Use of oral contraceptives by women with epilepsy
R. H. Mattson, J. A. Cramer, P. D. Darney and F. Naftolin
Oral contraceptives have not been associated with exacerbation of epilepsy
despite warnings in package inserts. No clinical study has provided
scientific evidence of worsening of seizures in epileptic women who use
oral contraceptives, and improvement in seizure control has occurred in
some cases. The main concern about use of oral contraceptives in this
population is their effectiveness in preventing conception. Failure rates
are higher in groups of women taking enzyme-inducing antiepileptic drugs.
The degree of increased metabolism of estrogen and progestin components is
highly variable and unpredictable among individuals. Use of higher doses
increases protection against conception but also increases the risk of side
effects, particularly in patients in whom no enzyme induction occurs. The
strength of hormones in the pill should be selected individually when
initiating use. Some women may require higher doses for full contraceptive
effect.
