What is the recommendation regarding oral contraceptives for women on antiepileptic drugs?

Women who are on antiepileptic drugs (AEDs) may experience reduced effectiveness of oral contraceptives due to the interaction between the medications. Many AEDs, particularly enzyme-inducing medications such as phenytoin, carbamazepine, and phenobarbital, can increase the metabolism of hormonal contraceptives, resulting in lower serum levels of the hormones and decreased contraceptive efficacy.

This means that while oral contraceptives can still be used in women taking AEDs, there is a need for careful consideration and often adjustment in the type or dosage of contraceptive used. Providers frequently recommend the use of higher-dose estrogen contraceptives or alternative contraception methods, such as long-acting reversible contraceptives (LARCs), to ensure adequate contraceptive protection.

Recommendations typically advise that women using AEDs should be counseled about the potential for reduced contraceptive effectiveness and should discuss their contraceptive options with their healthcare provider to ensure they have appropriate protection against unintended pregnancy.