Contraception for women with epilepsy: counseling, choices, and concerns

Abstract

Approximately 50% of all pregnancies in women with epilepsy (WWE) occur unplanned. This is worrying, given the increased occurrence of obstetrical complications in WWE, including the risk of seizures and their possible consequences for both the mother and the unborn child. Hormonal contraception is usually regarded as highly effective, but it is subject to numerous bidirectional drug interactions with several antiepileptic drugs. These interactions may lead to loss of seizure control or contraceptive failure. Further concerns are loss of bone mineral density and increased seizure activity due to hormonal effects. Many physicians lack sufficient knowledge regarding these issues, and most WWE have never received adequate counseling. Moreover, several studies show that a large proportion of WWE do not take their medicines regularly. This article reviews all of these issues and offers practical recommendations for the management of contraception in WWE.

Hormonal contraception in patients with epilepsy

“…Other hormonal contraceptive methods, such as medroxyprogesterone acetate depot injection, or implantable hormonal contraceptive may have some interaction with AEDs. Nonhormonal, highly effective methods, such as IUDs, may be ideal for women with epilepsy, since the contraceptive mechanism of IUDs is unaffected by changes in hepatic enzyme activity [14][15][16]. What's more, IUD poses a significantly lower risk for seizure increase in WWE than hormonal contraception [17].…”

Selecting Hormonal Contraceptives in Women Taking Antiepileptic Drugs : Review of Literature and Practical Recommendations

“…Nonetheless, there is limited information regarding potential impact of oral contraceptives on seizure in women with epilepsy. 6 A recent study suggests that oral contraceptive may exacerbate seizures, but previous study didn't support this statement. 7 The reports from Herzog and colleagues (2015) stated that hormonal contraception use may increase the risk of seizure (28,2%) compared to non hormonal one (9,7%).…”

“…However, there still a little doubt whether the use of oral contraceptive may exacerbate the seizure and needs future study to clarify the issue. 2,5,6 Some evidence grow with the link between steroid hormones and neurosteroids and seizure susceptibility. Nonetheless, there is limited information regarding potential impact of oral contraceptives on seizure in women with epilepsy.…”

“…7,8 Another consideration is non oral progesterone contraceptives may have less effect on seizure frequency compared to hormonal patch and progestin-only pills. 6,7 Progesterone has antiseizure properties. However, the outcome of phase III clinical trial of progesterone therapy couldn't meet the expectation.…”

“…This suggests the benefit of progesterone to treat women with perimenstrually exacerbated seizures. 6,7…”