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Topiramate (more than 200 mg daily) and contraception

Planned contraception

Types of planned contraception that may work well

The following types of planned contraception may work well for you if you take topiramate (more than 200 mg daily):

Barrier methods

Barrier methods are worn during sex to prevent the sperm reaching the egg. These barriers include:

  • Cap (FemCap)
  • Condom or sheath
  • Diaphragm
  • Femidom (Milex)

Hormonal contraception

Some methods of contraception use the hormones oestrogen and progestogen, and some use just progestogen. These hormones are similar to those that your own body produces to control your menstrual cycle, when each month your body prepares to have a baby.

  • Combined oral contraceptive pill (the pill) but in combination with condoms. See box below
  • Contraceptive injection (Depo-Provera)
  • Contraceptive injection (Noristerat) (short term method of contraception only)
  • Hormone releasing intrauterine system (IUS) (Mirena)

Combined oral contraceptive pill (the pill)
Your doctor might suggest you follow these steps, to make it work better:

    • Take a version of the pill that contains at least 50 micrograms of oestrogen and
    • Take the pill all the time, without the usual seven day break each month and
    • Take a version of the pill which has at least twice the amount of progestogen than usual

If you have bleeding during the time that you are taking the pill, this could be a sign that the pill is not working very well. In this case, your doctor may increase the dose of oestrogen in steps of 10 micrograms, up to a maximum of 70 micrograms. Even if you take a higher dose of the pill, and even if you have no bleeding, it still might not work very well. For this reason, your doctor may advise you to use condoms as well, until they can be sure that the pill would prevent you from getting pregnant. They can check if you are at risk of getting pregnant by giving you blood tests at certain times of the month. The blood tests show if the pill has stopped you from ovulating (releasing an egg). This means that you shouldn’t get pregnant. Or, the doctor may advise you to change to a different type of contraception.

Intrauterine devices

  • Copper intrauterine device (IUD) coil
  • Hormone releasing intrauterine system (IUS) (Mirena)

These are small, T-shaped birth control devices that are inserted into a woman's uterus (womb) to prevent pregnancy.

Sterilisation

  • Female sterilisation

This involves an operation to permanently prevent pregnancy. The fallopian tubes are blocked or sealed by applying a clip, ring or tying and cutting and removing a piece of each fallopian tube. This is to prevent eggs from reaching the sperm and becoming fertilised. It is usually carried out under local or general anaesthetic.

  • Male sterilisation

This involves an operation to cut or seal the tubes that carry sperm from a man’s testicles to the penis into the fluid that is ejaculated during sex. This is a permanent method of birth control and is usually carried out under local anaesthetic.

Types of planned contraception that are not recommended

Hormonal treatment

  • Contraceptive implant (Nexplanon)
  • Contraceptive patch (Ortho Evra)
  • Progestogen-only pill (the mini pill)
  • Vaginal ring (NuvaRing)

Natural birth control

  • Persona contraception monitor
  • Rhythm method
  • Sympto-thermal method

Unplanned contraception

This type of contraception can be used after unprotected sex or when a planned method of contraception has failed.

Types of unplanned contraception that may work well

  • Copper intrauterine device (IUD) coil
  • Levonorgestrel (Levonelle) morning-after pill – but see box below

Guidelines suggest that the intrauterine device (copper coil) could be better than levonorgestrel at reducing the risk of pregnancy.

Levonorgestrel (Levonelle)
A doctor will prescribe you a pill that contains 3 mg levonorgestrel, to take as soon as possible after sex. This is twice the amount of levonorgestrel that women who don’t take epilepsy medicines usually take.

Types of unplanned contraception that are not recommended

  • Ulipristal acetate (EllaOne) morning-after pill

How can I find out more about contraception?

Talk to your family doctor, epilepsy specialist nurse or your local family planning clinic. They can help you choose a form of contraception that will work for you and suit your lifestyle.

It’s important to be happy with your choice, and to know how to use it properly, if you don’t want to become pregnant.

Further information is available from:

NHS website
Website: nhs.uk

Family Planning Association
Website: fpa.org.uk

Code: 
F058.05
Event Date: 
Friday 23 October 2015 - 12:42

Epilepsy Action would like to thank Beth Irwin, epilepsy nurse/midwife, The Royal Hospital, Belfast, for her help in planning this information and Kim Morley, epilepsy specialist midwife for her contribution to this information.

Beth Irwin and Kim Morley have declared no conflict of interest.

This information has been produced under the terms of The Information Standard.

  • Updated May 2019
    To be reviewed May 2022

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