woman and doctor

AR Espinera, J Gavvala, I Bellinski, J Kennedy, MP Macken, A Narechania, J Templer, S VanHaerents, SU Schuele, EE Gerard, Epilepsy & Behavior, 2016;65:1-6.

Purpose

This study was done to learn how epilepsy specialists counsel women about contraception. The researchers also wanted to see if counseling by a neurologist in an academic epilepsy specialty care clinic was helpful in influencing the contraceptive choices of women with epilepsy.

An intrauterine device (IUD) is recommended by the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) as the contraceptive of choice for women with epilepsy. This recommendation is due to interactions that may occur between hormonal contraceptives and many seizure medications.

Counselling women about contraception is important to avoid unplanned pregnancy and breakthrough seizures. It is unclear, however, whether counseling is routinely done and who is responsible for giving this critical information to women with epilepsy.

Description of Study

  • Information was reviewed from medical records of 397 women age 18 to 45 seen at Northwestern University hospital for an initial visit between 2010 and 2014.
  • Information was obtained about the use of seizure medications, contraceptive methods, IUDs, and whether contraceptive counseling was done at each visit.
  • In 95 women with at least four follow-up visits, the association between counselling from an epileptologist and selection of an IUD was examined.

Summary of Study Findings

  1. Only 35% of women received counselling about contraception during their first visit. This only increased to 37% who were ever counseled by their fourth visit.
  2. Of the 95 women with epilepsy with at least four follow up visits, 28% were counseled about an IUD, 39%, generally counseled about contraceptive interactions, and 33% were not counseled about contraception.
  3. Women who received IUD-specific counseling by the epileptologists were more likely to switch to IUD than those with only general information or with no contraceptive counseling.

What does this mean?

  1. Contraceptive counseling was given to only 1 out of 3 women with epilepsy seen at an academic epilepsy center, most likely during their first visit.
  2. Women in this study who were specifically counseled about an IUD as an optimal form of birth control were more likely to get an IUD than those who were not counseled.
  3. Counseling by epileptolgists can play an important role in a woman’s choice of contraception. Since IUDs are a very effective form of contraception and do not interact with seizure medications, it is important for women to learn about this option as well as all available contraception.

Article published in Epilepsy & Behavior, December 2016.

Authored By: 
Sookyong Koh MD, PhD
Authored Date: 
01/2017
Reviewed By: 
Joseph I. Sirven MD
on: 
Monday, January 23, 2017