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Contraception for women with epilepsy: counseling, choices, and concerns

Authors Reimers A

Received 22 December 2015

Accepted for publication 19 January 2016

Published 19 April 2016 Volume 2016:7 Pages 69—76

DOI https://doi.org/10.2147/OAJC.S85541

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Professor Igal Wolman

Arne Reimers1,2

1Department of Clinical Pharmacology, St Olavs University Hospital, 2Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

Abstract: Approximately 50% of all pregnancies in women with epilepsy (WWE) occur unplanned. This is worrying, given the increased occurrence of obstetrical complications in WWE, including the risk of seizures and their possible consequences for both the mother and the unborn child. Hormonal contraception is usually regarded as highly effective, but it is subject to numerous bidirectional drug interactions with several antiepileptic drugs. These interactions may lead to loss of seizure control or contraceptive failure. Further concerns are loss of bone mineral density and increased seizure activity due to hormonal effects. Many physicians lack sufficient knowledge regarding these issues, and most WWE have never received adequate counseling. Moreover, several studies show that a large proportion of WWE do not take their medicines regularly. This article reviews all of these issues and offers practical recommendations for the management of contraception in WWE.

Keywords: ethinyl estradiol, progestins, epilepsy, antiepileptic drugs, interactions, pregnancy, seizure aggravation, bone mineral density

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