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Hiya-

I've taken Lamictal for 1.5 years and have been on Topa with it for a few months (though the topa is going because i hate it).

Anyway, how much of a burden/additional risk do anticonvulsants pose for women on hormonal birth control who do not want to become pregnant?

I hear a lot that there are risks here, but i haven't seen any hard numbers on how risky it could be. does anyone have any stories on how you or someone you know got pregnant on birth control and meds?

also, is one more risky than the other? i've heard that topa is worse, but this is just the word on the street.

loon

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My pdoc has just asked me if I am sexually active as the NICE guidelines for treatment of bipolar have come out saying that AC's shouldn't be used in women who could get pregnant as they pose significant risk of birth defects. It was enough for him to consider switching me to something else were I sexually active. So I would say yes, it is pretty bad.

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Loon, I found this:

While taking my AED daily, would the effectiveness of birth control pills be compromised? My gynecologist has prescribed birth control pills, although I have not yet started taking them. My neurologist says that the pills may not be effective for preventing pregnancy. Do different AEDs affect birth control pills differently? Are there other options you could recommend?

What a great question! Yes, some but not all antiepileptic medications interfere with the birth control pill. Unfortunately, many women are not aware of this fact, and this can lead to unwanted pregnancies. The group of medications that is most likely to reduce the effectiveness of birth control pills, are the older drugs such as phenytoin (Dilantin), carbamazepine, (Tegretal), phenobarbital, and primidone (Mysoline). In addition, two of the newer epilepsy drugs, oxcarbazepine (Trileptal) and topiramte (Topamax) also impact the effectiveness of birth control pills, to a lesser extent.

The other newer antiepileptic drugs, namely gabapentin (Neurontin), lamotrigine(Lamictal), tiagabine (Gabitril), levetiracetam (Keppra), zonisamide (Zonegran) do not effect birth control at all.

Unfortunately, Depo Provera (the birth control shot) is affected by the same AEDs that interfere with the pill. If you are on one of the AEDs that interfere with oral contraceptives, but you feel that they are the best means of birth control for you, your doctor can prescribe one with a higher dose of estrogen (50 mcg), which will counter-act the interference by AEDs. However, you should know that the higher dose might also increase the risk of side effects. Alternatively, you can use another form of birth control, such as a diaphragm or an intrauterine device (IUD).

Source: http://www.epilepsyfoundation.org/programs...tivetherapy.cfm

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Heya Loon,

The reference from Skittle and other epilepsy references are useful b/c ACs have been in use much longer as actual ACs than they have as mood stabilizers.

The quote though is out of date.

For example: a recent Dear Doctor letter from GSK advises women on Lamictal to not rely on hormonal contraception.

Like the other ACs this is largely due to liver enzymes (this is reminding me of another thread a while back but it's like a deja-vue thing).

I think the bottom line is that 1. It's not wise to accidentally get pregnant on ACs and 2. it's not wise for women on ACs to rely on hormonal contraception if pregnancy is a concern.

--ncc--

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ncc-

i only got pregnant (during a mania- not the time to have a child, especially on all my drugs and unemployed at the time) when i messed (on my own) with my Lamictal dose and decided to use the Sponge instead of the Pill.

Is there an effectiveness rating or something, or would you happen to have a guess or approximation, of how reliable using hormonal contraception on Lamictal would be compared to methods such as condoms? Obviously some of the other methods are less effective than the Pill to start with. I was wondering if even with having decreased potency due to the ACs if it was still better to use the Pill than other methods.

Thanks,

Loon

ncc-

i only got pregnant (during a mania- not the time to have a child, especially on all my drugs and unemployed at the time) when i messed (on my own) with my Lamictal dose and decided to use the Sponge instead of the Pill.

Is there an effectiveness rating or something, or would you happen to have a guess or approximation, of how reliable using hormonal contraception on Lamictal would be compared to methods such as condoms? Obviously some of the other methods are less effective than the Pill to start with. I was wondering if even with having decreased potency due to the ACs if it was still better to use the Pill than other methods.

Thanks,

Loon

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Loon, try having a look for medical answers on The Trip Database. It's pretty straightforward and you don't have to subscribe to enter a search field. I typed in a couple of questions along the lines of "the effect of lamotrogine on hormonal birthcontrol", but it's late here and my night time meds are making the screen blur. Hell, I might have typed complete nonsense here for all I know (typing with one eye open isn't the greatest thing)

Also, through the google search I started on, there seems to be some argument (recent - up to 2006) over views as to whether lamictal DOES or DOESN'T impact the efficacy of the pill etc. I'm wondering if it's just a case of hit and miss (I'm sure there's a crude sexual reference in there somewhere)

God,must go to bed. I'll be interested to hear what you come up with. Since contrary to my deluded soon-to-be ex husband's mind, I don't intend staying celibate forever. Ha

S

edited b/c I really wasn't making much sense

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After reading through the recent evidence, it is still unclear to me what to think about this. They seem to be indicating that I should take higher estrogen levels and report any breakthrough bleeding to my doctor, and use a back-up method if I get breakthrough bleeding.

I'm not really sure if this issue is exactly and totally related to the possible increase in birth control failure among women who take Lamictal.

Lamictal is a wonder drug for me.

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s-

i should really go there i think. i've been thinking about it. a couple of years ago i was at planned parenthood with it all paid for, ready to have it inserted wtih my legs on the table and everything, and they tried to push it in and i was "too small" for it to go in well, and i instantly got sick and felt like i was going to faint and throw up everywhere.

i'm not against it at all, it would be a good idea, but i'd just need to do it with a regular gyn and get knocked out or something. the insertion for me seemed like it would really suck. i've heard it is a lot easier for women who have had children.

pph didn't make me pay for the opened and used device though, because they couldn't get it to go in, which was nice.

loon

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yeah, the IUD can increase your chances of PID if you're not monogamous (with a faithful partner). right now i'm monogamous with my one partner of 4 years (no more multiple boyfriends- too risky health wise). considering my status right now it wouldn't be a bad idea. i'd just be afraid of disrupting the string that dangles out or otherwise dislodging it.

i was in the habit of always using condoms when i did have multiple boyfriends. i did worry about the health implications. i've decided it just isn't worth it now. and if i do get pregnant, i want to know who to blame and not end up on jerry springer!

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Heya Loon,

1. I responded in detail about*birth control* to another thread (I forget what it was called).

2. No, IUD does *not* increase risk of either ectopic or PID.

Work with me here.

3. IUD cuts the risk of a blastocyst forming by almost 99-100%.

3a. And its risk of adhering to the uterine lining to almost 0%.

3b. So, *if* a blastocyst forms, it's *more likely* to adhere to the fallopian tube than to the uterus.

3c. Thus, ectopic.

4. IUD increases the risk of a vaginal infection getting into the uterus.

4a. PID is caused by chlamydia.

4b. Chlamydia is a sexually transmitted disease.

5. I repeat. PID is caused by chlamydia which is a *sexually transmitted disease.*

Come *on,* Loon.

You know better.

;)

--ncc--

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ok, i'm not a particularly bright medical student over here, so let me see if i've got this right:

1. it is highly unlikely that a blastocyst will form if you have an IUD, and blastocysts are what would adhere to the fallopian tube to cause the ectopic pregnancy, therefore it is unlikely that an ectopic pregnancy would occur

2. PID is caused by Chlamydia, so if you don't get that, you won't get PID.

however, if you do get pregnant, it is more likely to be ectopic, and if you do get a common STD (chlamydia), you're likely to get PID.

so it would seem that the IUD is a safe method barring chlamydia. and with aids running around, no method is "safer" than condoms, so we're better off with both.

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