Recently, a study was conducted to get a better understanding of how epilepsy specialists were talking with women patients about contraception. The researchers who conducted the study were interested in understanding whether having counseling from a neurologist “in an academic epilepsy specialty care clinic was helpful in influencing the contraceptive choices of women with epilepsy.”
The World Health Organization, WHO, and the Centers for Disease Control both recommend using an intrauterine device for a contraceptive choice for those who have epilepsy. One of the main reasons they recommend IUDs is “due to interactions that may occur between hormonal contraceptives and many seizure medications.”
There are a number of important interactions between the antiepileptic drugs and hormonal contraception that must always be considered carefully. Some of the AEDs will induce hepatic enzymes, which will decrease the efficacy of hormonal contraception. The IUDs have been found to be a very effective type of contraceptive that is reversible and does not have any AED drug interactions.
However, as important as it is for women to have counseling for contraception, there is no clarity on whether counseling on this issue is provided or who should be providing the counseling if offered. Currently, there are no guidelines on who should deliver these recommendations. The study was meant to look at the hypothesis that this type of counseling by a Neurologist could affect the contraceptive choices made by women with epilepsy.
The study examined the medical records of 397 women who were between the ages 18 to 45 years old. These were patients who went to Northwestern University Hospital and who had their first visit between 2010 and 2014. The researchers looked at the use of seizure medications, along with contraceptive methods like IUDs and whether the women underwent contraceptive counseling at their visits. The researchers examined a subgroup of 95 women who had at least four follow-up visits, along with the “association between counseling from an epileptologist and selection of the IUD was examined.”
If a patient was pregnant or planning a pregnancy during the first visit, they were not a part of the further analyses. The same is true of patients who have had surgical sterilization.
What Did the Study Find?
Out of the 397 women who met the criteria for inclusion in the study, researchers found that only 35% of the women were counseled during their first visit. When the women were not counseled on the first visit, it meant that they were not likely to be counseled on later visits. They discovered that only 37% of the patients had received counseling by the time of their fourth visit.
Out of the 95 patients who had undergone four visits, there were 28.4% who had been counseled about an IUD being a good choice as a contraceptive. 38.9% of the subgroup of 95 patients received some form of general counseling regarding contraceptives and 32.6% were not counseled at all about contraception.
The women who did receive counseling specific to IUDs were more likely to make the change and use an IUD compared to women who received other counseling or no counseling at all.
What Do the Results Show?
The results show that there is simply not enough counseling occurring regarding contraceptives for women who have epilepsy. With only one out of every three women receiving counseling, it means that many women are not getting information that could help them to make an informed decision on the contraceptives that could be more beneficial to them and that would not interact with their antiepileptic medications.