Is the IUD safe for a person with epilepsy?

Monday May 6 2019

 

By Dr Vincent Karuhanga

I am 24 and have epilepsy. I had an ectopic pregnancy last year and because I had been using contraceptives, I was advised to use an IUD instead. Is it effective? Also, is it safe for a person with epilepsy and will I get pregnant again?
Angella

Dear Angella,
Epilepsy occurs when there is disturbance of the brain’s electrical activity resulting in fits and loss of consciousness.

A number of women are wary of getting pregnant, especially when the fits are not controlled properly fearing that their unborn child may be hurt or that they may get attacks during pregnancy curtailing oxygen supply to the unborn child, thus risking a miscarriage.

Although epilepsy itself and the drugs for controlling fits may reduce fertility, you already have only one tube from which you can get pregnant if at all it is normal but this still reduces fertility by 50 per cent.

Much as IUDs or coils are effective in preventing pregnancy (99 per cent), if a woman becomes pregnant when using intrauterine contraception (IUD), contraceptive implant, or progestogen-only pill, then the risk of an ectopic pregnancy increases. Overall, however, since they effectively prevent pregnancy, the association with ectopic pregnancy is not that significant.

It could be that the drugs you were taking for epilepsy have induced enzymes which break down the hormonal contraception making it less effective. Carbamazepine (Tegretol), phenobarbitone, and phenytoin can induce liver enzymes which may break down, combined pills, minipills, emergency pills, and contraceptive implants (but not Depo Provera which is broken down in blood).

Non-enzyme-inducing epilepsy drugs (except Lamotrigine whose levels are reduced contraceptive hormones) such as gabapentin, pregabalin, sodium valproate may be better when one requires contraception. Using an IUCD for pregnancy may not interfere with your medication for epilepsy just as the medication may not interfere with IUCD contraception efficiency.

Since you got an ectopic pregnancy and you were operated on hence now remaining with one tube, you need to do tests to find out whether the remaining tube is patent and able to cause pregnancy. If it is blocked, then you may have no need of taking contraception. If it is normal, then your doctor will advise you on the best method for contraception and how you can be helped to achieve pregnancy.

However, since loss of a tube means reduced fertility, you should now think of getting pregnant while drugs that are safe in pregnancy but control epilepsy are being used. In case you fail to get pregnant, IVF, surrogacy or adoption can be contemplated.

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