Practice 10-Minute Consultation

Contraception advice for women with epilepsy

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2010 (Published 11 May 2017) Cite this as: BMJ 2017;357:j2010
  1. Inuka Kishara Gooneratne, clinical fellow1,
  2. Mayurika Wimalaratna, general practitioner2,
  3. A K Probhodana Ranaweera, consultant obstetrician and gynaecologist3,
  4. Sunil Wimalaratna, consultant neurologist4
  1. 1Department of Neurology, Kettering General Hospital, Kettering, UK
  2. 2Wendover Health Centre, Buckinghamshire, UK
  3. 3Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Sri Lanka
  4. 4Neurology Department, John Radcliffe Hospital, Oxford University Hospital, Oxford, UK
  1. Correspondence to I K Gooneratne kishig{at}gmail.com
  • Accepted 30 March 2017

A 22 year old student attends your practice asking for contraception. She has idiopathic generalised epilepsy diagnosed five years ago, which is controlled with lamotrigine. She does not plan to conceive in the near future.

Active epilepsy affects around 6.4 per 1000 persons,1 Globally, 50% of women and girls with epilepsy are in the reproductive age range.2 Counsel women about the potential teratogenic effects of anti-epileptic drugs and provide information on contraception to avoid an unplanned pregnancy.3 Consider interactions between anti-epileptic drugs and hormonal contraceptives because using them together can reduce the efficacy of contraception or of seizure control.4

What you need to know

  • Anti-epileptic drugs such as carbamazepine, phenytoin, and phenobarbital can reduce the efficacy of hormonal contraceptives.

  • Consider long acting reversible contraceptives such as medroxyprogesterone acetate depo injection, copper intrauterine device, and levonorgestrel releasing intrauterine systems in patients on enzyme inducing anti-epileptic drugs.

  • Sodium valproate is not recommended in women of childbearing age because of high teratogenicity.

What you should cover

History

Consider asking about

  • Current status of epilepsy: Age at onset of seizures? Are seizures well controlled? What anti-epileptic drugs is the woman taking? Does she experience any adverse effects from taking these drugs?

  • Preferred contraceptive: Does she use any contraception at present or …

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