Although there are different ways to commonly manage epilepsy, the U.S. Centers for Disease Control and Prevention (CDC) notes that two in three people respond well to medication. That may explain why it’s typical for doctors to try antiseizure medications first when dealing with someone who has epilepsy. While the exact type and number of medicines you’ll need may vary depending on your symptoms, you always need to discuss the potential side effects with your doctor. One particular side effect of certain antiseizure medications may derail your family planning. Here’s what you need to know.
Although many women with epilepsy can have healthy pregnancies, it’s important to note that these pregnancies often require special care. Depending on the antiseizure medication you take, you may have a higher risk of your fetus developing malformations. These malformations can include neural tube defects like spina bifida–a condition in which the neural tube doesn’t form or close properly along the spine–among others, a cleft lip or palate, low birth weight, or intellectual issues like a low IQ.
However, it’s not always possible for you to simply switch to something else. For those living with epilepsy, a pregnancy isn’t a simple life event. That’s why it’s common for them to use birth control while managing their condition.
Unfortunately, certain antiseizure meds can affect how effective your hormonal birth control is. These drugs can reduce their effectiveness through a process known as enzyme induction, in which a substance can influence how quickly the body breaks down another substance. In this case, the estrogen in hormonal birth control is metabolized more rapidly by the cytochrome P450 system. When this happens, this form of birth control isn’t as effective as it’s supposed to be.
To complicate the situation further, the estrogen in hormonal birth control can also make antiseizure medications like lamotrigine, oxcarbazepine, and valproate less effective. While the exact cause needs to be explored, women who take higher doses of hormonal birth control while on these medications often have worsening seizure control or lose it entirely.
While this doesn’t have to be your experience, it’s definitely an indicator that you should discuss your birth control and antiseizure medications with your doctor.
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Although interactions are likely between these medications, that doesn’t mean they’re inevitable. The primary suggestions when dealing with seizure management and family planning are to adjust what you’re taking. There are over 40 antiseizure drugs available, so your doctor has plenty of options to explore. That’s why the first step your doctor may take is to find alternatives to your current medical regimen.
Health professionals use a three-tier system to determine how likely your medications are to affect your birth control. These are strongly interacting, mildly interacting, and non-interacting. Drugs like carbamazepine, oxcarbazepine, phenobarbital, phenytoin, and primidone are “strongly interacting,” which means they can have a big impact. On the other hand, clobazam, eslicarbazepine, rufinamide, and topiramate are “mildly interacting,” which is a much lower risk.
Perampanel may also be an issue if you’re taking 12 mg/day or more. Fortunately, drugs like ethosuximide, gabapentin, lacosamide, levetiracetam, lamotrigine, pregabalin, vigabatrin, and stiripentol are less likely to have an effect.
Of course, you can also explore changing your method of contraception. Switching to a copper or hormone-releasing intrauterine device (IUD) is a good option as it’s likely to be effective regardless of the type of antiseizure medications you take. You may also be able to take the medroxyprogesterone depot shot (Depo) as a form of contraception. Your doctor may suggest that you take it every 10 weeks instead of 12, if you’re on antiseizure drugs that strongly interact with hormonal birth control, though.
You should also discuss continuous estrogen-progestin pills with your doctor. These pills contain at least 30 micrograms of estrogen, and you would take them every day–except for a four-day break every three months. Even when taking these pills, though, you need to use barrier methods like condoms and vaginal diaphragms.
As always, make sure to discuss potential side effects of these medications.
According to the CDC’s 2024 statistics, most of the adults actively living with epilepsy were between the ages of 18 and 44. While their specific situations may vary, that is generally also the age group that may be concerned about having children. After reading the section above, you have a fair idea of what to discuss with your doctor when you don’t want to have children. But how does that change when you do?
Generally, it’s good to start that discussion with your doctor a year or two before you plan to start trying. That gives you enough time to make any changes to your regimen, so you have a healthy pregnancy. It’s important to be careful, as you never know when you might get pregnant. In a prospective study, researchers found no significant difference in the fertility rates between healthy women who were living with epilepsy and healthy women without the condition.
Before trying to get pregnant, your doctor may assess the effect your antiseizure medication can have on a developing fetus. As mentioned previously, some drugs like valproate can cause deformities, so if you’re planning to get pregnant, your doctor will likely switch you to another medication. Since the risk to the fetus increases with a higher dose, you may also need to take a higher dose of medication.
Even with these changes, though, the aim is for you to be free of seizures for at least nine months before trying to conceive. This is critical as having seizures while pregnant can lead to serious complications. You are prone to falling or injury while having a seizure, and there is the potential for harm to the fetus from reduced or the absence of oxygen during your seizure.
Finally, you’ll need to start taking five milligrams of folic acid. This vitamin is essential because it helps the neural tube, which develops into the brain and spinal cord, form. Starting early also gives your doctor time to note if it’s affecting your antiseizure medications. If you’re taking phenytoin, folic acid may decrease its concentrations.
Of course, your doctor’s surveillance doesn’t end when you get pregnant. They’ll still need to monitor you for seizures and any signs that your regimen isn’t effective. Additionally, about 10 percent of pregnant women with epilepsy may have a higher risk of complications such as preterm birth, preeclampsia, gestational hypertension, spontaneous abortion, and hemorrhage after giving birth.
With all these matters in mind, it highlights why you should always talk to your doctor if you’d like to have children.
RELATED: Seizure Clusters: Why Quick Action Is Essential for Your Safety
While more studies need to be done and some of the existing information needs to be updated, the data that exists shows that Black people’s experiences can be complicated. Based on what’s been presented so far, you can likely tell that family planning while on antiseizure drugs needs active monitoring. However, that may not be easy for Black Americans.
Actively managing seizures is imperative when it comes to family planning–especially if you’re thinking of conceiving. However, one review of patients who sought care at the University of Rochester Medical Center showed that Black people had higher visits to the emergency department than white people. They were also less likely to have access to epileptologists, poorer access to surgical treatment, lower rates of anti-seizure medication adherence, and increased mortality from epilepsy.
In another paper, researchers dug deeper to find other factors that may influence why Black Americans weren’t getting the same type of care for their epilepsy. In this case, they found that Black people were less likely to be referred to the epilepsy monitoring unit (EMU) at Penn Epilepsy Center after having a seizure. They were also less likely to be referred to the EMU for a differential diagnosis, which can affect the identification of the right course of care.
Finally, one issue that doctors have to monitor if you’re interested in having a family is the frequency of your seizures. Ideally, you should be seizure-free for nine months before trying. However, it can be difficult to account for a condition known as status epilepticus (SE). SE is a potentially life-threatening condition where you can either have an abnormally prolonged seizure that lasts for more than five minutes, or you may not fully regain consciousness between recurring seizures.
In SE, the seizures can be convulsive or nonconvulsive. While the former is obvious, the latter has to be diagnosed by an abnormal electroencephalogram. Nonconvulsive SE may look like a long episode of confusion, agitation, loss of consciousness, or even a coma.
When looking at SE mortality statistics in the U.S. from 1999-2020, researchers found that the mortality rate had doubled from previous years. The people who had been affected most significantly by the condition included those who were between 50 and 75 years of age and Black Americans. Although this information would need to be studied further, potentially having a higher risk of SE is an issue that all Black Americans should discuss with their doctors.
If you’re taking birth control and antiseizure medication, it’s a good idea to discuss potential interactions with your doctor. Doing this ensures that neither one is negatively affecting the other. In the event that you decide that you’d like to get pregnant, make sure that you talk to your doctor early so they can determine the safest route to that outcome. That’s the best way to ensure that everyone is healthy at the end of the day.
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