Hormonal contraception and epilepsy

Attempts to normalize lifestyle and optimize quality of life in women with epilepsy should include the option of a reliable method of birth control, i ncluding oral contraceptives (OCs). Despite the well-known effects of estro gen on lowering seizure threshold, it has never been shown that estrogen-co ntaining OCs worsen seizures in epileptic patients. In theory, the presence of progesterone (which is known to inhibit seizures experimentally) in OCs could counterbalance the seizure-promoting effects of estrogen. However, t here is evidence that some OCs may fail, when combined with antiepileptic d rugs (AEDs), possibly because of the latters' inducing effects on endogenou s estradiol and progesterone. Physicians have a duty to offer appropriate a nd accurate counseling to epileptic patients concerning optimal choice in t he use of OCs for those considering this method of contraception. Recommend ations include possible use of a noninducing AED, or (for patients taking i nducing AEDs) use of an OC containing greater than or equal to 50 mu g estr ogen. Patients should be warned that midcycle bleeding indicates possible O C failure and that the absence of such bleeding is not an indication of OC effectiveness. Additional contraceptive measures are also advised.