In general, birth control that’s safe for the general population is safe for people with epilepsy. However, if you have epilepsy, there are some important additional considerations.
On this page you’ll learn about:
- The importance of birth control for people with epilepsy
- How common anti-seizure medications (ASMs) impact birth control effectiveness
- Most effective reversible birth control options for people with epilepsy
- Less effective reversible birth control options for people with epilepsy
- Anti-seizure medications (ASMs) impacted by birth control
On this page, you'll also find answers to common questions about epilepsy and birth control:
- Why is birth control important for people with epilepsy?
- What are the most effective birth control options for people with epilepsy taking an interacting anti-seizure medication (ASM)?
- Will emergency birth control (e.g., Plan B) be impacted by my anti-seizure medication (ASM)?
- How soon after giving birth is it recommended to restart birth control?
- Will I need to make any changes to my anti-seizure medication (ASM) when I stop birth control?
The Importance of Birth Control for People with Epilepsy
Effective birth control is especially important for people with epilepsy. Controlling if and when you become pregnant allows you to take steps prior to pregnancy to optimize the health and safety of you and your baby. For more information about planning for pregnancy, see our Pregnancy Planning page.
People with epilepsy have some important additional considerations when choosing a birth control method. Some anti-seizure medications (ASMs) may interfere with your birth control, making your birth control less effective. Meanwhile, some birth control options may interfere with a few specific anti-seizure medications and could impact your seizure control. It’s critical to work with your care team to choose the right birth control for you.
Each person’s situation is unique. Factors like the specific ASM you’re taking, your seizure history, and any other medical conditions you have can influence the best choice of birth control for you.
How Common Anti-seizure Medications (ASMs) Impact Birth Control Effectiveness
Some ASMs may interfere with your birth control, making your birth control less effective. The following table provides a list of ASMs by how strongly they interact with some forms of birth control.
Table 1: Anti-seizure Medications (ASMs) That Could Make Birth Control Less Effective
| Strongly-interacting ASMs (Can make some birth control methods less effective) | Carbamazepine, Cenobamate, Oxcarbazepine, Perampanel, Phenobarbital, Phenytoin, Primidone |
| Mildly-interacting ASMs (Can make some birth control methods less effective, but to a lesser extent to strongly-interacting ASMs) | Clobazam, Eslicarbazepine, Felbamate, Lamotrigine, Rufinamide, Topiramate |
| Non-Interacting ASMs (Will NOT make birth control less effective, regardless of the type of birth control) | Brivaracetam, Clonazepam, Ethosuximide, Gabapentin, Levetiracetam, Lacosamide, Pregabalin, Valproic Acid, Zonisamide |
The following table lists different birth control options and highlights in pink the options that research has shown may be impacted by mildly or strongly-interacting ASMs.
Table 2: Effectiveness of Various Birth Control Methods and Potential Interactions with ASMs
| Birth Control Method by Effectiveness | Potential of ASM Affecting Birth Control Effectiveness |
|---|---|
| Most Effective Less than 1% pregnancies per 100 persons in a year | |
| Vasectomy | Birth control not affected by ASMs |
| Tubal Ligation | Birth control not affected by ASMs |
| Etonogestrel/Progesterone Implant | Some ASMs may make Etonogestrel/Progesterone Implants less effective |
| Copper IUD | Birth control not affected by ASMs |
| Progestin IUDs | Birth control not affected by ASMs |
| Least Effective 6% to 12% pregnancies per 100 persons in a year | |
| Depo-provera Injection | Some ASMs may make birth Depo-provera Injections less effective |
| Pill | Some ASMs may make the Pill less effective |
| Patch | Some ASMs may make the Patch less effective |
| Vaginal Ring | Some ASMs may make Vaginal Rings less effective |
| Diaphragm | Birth control not affected by ASMs |
| Least Effective More than 10% pregnancies per 100 persons in a year | |
| Male Condom* | Birth control not affected by ASMs |
| Female Condom* | Birth control not affected by ASMs |
| Fertility Awareness Methods | Birth control not affected by ASMs |
| Spermicide | Birth control not affected by ASMs |
| Withdrawal | Birth control not affected by ASMs |
*Condom use isn’t affected by ASMs. However, when used alone, condoms are only 85% effective in preventing pregnancy with typical use. They are the only way to prevent sexually transmitted infections (STI) and are recommended for all sexually active people at risk for STIs.
Most Effective Reversible Birth Control Options For People With Epilepsy
Intrauterine Devices (IUDs)
IUDs come in two main types: copper IUDs (Paragard) and hormone-eluting IUDs (Mirena, Kyleena, Skyla, and Liletta). The hormone actions are local, in the uterine cavity, and negligible amounts of the hormones get absorbed into the bloodstream. Both types of IUDs are highly effective, long-acting, reversible birth control options that won’t be affected by ASMs, nor will they affect seizure control.
Depo-Medroxyprogesterone Acetate (Depo-Provera, “Depo”)
Depo-Medroxyprogesterone (Depo) is a shot that your doctor usually administers every 12 weeks. It’s a highly effective birth control method that isn’t substantially affected by any ASM. But some doctors recommend that you get the shot every 10 weeks if you are on an interacting ASM (i.e. if you are on one of the “Strongly-interacting” or “Mildly-interacting” ASMs listed in Table 1.)
Etonogestrel/Progesterone Implants
Etonogestrel/Progesterone Implants are a long-lasting, reversible form of birth control that are placed in the upper arm. Overall, these implants are more effective at preventing pregnancy than many other forms of birth control, but their effectiveness may be influenced by the mildly and strongly interacting ASMs listed in Table 1.
Less Effective Reversible Birth Control Options For People With Epilepsy
The following hormonal birth control options may be LESS effective at preventing pregnancy when they are paired with certain interacting ASMs (See Table 1 for the list of strongly and mildly interacting ASMs). If you do use one of these options, you should use an additional backup barrier method.
Combined (estrogen + progesterone) oral birth control pills (also called “the Pill”)
Combination birth control pills, also known as the pill, are oral contraceptives that contain estrogen and progestin. Different types of combination birth control pills contain different doses of estrogen and progestin.
Vaginal rings
A vaginal ring is a small, flexible ring worn inside your vagina for birth control. It releases the hormones estrogen and progestin through your vaginal lining to prevent pregnancy. It’s worn for three weeks and then removed for one week.
Estrogen patches
An estrogen patch is a type of contraception that contains the hormones estrogen and progestin. You wear the patch on your body. The birth control patch works similarly to combination oral birth control pills.
Progesterone-only pills (also called the “mini-pill” or “POP”)
Progesterone-only pills, also called mini-pill or POP, is an oral contraceptive (also known as a birth control pill) that contains the hormone progestin. Unlike combination birth control pills, the minipill — also known as the progestin-only pill — doesn't have any estrogen in it.
Anti-seizure Medications (ASMs) Impacted By Birth Control
Birth control that includes estrogen, such as birth control pills, the vaginal ring, and the estrogen patch, will lower the amount of lamotrigine in your bloodstream. It is also possible for this to occur with oxcarbazepine and valproic acid but to a smaller extent.
If the dose of lamotrigine is not adjusted when these birth control treatments are started, seizure control can worsen. This may also occur with oxcarbazepine and valproic acid.
If you are taking lamotrigine, oxcarbazepine, or valproic acid and planning to start birth control, reach out to your care team to discuss. They will make a plan to monitor you and make any changes necessary to your dosage to make sure you maintain seizure stability.
Common Questions about Birth Control & Epilepsy
Consult With Your Doctor
We understand how important it is for you to find the birth control method that is right for you. The good news is that there are several birth control options that are safe and effective for people with epilepsy. Work with your care team to identify the right option for you.
Download our Epilepsy Diagnosis and Living With Epilepsy - Questions to Ask Your Doctors, and bring a copy to your appointments to help guide your conversations and get the answers you need.
You can also use the Epilepsy Foundation Seizure Diary to track your seizures and share the information with your doctor.
Reviewed by: Page Pennell, MD FAES, September 2023