Contraception for women with epilepsy

Epilepsy is one of the most common neurological disorders. In order to prevent unintended pregnancies or impaired seizure control, the bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. If combined hormonal contraceptives are used in combination with enzyme-inducing antiepileptic drugs (EI-AED) contraceptive efficacy may be reduced. To improve contraceptive safety continuous administration of a monophasic combined oral contraceptive (COC) without a hormone-free interval is recommended. The progestin component should be well above the ovulation inhibiting dose; however, absolute reliability of contraception cannot be guaranteed. Thus, in case of doubt additional contraceptive methods, such as barrier methods (e. g. condoms) should be recommended. Low or intermediate dose progestin preparations (e.g. progestin only pills and progestin implants) should not be used in combination with AEDs. High-dose injectable depot procedures appear to be effective even in combination with EI-AEDs, but due to side effects should only be prescribed after a thorough consideration of the risks and benefits. The use of copper intrauterine devices and levonorgestrel-releasing intrauterine coil systems may be an alternative for many women with epilepsy in need of contraception. For women with epilepsy an interdisciplinary collaboration between treating physicians from neurology and gynecology is crucial for optimal treatment. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.