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Forum Name: Gynecology

Question: Hormonal Birth Control and Carbamazepine


 MsFeasance - Sun Mar 09, 2008 8:43 pm

I am a 24 year old female who recently became sexually active. I've never had unprotected sex (we've always used a condom), but just to be safe, my partner and I would like to have a backup method.
Here's where it gets sticky: I have epilepsy, and I've been on carbamazepine since 1993. All my neurologists have said that all anticonvulsants cut the effectiveness of hormonal birth control by 50%; which is to say, I might as well not use it at all. I dislike the idea of a copper IUD; and I've known many women who got pregnant using them. When the Mirena IUD came out, I was excited, then subsequently crushed when I found out you have to have given birth before in order to use it. Is there a hormonal reason why you have to have given birth before, or is it possible to have an exception made in a unique case?
 Alexandra C, RN - Mon Mar 17, 2008 9:22 am

Hello,

The IUD is an excellent contraceptive, it is safe, economical (if left in place for the full period of efficacy), and effective. However, the IUD is generally not recommended as a first-line contraceptive for women who have never been pregnant (nulligravidas) or women who have never given birth (nulliparas). This is because it is much more difficult to insert the IUD through the cervix and into the uterus in a nullipara, and there is some increased risk of mechanical problems. Also, a good candidate for an IUD must be in a monogamous relationship. Some providers are more willing to use the IUD in a nulliparous woman than others, so you should talk to your doctor about why Mirena may or may not be appropriate for you. I do not think that your use of carbamazepine would interfere with the levonorgestrel absorption from the Mirena because it affects the reproductive system locally instead of systemically. Since you are already using condoms and are looking for a back-up method, you might consider using a diaphragm, this would decrease your likelihood of pregnancy and help avoid some of the potential drawbacks of the IUD.

Good luck to you!

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