The combined contraceptive pill (OCP)

Around 25% of those diagnosed with epilepsy in Ireland are women of childbearing potential. Women with epilepsy can choose from the standard methods of contraception.

Your exact choice will depend on your individual needs and you can discuss this with your doctor, but you will need to pay particular attention to some methods more than others.

The combined contraceptive pill (OCP)
There is no evidence to suggest that taking the pill adversely affects symptoms. However, it is vitally important to tell your health professional that you are taking anti-epileptic medication. Some of the anti-epileptic medicines can break down (or metabolise) the OCP faster, thereby reducing its effectiveness. These are known as enzyme-inducing anti-epileptic drugs. They include; phenobarbitone, primidone (Mysoline), phenytoin (Epanutin), carbamazepine (Tegretol), topirimate (Topamax) and oxcarbazepine (Trileptal). If you are taking any of these drugs, you should be on an OCP with a minimum of 50mcg oestrogen content or a combination of the OCP to obtain a maximum dose of 50mcg of oestrogen.

Any evidence of breakthrough bleeding would suggest that this method is not effective and should be reported to your GP immediately. A barrier method of contraception is advised until reliability is achieved.

Anti-epileptic medications which are non enzyme-inducing include; sodium valproate (Epilim), vigabatrin (Sabril), clonazepam (Frisium), gabapentin (Neurontin), pregabalin (Lyrica), tiagabine (Gabatril), levetiracetam (Keppra) and lamotrigine (Lamictal). .
The lower dose pill (25-35mcg of oestrogen) can be taken as usual if you are taking any of these drugs. Any evidence of breakthrough bleeding would suggest that this method is not effective and should be reported to your GP immediately.

The progesterone-only pill (mini-pill)
This method of contraception is not recommended, as it is less effective, particularly if enzyme-inducing anti-epileptic drugs are being taken.

Emergency contraception
There is no evidence to suggest that women with epilepsy should not take emergency contraception. Those taking enzyme inducing anti-epileptic medications will need a higher dose of the ‘morning after pill’ than women who are taking non-enzyme inducing drugs.

Depo Provera
This contraception method is a single injection into the buttock. It is usually administered every 12 weeks. For women on enzyme-inducing anti-epileptic drugs, it should be given every 10 weeks, as these drugs reduce the effectiveness of the injection

Barrier methods
The condom for males or the ‘Femidom’ for women if used correctly can be effective for the woman with epilepsy. There are no large-scale studies but research to date suggests that the Femidom is as effective as the male condom.

Implants
A contraceptive implant is a rod-shaped device that is inserted under the skin just above the elbow for a period of three years. This method is NOT advisable for everyone on enzyme-inducing anti-epileptic drugs and an alternative method should be considered.

Intra-uterine contraceptive devices
There are two types of IUD available; Mirena, and a device containing copper and the Flexi T 300. When deciding which device is for you, it should be noted that the Flexi coil is less effective than the Mirena; up to 5% may get pregnant during three years of usage. Mirena is a small t-shaped device that delivers the hormone, levonorgestrel to the uterus and therefore it is unlikely to cause a problem for women with epilepsy. It should not be affected by enzyme inducing anti-epileptic medication.

The Persona device
This method relies on testing your urine for hormonal changes during your menstrual cycle. It is not a recommended method of contraception for women on anti-epileptic medication.

The rhythm method
This method also relies on hormonal changes and is therefore not recommended for women on anti-epileptic medication.

The EVRA patch
Evra is a thin square patch worn on the skin to prevent pregnancy. Each patch is worn for seven days every week for three consecutive weeks and the fourth week is patch-free, with no patch required. The patch is not recommended for women on enzyme-inducing anti-epileptic drugs.

Folic acid
If you are a woman of childbearing potential and have been diagnosed with epilepsy, it is important to be made aware of the potential benefits of talking folic acid. By taking the higher dose tablet of folic acid, 5mg as prescribed by your doctor prior to contraception, you may reduce the risk of neural tube defects such as spina bifida.

All women are different and require individualised care when it comes to family planning. This issue requires discussion with your GP or family planning centre or your community epilepsy nurse. In some cases, you may be dealing with a health professional who has not been involved with your epilepsy care, and you need to discuss your epilepsy to ensure that they are aware of your status.

For further information about epilepsy contact:
Mail: Brainwave, The Irish Epilepsy Association, 249 Crumlin Road, Dublin 12.
Phone: 01-455 7500
Email: info@epilepsy.ie
Website: www.epilepsy.ie

Become a member of Brainwave here

Back to "Basics"

Back to Homepage

Basics | Exploring Treatments | Advanced Resources | News | Contact Us | Disclaimer

	Copyright © 2008. All rights reserved.
	We subscribe to the principles of the Health On the Net Foundation