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Birth Control for Women with Epilepsy

More than one million women and girls in the United States are living with seizure disorders. They face many unique challenges, from changes during the monthly cycle which may trigger seizures to concerns regarding pregnancy. Social factors leave them vulnerable to discrimination and abuse. Yet their plight and the manner in which they are affected has been largely ignored. As an important part of the Epilepsy Foundation's role in advocating for all people with epilepsy, we are committed to addressing the unique health concerns of women with epilepsy.

Many women have questions and concerns about using birth control medications. This information sheet explores the complex interactions between hormonal birth control and some of the medications used to control seizures. It will also answer other common questions related to birth control in women with epilepsy. How does one know which is the best method of birth control? Are there special concerns about "the pill" for women with epilepsy? Are there problems with other forms of hormonal birth control? What are warning signals that contraception is not working? Will seizure patterns change while taking birth control pills or other birth control methods?

Is there any way to be sure that I don't get pregnant?

All available birth control methods can be used by persons with epilepsy. These include:

barriers: diaphragms, spermicidal vaginal creams, intrauterine devices (IUDs) and condoms

timing: the "rhythm method" where intercourse is avoided during a woman's ovulation period or withdrawal by the man prior to ejaculation

hormonal contraception: birth control pills, hormone implants, or hormone injections

Of these, hormonal contraception is the most reliable method for most women, but it is not 100% effective, especially in women with epilepsy. Keep in mind that even in the general population there is always a slight chance of an unwanted pregnancy despite appropriate use of contraceptives.

If you have decided that you never want to have children, you can talk to your doctor about an operation called a tubal ligation. This procedure is the most secure way to ensure that you will never become pregnant. If you are in a monogamous relationship (only one male partner) he can have a similar operation, a vasectomy. This would not protect you from pregnancy with other male partners. These are serious decisions, and you need to think about them carefully before choosing either of these procedures.

How do I know which method is best for me?

You need to work with your gynecologist and your neurologist to choose the birth control method that is most appropriate for you. It is possible that your antiepileptic drug (AED) may make your hormonal birth control less reliable, resulting in an unwanted pregnancy. You and your physicians may consider different combinations of hormonal birth control and seizure medications to find the one that works best for you.

How will my seizure medication affect my hormonal birth control?

There are complex interactions between the hormones (estrogen and progesterone) contained in birth control pills or devices, and some of the medications used to control seizures. Some of these medications increase the breakdown of contraceptive hormones in the body, making them less effective in preventing pregnancy. The seizure medications that have this effect are often called "liver enzyme-inducing" drugs. They are carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax).

Valproate (Depakote) and felbamate (Felbatol) do not increase breakdown of hormones, and may even increase hormonal levels, which may require an adjustment in the dose of your birth control.

Gabapentin (Neurontin) and lamotrigine (Lamictal) have no effect on this system and do not interfere with the effectiveness of hormonal birth control.

Are there special concerns about "the pill" for women with epilepsy?

Yes, there are. The popular "mini pill" has a relatively small amount of estrogen (less than 35 micrograms.) That's not enough to protect women with epilepsy from becoming pregnant, because many of the commonly prescribed seizure medications reduce the amount of time that hormones are in your bloodstream. You may need contraceptive pills with higher doses of estrogen, and even then, there is a risk of unexpected pregnancy. It is a good idea to use barrier methods (a diaphragm, spermicidal cream or a condom) in addition to the contraceptive pill, if you are taking one of the seizure medications that speed up the breakdown of the hormones in birth control pills.

Are there problems with other forms of hormonal birth control?

Hormonal implants, like levonorgestrel (Norplant) which is placed under the skin, may not provide effective birth control protection if you are taking certain epilepsy drugs. The medications that cause the most problems with Norplant are the "liver enzyme-inducing" seizure medications such as carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax). These antiepileptic drugs increase the rate of breakdown of birth control hormones.

Medroxyprogesterone (Depo-Provera) is a hormonal injection used for birth control and it may need to be given more frequently in women with epilepsy taking medications such as those mentioned above. If you are using one of these forms of birth control, and you take one of the liver enzyme-inducing medications, it is a good idea to use a second barrier method of contraception in addition, such as a diaphragm, a spermicidal cream, or have your partner use a condom.

Are there any warning signals if my contraception is not working?

Bleeding in the middle of your cycle while you're on hormonal contraception could be a sign that you are ovulating and may become pregnant. If bleeding occurs, ask your doctor to help you select an additional form of contraception such as a diaphragm, spermicidal vaginal cream, or a condom. It is important for you to know that hormonal contraception can fail without mid-cycle bleeding.

Does it matter that my periods aren't regular?

Yes, because it may make hormonal birth control and timing methods more complicated. Usually, irregular menstrual cycles mean that hormones are out of balance in some way. It is important for your gynecologist and your neurologist to know if your periods are irregular so that they can help you choose the best method of contraception. It may be necessary to consult with an endocrinologist, a doctor who specializes in diagnosing and treating hormonal problems.

Will my seizure pattern change if I use hormonal birth control?

Current research does not indicate changes in seizure frequency when women with epilepsy use hormonal birth control, but individual reports suggest they may change. Some women have reported more seizures, some have reported less. If you notice a change in your seizure pattern when you use hormonal birth control, contact your physician.