getAhead - Teenage girls with epilepsy

• Epilepsy, your periods and fertility
• Contraception
• Pregnancy
• Cosmetic side-effects and epilepsy treatments
• Getting more info

Epilepsy, your periods and fertility

The effect of periods (menstruation) on epilepsy is still being researched, but it is thought that the changing levels of female hormones during your monthly cycle can play a part. Make an appointment to talk to your doctor or a nurse if you are at all worried about your period starting, irregular periods or if you notice that you tend to have regular 'clusters' of seizures just before or during your period (these are called catamenial seizures).

Irregular periods may be caused by cysts on the ovaries - called polycystic ovaries (PCO). This condition is more common among young women with epilepsy than the general population and may affect fertility. Sometimes polycystic ovaries occur with changes in hormone levels causing weight gain, acne and hirsutism (when the hair on your face and body becomes more noticeable). This combination of symptoms is termed polycystic ovary syndrome (PCOS) and may occur more frequently among women taking sodium valproate. If you are experiencing these effects and are concerned, do talk them through with your doctor.

Contraception

Some commonly prescribed epilepsy medications reduce the effectiveness of the Pill, for example, phenytoin, carbamazepine, phenobarbitone, primidone, topirimate, oxcarbazepine. These epilepsy drugs speed up the way the body breaks down the Pill, leaving you with inadequate protection. Some epilepsy drugs have no effect on the Pill. Examples are newer drugs such as vigabatrin, gabapentin, tiagabine, levetiracetam, as well as the older but commonly used sodium valproate and the benzodiazepines (clobazam, clonazepam).

What to do if you are taking an epilepsy medication that affects the Pill?

• Consider using additional contraception until you are able to discuss the matter with a doctor or nurse.
• Discuss with your doctor whether an alternative method of contraception is advisable or whether now would be a good time to change to a different epilepsy medication that may be more suitable for your life ahead as a woman.
• Never stop taking your epilepsy medication until you have talked to a doctor or nurse.

The morning-after pill (also known as the 'emergency contraception' pill)

If you think your contraception might have failed, you can take the morning-after pill. If you are taking an epilepsy medication listed above that affects the Pill, your doctor may need to prescribe a slightly higher dose of the morning-after pill.

Talking about contraception and epilepsy

When you talk to your GP, family planning nurse or Family Planning Association clinic about contraception, you must mention that you have epilepsy. Hormonal contraception such as the Pill is a medication in its own right, which needs to be considered with your epilepsy treatment. Likewise, when you see a doctor or nurse about your epilepsy, you must tell them you are on the Pill, as any changes to your epilepsy medication could make your contraception less reliable.

Pregnancy

For women with epilepsy especially, family planning is really important. Pregnancy can affect how well your epilepsy medication controls your seizures. Also, while the majority of babies born to women with epilepsy are healthy, there is a small risk that epilepsy itself or the epilepsy drugs may affect the unborn baby. You should therefore talk about these risks when you are planning to have a baby before you get pregnant. For these reasons, until you are ready to become pregnant, it is vital that your choice of contraception is correct and does not fail you.

Cosmetic side-effects and epilepsy treatments

As with many drug treatments, there are side-effects that have been linked to the use of some epilepsy treatments. Unfortunately, weight gain can occur when taking sodium valproate, and also gabapentin and vigabatrin. Because being very overweight can affect your health in the long run, you and your doctor should review your diet, monitor your weight and consider changing your epilepsy treatment if it continues to rise.

Acne and hirsutism (when the hair on your face or body becomes more noticeable) are side-effects which can occur with the medication phenytoin. Do talk them through with your doctor if you are unhappy about them.

Getting help and advice from health professionals

Everyone finds their teens difficult in getting used to the changes in the way their body looks and works. So being a woman with epilepsy and probably experiencing additional physical changes that may arise from some medications, it is perfectly natural to go through phases where you may feel down about your epilepsy and how your medication makes you look and feel.

That's why it is important to talk to your doctor or specialist nurse about your epilepsy and its treatment. They will talk through any concerns you have and help you manage your epilepsy in a way that suits you as an individual and in respect to what is important to you.

22 September 2005

Getting more info

• Epilepsy Action website
• Epilepsy Action Freephone Helpline 0808 800 5050 and Email Helpline helpline@epilepsy.org.uk are both staffed by trained epilepsy advisors who can advise you as to next steps to take and provide free factsheets