Gynecologic Health

Unique Concerns for Women and Girls with Epilepsy

How can anti-epilepsy medications affect the effectiveness of oral contraceptives?
Many of the medications we use to treat seizures are metabolized and broken down by the liver, and that happens to be the same system that breaks down birth control pills. Some of the common medicines for epilepsy—Dilantin (phenytotin) and Tegretol (carbamazepine)—turn the liver on. So anything a patient ingests that is also metabolized by the liver will be broken down faster, so the pill gets broken down more quickly and becomes less effective. The American Academy of Neurology suggests that women can still use oral contraceptives, but they need to be on the higher dose pill and have at least 50 micrograms per day of estrogen in their pill.

This is less of an issue with the newer anti-epilepsy medications. In fact, since progesterone protects against seizures, some women opt to take a progesterone-only agent for birth control because they may have the added advantage of better seizure control.

Can medication or seizures affect sexual function among women?
Both the medications and the seizures can lead to decreased sexual drive and decreased satisfaction with sex. Some people who have surgery for their epilepsy and then become seizure-free have an improvement in their sexual drive. And of course, it's very important to educate people and tell them that their low sex drive is from the epilepsy or the medication; it relieves some degree of self-blame for that issue.

Why are women with epilepsy more likely to have fertility problems?
There's about a two-fold increased risk of infertility. If women with epilepsy have irregular menstrual cycles, they are much more likely to have problems with fertility. And some of the fertility treatments that are used to induce ovulation can actually make seizures worse. Individual recommendations can be made based on a particular woman.

What if you have epilepsy and found out that you are pregnant?
First of all, if you have epilepsy and planning to become pregnant, it is advisable to talk to your doctor about your epilepsy treatment. If you have an epilepsy and found out that you are pregnant, consult your doctor immediately. You may need to stay on medication during your pregnancy and make some changes in your treatment that reduce the risk of birth defects.

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