3.1 CONTRACEPTION Already at the first visit, it is necessary to ask adolescents and women of child-bearing age about contraception, inform them about the importance of family planning, and discuss the pros and cons of individual methods of contraception. Hormonal contraceptives are not contraindicated in patients with epilepsy. In women with epilepsy, specific factors influence the choice of a suitable method of family planning: High reliability is a crucial factor. Unwanted pregnancy can unfavourably influence the course of epilepsy, AEDs taken during pregnancy carry higher risk of teratogenicity. Use of combined oral contraception can lead to lowering of LTG plasma levels. Several AEDs may lower the reliability of some methods of contraception (oral contraception, implants). The main reason is an increase in the activity of hepatic enzymes leading to more rapid metabolism of ethinylestradiol (documented for PB, PHT, PRM, CBZ, ETS and TPM at doses >200mg/day). Age-specific factors must be taken into consideration when choosing the method of contraception. In adolescence, contraception is influenced by several well-described factors: worse compliance leading to significantly lower reliability; worse tolerance of unwanted effects; more partners; lower financial resources; worse co-operation with the treating physician. I. Combined oral contraception (COC) Monophasic formulations with the same oestrogen and progestogen dose throughout the whole cycle are appropriate. These formulations also allow the use of the so called continual scheme in patients with catamenial epilepsy (i.e. use of several packages in sequence without the seven pill-free days to allow withdrawal bleeding). In patients using hepatic enzyme inducing drugs (see above), intermediate-dose contraceptives should be used (30-37.5μg of ethinylestradiol). Ineffectiveness of COC is indicated by breakthrough bleeding. In this case, contraception with 50μg ethinylestradiol is needed.
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