Epilepsy_Contraception_Flashcards
What factors should be considered for women with epilepsy regarding contraception?
The effect of the contraceptive on the effectiveness of the anti-epileptic medication, the effect of the anti-epileptic on the effectiveness of the contraceptive, and the potential teratogenic effects of the anti-epileptic if the woman becomes pregnant.
What does the Faculty of Sexual & Reproductive Healthcare (FSRH) recommend for women with epilepsy?
The consistent use of condoms, in addition to other forms of contraception.
What are the UKMEC recommendations for women taking phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine?
UKMEC 3: the COCP and POP. UKMEC 2: implant. UKMEC 1: Depo-Provera, IUD, IUS.
What are the UKMEC recommendations for women taking lamotrigine?
UKMEC 3: the COCP. UKMEC 1: POP, implant, Depo-Provera, IUD, IUS.
What should a COCP contain if chosen for a woman with epilepsy?
A COCP should contain a minimum of 30 µg of ethinylestradiol.
summarise epilepsy contraception
Epilepsy: contraception
There are a number of factors to consider for women with epilepsy:
the effect of the contraceptive on the effectiveness of the anti-epileptic medication
the effect of the anti-epileptic on the effectiveness of the contraceptive
the potential teratogenic effects of the anti-epileptic if the woman becomes pregnant
Given the points above, the Faculty of Sexual & Reproductive Healthcare (FSRH) recommend the consistent use of condoms, in addition to other forms of contraception.
For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS
For lamotrigine:
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
If a COCP is chosen then it should contain a minimum of 30 µg of ethinylestradiol.
A 21-year-old woman attends her GP to discuss contraception options as she is in a stable relationship. She has recently been diagnosed with partial epilepsy for which she takes carbamazepine regularly. She also has a history of heavy menstrual bleeding. Past medical history is unremarkable otherwise.
Which one of the following would be the most appropriate method of contraception at this time?
Intrauterine device (Copper coil)
Nexplanon
Intrauterine system (Mirena)
Depo- provera
Combined oral contraceptive pill
Intrauterine system (Mirena)
The choice of contraception is based on individual preference while taking in to account relative cautions or contraindications. In this case, the first consideration is the need for a method that would not be affected by the enzyme inducing effect of carbamazepine, such as the intrauterine system. The combined oral contraceptive pill (COCP) would be useful for heavy bleeding but the failure rate would be high due to enzyme induction. Nexplanon can itself cause heavy bleeding initially and in addition, the dose of progestogen in the circulation is low and will also be affected by enzyme induction. Depo-provera could be used but prolonged use in young individuals could lead to reduced bone density. The intrauterine system (Mirena) would be effective both for reducing heavy bleeding and providing contraception that would be effective along side her anti-epileptic medication.
