Kontrazeption bei Frauen mit Epilepsie

Epilepsy is one of the most common neurological disorders. For women with epilepsy collaboration between neurologists and gynecologists is crucial. To prevent unintended pregnancies and impaired seizure control the bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. Enzyme-inducing AEDs (EI-AED) may reduce the efficacy of hormonal contraceptives. To improve contraceptive safety monophasic combined oral contraceptives (COCs) should be used continuously without a hormone-free interval if used in combination with EI-AEDs. The progestin component should be well above the ovulation inhibiting dose. Progestin-only pills (POPs) are likely to be ineffective if used in combination with EI-AEDs. Subdermal progestogen implants (Implanon/Nexplanon/Implanon NXT) are not recommended for patients on EI-AEDs because of published high failure rates. High-dose injectable contraceptives appear to be effective; however they are not the first choice due to potential serious side effects. According to the World Health Organization (WHO) the use of copper intrauterine devices or the new levonorgestrel-releasing intrauterine system (IUS) may be an alternative for many women with epilepsy in need of contraception even if used in combination with EI-AEDs.