Oral Contraception for Women with Sturge-Weber Syndrome

SEPTEMBER 12, 2014

Here is a question, derived from one Dr. Comi received, which may be helpful to other women.

Question: Can a woman with Sturge-Weber syndrome use the pill (oral contraception)?

Response: There is no one answer to this question and further study of this issue is needed, but here are some important issues related to this which you can discuss with your doctors.

There are risks and careful consideration should be given to this discussion which should be had with your GYN doctor. The first issue is that some anticonvulsants including phenytoin (Dilantin), carbamazepine (Tegretol), barbiturates, primidone (Mysoline), topiramate (Topamax), and oxcarbazepine (Trileptal) can decrease the effectiveness of hormonal birth control methods (pill, patch, ring). Other anticonvulsants do NOT appear to reduce contraceptive efficacy, including gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), and tiagabine (Gabitril). However, there is some concern that oral contraceptives may reduce the effectiveness of lamotrigine, and I have seen the pill interfere with maintaining adequate blood levels of Tegretol in a woman with Sturge-Weber syndrome with resulting seizures. Depending on what medications you are on, and how well controlled your seizures are, this may or may not be an issue for you. Please discuss with your doctor.

Secondly, there is an increased risk of stroke, particularly with forms of the pill that contain estrogen and this of course is a concern with Sturge-Weber syndrome. If you smoke you should probably not be on the pill-this increases the risk of stroke too. Also if you have bad migraines with aura, this is not a good choice for you either as this has been associated with an increased risk of stroke. Those who have had prior strokes or stroke-like episodes as a teenager or as an adult should probably not use the pill. If you do decide to consider the pill, be sure to discuss the different forms with your GYN and select the form least associated with increased stroke risk.

Some women with Sturge-Weber syndrome have more migraines or seizures related to certain times in their cycle. For them, some forms of the pill can be helpful in preventing their seizures or migraines. Please discuss with your doctor. Finally, be sure to discuss other forms of contraception (if that is the reason you are considering the pill). They may be good choices for you.

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