Why is birth control important for people with epilepsy?
Birth control allows everyone, including people with epilepsy, the opportunity to make their own decision about if and when they want to become pregnant. When living with epilepsy, there are a few steps to take before choosing the correct birth control method for you. Some anti-seizure medications (ASMs) may interfere with your chosen birth control. This can make birth control less effective. Other birth control selections can affect certain ASMs. As a result, this may impact your seizure control.
Working with your healthcare team to select the correct birth control for you is crucial. Your team will review medications, your seizure history, and any other medical conditions you may have to help find the best choice for you.
How can anti-seizure medications impact birth control effectiveness?
As mentioned previously, some anti-seizure medications can make birth control less effective. This table offers a comprehensive look at ASMs by how strongly they interact with some forms of birth control.
Which reversible birth control options are most effective for people with epilepsy?
Intrauterine Devices (IUDs)
Both types of IUDS — copper (Paragard) and hormone-eluting (Mirena, Kyleena, Skyla, and Liletta) are highly effective, long-acting, reversible birth control options that aren’t affected by ASMs. They also don’t impact seizure control.
IUDs are the most effective, reversible form of birth control regardless of the ASM you are taking.
Depo-Medroxyprogesterone Acetate (Depo-Provera, “Depo”)
Depo is a highly effective birth control method that ASMs don’t substantially affect. Some doctors recommend getting the shot every 10 weeks (vs. the usual 12-week interval) if you are taking a strongly or mildly interacting ASM. See Figure 1 above for a list of those ASMs.
Etonogestrel or Progesterone Implants
These implants are a long-lasting reversible birth control option that are more effective at preventing pregnancy than many other forms of birth control. However, ASMs that interact may impact an implant’s effectiveness. See Figure 1 above.
This medication can have some adverse events that need to be reviewed along with your doctor.
Which reversible birth control options may be less effective for people with epilepsy?
Some hormonal birth control options may be LESS effective at preventing pregnancy when they are paired with certain interacting ASMs (See Figure 1 above for the list of strongly and mildly interacting ASMs). If you do use one of these options, you should use an additional backup barrier method.
- Combined (estrogen + progesterone) oral birth control pills (“the Pill”)
- Vaginal rings
- Estrogen patches
- Progesterone-only pills (“mini-pill”)
Will my birth control impact the anti-seizure medication I take?
Birth control that includes estrogen, such as birth control pills, the vaginal ring, and the estrogen patch, will lower the amount of lamotrigine in your bloodstream. It is also possible for this to occur with oxcarbazepine and valproic acid but to a smaller extent.
If the dose of lamotrigine is not adjusted when these birth control treatments are started, seizure control can worsen. This may also occur with oxcarbazepine and valproic acid.
Before taking birth control, reach out to your care team if you are taking lamotrigine, oxcarbazepine, or valproic acid. They will plan to monitor you and make any changes necessary to your dosage to make sure you maintain seizure control.
Will I need to make any changes to my anti-seizure medication when I stop birth control?
If you’re taking lamotrigine, oxcarbazepine, or valproic acid, and you’re thinking of discontinuing estrogen-containing birth control (combined oral contraceptive pills, vaginal rings, or skin patches), consult with your doctor about reducing your ASM dosage. We recommend that you have this conversation before you make any changes to your birth control.
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