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News
A surprising number of women with epilepsy may be unknowingly at risk for birth control failure. A new study in Neurology found that nearly 1 in 3 women with epilepsy prescribed hormonal contraceptives were also on enzyme-inducing anti-seizure medications (ASMs) that can reduce contraceptive effectiveness — and the overlap lasted a median of 7 months, suggesting the interaction often goes unrecognized.
A new study published in Neurology reveals a troubling prescribing gap: nearly 1 in 3 women with epilepsy on hormonal contraceptives were also prescribed enzyme-inducing anti-seizure medications (ASMs) known to reduce birth control effectiveness. Enzyme-inducing ASMs accelerate the breakdown of hormonal contraceptives in the bloodstream, potentially rendering them ineffective — yet this well-established drug interaction appears to be widely overlooked in clinical practice.
The retrospective cohort study analyzed Medicaid data from over 110,000 women with epilepsy of reproductive age (2016–2021). Among the 21,923 prescribed a susceptible hormonal contraceptive, 32.6% had at least 14 days of overlap with an enzyme-inducing ASM — with a median overlap duration of 218 days (~7 months). Women with intellectual disability or drug-resistant epilepsy (DRE) faced significantly higher odds of overlap, as did women aged 35 and older.
Why it matters: Unplanned pregnancies in women with epilepsy carry heightened risks — including seizures during pregnancy and fetal exposure to teratogenic ASMs. Experts stress that contraception and family planning must become a routine part of epilepsy care, with better cross-specialty communication between neurology and reproductive health providers.
