Contraception

Why is it important to get the right contraception?

Contraception is important for anyone who is sexually active and wants to avoid an unplanned pregnancy. But it’s particularly important if you take epilepsy medicine.

Some epilepsy medicines can make hormonal contraceptives less effective. This can increase your chance of getting pregnant.

Some types of contraception can affect how lamotrigine works. They can make lamotrigine less effective and increase the risk of having a seizure. You can find out how in the section below.

Male and female condoms are the only type of contraception that will prevent sexually transmitted infections (STIs).

There are pros and cons to all types of contraception. Your healthcare professional can help you find the right one for you.

Planning a pregnancy with epilepsy

If you would like to have a baby in the future, preconception counselling can help prepare for a healthy pregnancy and baby. It’s important to keep taking your epilepsy medicines until you have spoken to your doctor or epilepsy specialist nurse.

Find out more about planning a baby.

Which types of contraception can be affected by enzyme-inducing epilepsy medicines?

Research shows that enzyme-inducing epilepsy medicine may stop these types of contraception working as well as they should:

• Combined oral contraceptive pill (the pill)
• Progestogen-only pill (the mini pill or POP)
• The contraceptive implant
• The contraceptive patch
• The vaginal ring
• Emergency contraceptive pill (the morning after pill)

Other types of contraception will not be affected by your epilepsy medicines. These may be more appropriate for you. Your doctor or nurse should discuss the options with you and make sure you are aware of the risks and benefits.

If you decide to use contraception that is affected by enzyme-inducing epilepsy medicines, you should also use a barrier method. For example, condoms. This will reduce the chance of getting pregnant.

You may still be able to use the combined oral contraceptive pill if other contraceptives are not suitable for you. In this case, your doctor or nurse may advise you take a higher dose than usual and take it continuously, without breaks. But this method might not work as well as other alternatives.

Visit the NHS website to find out more about different types of contraception.

Which types of contraception are not affected by enzyme-inducing epilepsy medicines?

The following types of contraception are not affected by enzyme-inducing medicines:

• Copper IUD (Copper-intrauterine device/copper coil/Cu-UID)
• IUS (LNG-interuterine system, hormonal coil)
• Barrier methods (condoms, diaphragm or cap)
• Contraceptive injection (DMPA)

Sterilisation

Sterilisation is another option if you decide you do not want any children in the future. This is a permanent option and involves surgery.

Female steralisation involves blocking or cutting the fallopian tubes to stop sperm meeting an egg.

Male sterilisation is called a vasectomy. This is a surgery that stops sperm being ejaculated during sex.

What if I am taking more than one epilepsy medicine?

You may be taking more than one epilepsy medicine. Your contraception will be affected if even just one of your medicines is an enzyme-inducer. Speak to your healthcare professional about using contraception that is not affected by enzyme-inducing medicines.

Emergency contraception and epilepsy medicines

There are two types of emergency contraception:

• The Copper IUD (Copper intrauterine device/Copper coil/Cu-IUD)

The copper IUD can be used as an emergency contraceptive if fitted within 5 days of having unprotected sex. It is the most effective kind of emergency contraception. It also provides highly effective ongoing contraception.

• Oral emergency contraception (the morning after pill)

The morning after pill can be affected by enzyme-inducing medicines. It may not work as well as the copper IUD. You may be offered the copper IUD instead. More research is needed to know the effectiveness of using emergency oral contraception with enzyme-inducing epilepsy medicines.

If you want to take the morning after pill, you may be able to take:

• A double dose of levonorgestrel (Levonelle is one of the brand names), or
• A single dose of ulipristal acetate (ellaOne is one of the brand names)

Emergency contraception is more effective the sooner you take it after unprotected sex. You can use it up to 5 days after unprotected sex. The longer the delay, the less effective it becomes. This increases the chance of an unplanned pregnancy.

Tell your pharmacist, doctor or nurse what medicines you are taking so they can prescribe you the right dose of oral contraception.

The NHS website has information about emergency contraception and where to get it.

Lamotrigine

Effect of contraception on lamotrigine

Some forms of contraception might reduce the amount of lamotrigine in your body. This might make you more at risk of having a seizure.

These contraceptives include:

• Combined oral contraceptive pill (the pill)
• Contraceptive patch
• Vaginal ring

It is important to talk with your epilepsy specialist or nurse if you take lamotrigine and are thinking about starting contraception. Or, if you want to change the type of contraception you are using.

Your lamotrigine dose might need altering if you change the contraception you are using. You may need a higher dose of lamotrigine if you start taking one of the types of contraception listed above.

Some forms of combined oral contraceptive pill and contraceptive patch have a week’s break, or include inactive pills. The level of lamotrigine in your body can increase and become too high during this break. This could cause problems and lead to increased side effects.

The progestogen-only pill (POP or mini-pill) may increase the amount of lamotrigine in your blood. This could increase your risk of side effects.

Effect of lamotrigine on contraception

What types of contraception that can be affected by lamotrigine?

These contraceptives may not work as well if you take lamotrigine:

• Combined oral contraceptive pill (the pill),
• Contraceptive patch and
• Vaginal ring
• Progestogen-only pill (the mini pill or POP)
• The contraceptive implant

You should also use a barrier method if you choose to use one of the contraceptives affected by lamotrigine. This will help to reduce the chance of an unplanned pregnancy. Condoms are one form of barrier method.

Ideally, you should use one of the types of contraception that is not affected by enzyme-inducing epilepsy medicines.

What types of contraception can be used with lamotrigine?

These types of contraception should be unaffected by lamotrigine:

• Copper IUD (Cu-IUD, copper coil)
• IUS (LNG-interuterine system, hormonal coil)
• Barrier methods (male and female condoms, diaphragm or cap)
• Contraceptive injection
• Sterilisation

It may still be helpful to discuss your choice of contraception with your doctor or nurse. This is particularly important if you are taking a medicine that has a higher risk of causing birth defects.

See our webpage to find out more about epilepsy medicines in pregnancy.

Should I use contraception if my partner is taking epilepsy medicines?

You may decide to use contraception, such as a condom, if there is a chance you could get your partner pregnant. This is because the risk of your partner getting pregnant is smaller if you both use contraception.

Using a male contraception is particularly important if your partner is taking epilepsy medicines that can harm an unborn baby. For example, sodium valproate or topiramate.

Condoms can also reduce the risk of either partner getting a sexually transmitted information.

Where can I find out more about contraception?

The NHS website has a guide to contraception.

The Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Effectiveness Unit Guidance: Drug Interactions with Hormonal Contraception

Medicines and Healthcare products Regulatory Agency (MHRA):

• • Epilepsy medicines in pregnancy
  • Patient guide: What you need to know about valproate
  • Advice for male patients on valproate
  • Topiramate pregnancy prevention programme: Patient guide

You can also speak to your doctor, epilepsy specialist nurse or your local sexual health clinic.