Contraception

Of all the individuals diagnosed with epilepsy in Ireland about 25% or 10,000 are women of childbearing potential. In today's society choice is of vital importance for women, especially those affected by epilepsy. This section intends to explain the various methods of contraception available to women with epilepsy.

Women with epilepsy can choose from the standard methods of contraception. The exact choice should depend on the individual's needs but particular attention will need to be paid to some methods more than others. There are three main types of planned contraception, namely:

Barrier Methods
Hormonal Treatment
Natural birth control (rhythm and persona)

We have provided further details on the different types of the contraception which is available under the Barrier Methods and Hormonal Treatment types below.

1) Barrier Methods

The barrier methods are types of contraception used during sex to help prevent the sperm from reaching the egg. These barriers include:

Caps
Condoms
The coil
Diaphragms
Femidoms

2) Hormonal contraception

Some methods of hormonal contraception use the two hormones oestrogen and progesterone, or just progesterone alone, similar to those produced by women, to control menstruation. Hormonal contraception includes:

Combined oral contraceptive pill (COCP)
Contraceptive implanContraceptive patch
Depo-Provera contraceptive injection
Mirena coil (IUS)
Contraceptive injection
Progesterone-only pill (the mini pill)
Vaginal ring

Contraception and Epilepsy Medications

1) Enzyme inducing ASMs

Enzyme inducing Anti Seizure Medicines may make some methods of contraception less effective because of a possible drug interaction. They may affect methods of contraception that contain hormones such as the Pill or contraceptive implants. This is because they increase the level of enzymes that break down the hormones in the body. This means that the hormones in contraceptives are broken down more quickly than usual, so they stay in the body for less time and are less effective in preventing pregnancy. The list of Enzyme inducing ASMs include:

Carbamazepine (Tegretol)
Cenobamate (Ontozry)
Esclicarbazepine(Zebinix)
Oxcarbamazepine (Trileptal)
Perampanel (Fycompa)
Phenobarbitone
Phenytoin (Epanutin)
Primidone (Myosoline)
Topirimate (Topamax) >200mg Daily
Rufinamide (Inovelon)

For the medications listed above, the following contraception is recommended:

Caps
Condoms
The Coil
Diaphragms
Femidoms
Combined oral contraceptive pill (COCP)
Depo-Provera contraceptive injection
Mirena coil
Noristerat contraceptive injection
Unplanned emergency contraception - the morning after pill called Levonorgestrel (Levonelle); note that other types of morning after pill are not recommended

The following contraception are not recommended for the medications listed above:

Contraceptive Implant
Contraceptive Patch
Progesterone only pill
Vaginal ring
Natural birth control
Emergency contraception Ulipristal (EllaOne)

2) Non-enzyme inducing ASMs

There are also ASMs that are non-enzyme inducing, which many women with epilepsy may be prescribed. We have listed these below:

Biravetracetam (Briviact)
Clobazam (Frisium)
Clonazepam (Rivitrol)
Ethosuximide(Zarontin)
Gabapentin (Neurontin)
Lacosimide (Vimpat)
Lamotrigine (Lamictal) - NB special precautions section below.
Levetiracetam (Keppra)
Rufinamide (Inovelon)
Sodium Valproate (Epilim) - NB special precautions section below.
Tiagabine (Gabitril)
Topirimate (Topamax) <200mg daily - NB special precautions section below.
Vigabatrin (Sabril)
Zonisamide (Zonegran)

For the medications listed above, the following contraception is recommended:

Cap
Condoms
The coil
Diaphragms
Femidoms
Combined oral contraceptive pill (COCP)
Contraceptive implant
Contraceptive patch
Depo-Provera contraceptive injection
Mirena coil
Noristerat contraceptive injection
Progesterone-only pill (the mini pill)
Vaginal ring
Unplanned (emergency) contraception Levonorgestrel (Levonelle); Ulipristal acetate (EllaOne)

The following contraception are not recommended for the medications listed above:

Natural birth control

Special Precautions

Some research has suggested that Lamotrigine may interact with the COCP, contraceptive patch and vaginal ring reducing the effectiveness of Lamotrigine, thus increasing the risk of breakthrough seizures. You should discuss this with your neurologist/ epilepsy nurse specialist to see if your dose of medication needs to be increased. In turn Lamotrigine may also interfere with the COCP, contraceptive patch and vaginal ring causing them to work less well. For this reason a second method of contraception should be employed.
With regard to Sodium Valproate (Epilim), it is extremely important that you are aware of the potential impacts of the medication should it be taken during pregnancy. Visit the 'Valproate' section of our website to learn more about this important information and the protocols which should be taken around the prescribing of this medication to women of child-bearing age.
In the summer of 2022, a new research paper was published suggesting that the potential neurodevelopmental impacts associated with the anti-seizure medication (ASM) Topiramate (Topamax) if prescribed during pregnancy may be more significant than previously thought. Visit the 'Topiramate' section of our website to learn more about this.
It is important to note that the barrier methods of contraception, or having any type of coil inserted (including the intrauterine system, Mirena®), are usually the most suitable forms of contraception to consider if you are taking an enzyme inducing drug for your epilepsy.

How can I find out more about contraception?

Talk to your family doctor, epilepsy specialist nurse, your local family planning clinic. They can help you choose a form of contraception that will work for you and suit your lifestyle. It’s important to be happy with your choice, and to know how to use it properly, if you don’t want to become pregnant.