Progestin-Containing IUD Appears Safe for Women with Epilepsy

Progestin-containing intrauterine device (IUD) was deemed safe and acceptable as a long-acting contraceptive for women with epilepsy, a study published in Epilepsia has found.

Drug interactions impact the safety and efficacy of oral contraceptives for women with epilepsy. Study authors from Columbia University Medical Center conducted a prospective, observational study (n=20) to evaluate the safety, acceptability, and pharmacokinetic impact of a progestin-containing IUD in women with epilepsy. 

Study participants had well-controlled epilepsy on a stable antiepileptic drug regimen and were initiating a progestin-containing IUD (levonorgestrel 52mg). For each antiepileptic, researchers compared the trough concentration prior to inserting the IUD vs. trough concentration at 3 weeks, 3 months, and 6 months later. They also compared the seizures occurring during the month prior to IUD insertion vs. seizures occurring in the 6 months following. 

During the baseline month, 75% of participants were seizure-free and the remaining women reported between 1–3 seizures. A total of 14 women received monotherapy and 6 received polytherapy. Lamotrigine, used by 12 women, was the most common antiepileptic. 

Trough concentrations remained stable during the 6 months following IUD insertion and did not exhibit any clinically meaningful deviations from baseline. Patients’ diary data indicated that seizure frequency worsened in 3 women, remained the same in 13 women, and improved in 4 women after IUD insertion; none of the participants expressed that the IUD worsened her seizure control. 

In addition, all study participants were either “somewhat satisfied” or “very satisfied” with the IUD during the study and all participants continued IUD use at 6 months. No pregnancies occurred during the study duration. 

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