 weeks.

Contraceptive Patch

The contraceptive patch releases two hormones - oestrogen and progestogen (one of the forms of progesterone) into the bloodstream. These are similar to the natural hormones that women produce in their ovaries and like those used in the combined oral contraceptive pill. There is not enough information at the moment on whether this is an effective form of contraception for women with epilepsy.

The Contraceptive Pill (Combined Oral Contraceptive Pill)

The combined oral pill (‘the Pill’) contains the hormones oestrogen and progesterone. This is the Pill most widely used.

Some anti-epileptic drugs (AEDs) are enzyme inducing, which means they speed up the way in which the liver breaks down the Pill. This is likely to make the Pill less effective and could lead to an unplanned pregnancy.

Epilepsy drugs which do reduce the effectiveness of the Pill:  Epilepsy drugs which do not reduce the effectiveness of the Pill:
Enzyme-inducing drugs:
  • carbamazepine
  • ethosuximide ( though there is conflicting information about this )
  • oxcarbazepine
  • phenobarbital
  • phenytoin
  • primidone
  • topirimate

Non-enzyme inducing drugs:
  • lamotrigine*
  • clonazepam
  • gabapentin
  • levetiracetam
  • tiagabine
  • pregabalin
  • sodium valproate
  • vigabatrin
  • zonisamide

* Recent research on a small group of women has indicated that even though lamotrigine is not enzyme inducing, it may interact with the oral contraceptive pill. This interaction may have a twofold effect:

  1. The oral contraceptive pill may be less effective, increasing the risk of unwanted pregnancies.
  2. The lamotrigine may be less effective increasing the risk of seizures.

If you take lamotrigine and the oral contraceptive pill, you may wish to make an appointment with your GP or epilepsy specialist to discuss your epilepsy treatment and contraception. It would also be helpful to inform your GP of any change in your seizure pattern.

The Progesterone-only Pill - the ‘Mini Pill’

This pill only contains the hormone progesterone. The mini pill is less reliable than the combined pill, especially if enzyme-inducing anti-epileptic drugs (AEDs) are being taken. Therefore, the mini pill is not recommended if you take enzyme-inducing AEDs.

If you do choose to take the mini-pill and it is essential that you do not become pregnant, you may be advised to use a barrier method such as a condom or the cap as well as the mini-pill.

Intrauterine Devices (IUDs)

An IUD is also known as ‘the coil’. It is a device that is fitted into the womb. IUDs are not affected by anti-epileptic drugs (AEDs). If you choose to use an IUD there is a small risk that you may have a reflex seizure when it is being put in, although this is rare. For this reason, it is advisable to tell the person inserting the device that you have epilepsy; so that they are prepared should you have a seizure.

Intrauterine Systems (IUS)

IUSs are similar to IUDs and are fitted into the womb. Unlike IUDs, which do not contain hormones, IUSs contain the hormone progesterone. An example of an IUS is the Mirena coil, which contains slow release progesterone called levonorgestrel.

Although IUSs contain progesterone, they are not affected by anti-epileptic drugs (AEDs) because the hormone is released straight into the womb rather than travelling around the body.

There have been occasional reports of a woman having a seizure when the IUS is being inserted, but this is rare.

Persona and Rhythm Methods

Persona is a method of contraception that relies on testing urine for hormonal changes relating to ovulation. As the hormone levels in urine may be affected by both epilepsy itself and by anti-epileptic drugs (AEDs), this is not a method of contraception that is recommended for women with epilepsy.

In the same way, the rhythm method depends on regular hormonal changes during each menstrual cycle. Neither the Persona nor rhythm methods are considered to be reliable forms of birth control for women with epilepsy.

Progestogen Implants

Contraceptive implants, such as Implanon, contain the hormone progesterone and are implanted under the skin in the arm. Implants may be affected by enzyme-inducing anti-epileptic drugs (AEDs) and so are not recommended if you take any of these.

Emergency Contraception

The ‘morning after’ pill is a form of emergency contraceptive that can be used after unprotected sex or when your contraceptive has failed. It can be used by women with epilepsy, but if you are taking enzyme-inducing anti-epileptic drugs (AEDs) you will need to take twice the dose that women not taking enzyme inducing AEDs take.

Current guidelines advise that women taking enzyme-inducing AEDs should take 1.5mgs of levonorgestrel (morning after pill) immediately and another 1.5mgs 12 hours later. This dose of levonorgestrel cannot be bought in a pharmacy. It must be prescribed by a doctor.