More Women with Epilepsy Should Consider Contraceptives

Because many antiepileptic drugs have teratogenic potential, health care providers commonly recommend contraceptives to women with epilepsy.

Antiepileptics and sex hormones such as estrogen and progesterone interact in a convoluted manner. Many antiepileptics also reduce hormonal agents’ serum levels and efficacy. Sex hormones’ neuroactive properties further complicate the safe and effective use of hormonal contraception in women with epilepsy.

Epilepsia recently published a study in its January 2016 issue that showed inadequate contraceptive use among women with epilepsy. The study included 1144 patients aged 18 years or older who completed the Epilepsy Birth Control Registry Web-based survey, which included questions about a range of demographics and collected information about seizure disorder type and medications (eg, enzyme inducers, non-inducers, inhibitors, and antiepileptic drug use).

The survey participants were younger, more educated, less likely to have had irreversible contraception (6.4%), and more likely to have had a recent seizure in the past year (92.3%) than the general population. The researchers indicated that the low rate of irreversible contraception use was driven by the cohort's younger age and selection bias; sterilized patients would not pursue further information on contraception.

The study authors found that 30.3% of patients were not using highly effective contraception (meaning, a failure rate lower than 10%). However, intrauterine devices (IUDs) were more common in the survey cohort than the general population, and they were particularly more common among patients taking enzyme-inducing antiepileptic drugs. Unlike hormonal methods, copper IUDs lack drug-drug and drug-disease interactions.

Patients taking enzyme-inducing antiepileptic drugs were less likely to use hormonal contraception than the cohort as a whole or the general population. Hormonal contraception reduces serum lamotrigine levels, but its use in lamotrigine users was comparable with the general population.

Patients who had insurance coverage or were white were most likely to use highly effective contraceptives. Meanwhile, education level had no influence on contraception choice.

Only 25.4% of patients discussed contraceptive use with their neurologist (87.4% had a neurologist), but 55.3% considered their antiepileptic medications when selecting their contraceptive method.

Pharmacists’ patient education, as well as further outreach and cooperation with neurologists, may increase the use of highly effective contraception and optimize contraceptive choice.