Contraception and epilepsy

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Talking about sex can feel a bit awkward, and that's completely normal. But it's also an important part of looking after your health and wellbeing.

As you get older, relationships, sex and contraception may start to become part of your life. Whether you're already thinking about these things or just want to understand your options for the future, having the right information can help you make informed choices. There's nothing to be embarrassed about, and it's always okay to ask questions.

Is it something you’ve given much thought? What are your considerations? At school you learn the basics – condoms and the pill. But what about all the other options available to you? With so much to consider it can be information overload at times and, let’s be honest, it can be slightly off-putting. But you want safe sex with reliable contraception. It’s that simple.

But what if you or your partner has epilepsy?

Your contraception choices will depend on the epilepsy meds you’re taking. Some epilepsy drugs can affect how successful the protection is while others can only be prescribed alongside contraception.

What will affect my epilepsy?

Hormonal contraception has a high success rate and is a popular choice. However, if you use enzyme-inducing medication (such as carbamazepine, phenytoin, phenobarbital and primidone), hormonal contraception like the pill breaks down much faster in your body and becomes less effective. Your doctor and epilepsy team/specialists may advise you to use barrier methods of contraception instead.

Your meds

Valproate:

Taking this drug can have a serious effect on your contraceptive options. It can also cause serious harm to an unborn baby if taken during pregnancy. Even if you’re not having sex, you’ll need regular reviews with your doctor if you’re taking this and your periods have started. It’s important to talk through your treatment (and contraception options) with your epilepsy doctor or find more information here.

Lamotrigine

Lamotrigine demands special attention when it comes to contraception. That’s because there’s some evidence that taking the pill can lower the levels of lamotrigine in your blood. Which means it can reduce your seizure control. Talk to your epilepsy doctor about taking lamotrigine and your best contraceptive options.

Take a look at the different types of hormonal contraception available

Intrauterine System (IUS)

This is a small T-shaped device that a doctor or nurse can put into your womb to reduce the chances of you getting pregnant. When inserted correctly it’s 99% effective. It releases the hormone progestogen which thickens the cervical mucus. This makes it difficult for sperm to travel through the cervix. It also thins the womb-lining to stop an egg being able to implant itself. Although an IUS can last for 3-5 years it’s not recommended for people with epilepsy because the dose can’t be altered to suit your individual needs.

Contraceptive pill

There are two types of ‘pill’, both of which are 99% effective. There’s the Progestogen-only Pill (POP) which is the most common contraceptive pill. Like an IUS, this releases progestogen hormones to thicken the mucus in the cervix and stop sperm fertilising an egg. Alternatively, the Combined Pill (commonly known as ‘the pill’) contains both progesterone and oestrogen to mimic the hormones that women naturally produce in their ovaries. To stop the chances of fertilisation, the pill stops ovulation (egg release) and keeps the egg and sperm apart. Whichever pill you choose, you will need to take it daily – without fail - for it to be successful.

Implant

Also known as Nexplanon, the contraceptive implant is a small flexible plastic rod that’s inserted in your upper arm by your doctor. It releases progestogen hormones into your bloodstream and can last for up to 3 years. With a 99% success rate it’s a popular choice, however it’s not recommended if you take anti-seizure medication (ASMs).

Injection

Similarly to the implant and pill the contraceptive injection also releases progestogen hormones into your bloodstream and is 99% effective. There are different versions available, Depo-Provera is the most common option in the UK and can last up to 13 weeks. By comparison it’s competitor brand Noristerat lasts for up to eight weeks. It’s not recommended if you take epilepsy meds but chat to your epilepsy doctor/specialist for a professional medical opinion.

Vaginal ring

Sometimes called the NuvaRing, this is a small, soft, plastic ring that releases a continuous dose of progestogen and oestrogen when placed inside the vagina. Although 99% effective if you’re not taking ASMs, it’s not recommended if you are as the odds of protection are considerably less.

Morning after pill

For the morning after the night before, or up to five days after you’ve had sex, the morning after pill provides emergency contraception that can prevent pregnancy. However, enzyme-inducing meds can reduce the morning after pill’s effectiveness. That doesn’t mean it’s not an option – just remember to tell the pharmacist about your ASMs so they can ensure you have the right dose.

What won’t affect your epilepsy?

Barrier methods of contraception offer protection regardless of you or your partner’s medication. Their effectiveness may not be as guaranteed as hormonal contraception but they still have a high success rate. So, what are your options?

Condoms

Probably the first contraceptive you ever learnt about and just about the easiest to get hold of. Condoms share the responsibility of contraception between you and your partner and if you’re concerned about your medication – this will have zero effect.

Femidon

These work in the same way as a condom except they’re worn inside the vagina to prevent sperm entering the womb.

Intrauterine device (IUD)

Often referred to as ‘The Coil’ or ‘Copper Coil’. Like an IUS this is a small T-shaped device made of plastic or copper that’s placed in the womb by a doctor or nurse. Lasting between 5-10 years it releases copper rather than hormones to reduce the chances of pregnancy. Simply speaking it creates a hostile internal environment where sperm cannot survive.

Cap/diaphragm

This is a soft, silicone circular dome that’s inserted into the vagina before sex. It prevents sperm passing through the cervix and entering the womb. You need to use spermicide with it – a gel that kills sperm - and leave it in the vagina for six hours after sex. Although it’s 92% effective, it doesn’t protect against sexually transmitted infections (STIs). There’s also a risk it may cause toxic shock syndrome (TSS) and so shouldn’t be used during your period.

Everyone is different.

Just as we all have different tastes and are attracted to different people, our bodies respond to different contraception in different ways. Talk to your epilepsy doctor or visit brook.org.uk to find what suits your body best.

“I was lucky enough to feel open and speak with my mum. But I also spoke to my GP and my epilepsy consultant who were really helpful about what contraception I can, and should, go on whilst being on anti-epileptic drugs. Growing up is scary, even more so when you have epilepsy.”

Olivia - Aged 23

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