Quick answer. Epilepsy raises some issues specific to women. Some anti-seizure medicines and hormonal contraception can affect each other, so contraceptive choice should be worked out with the epilepsy team. If you are thinking of pregnancy, plan it in advance with your team, because some medicines carry risks in pregnancy – valproate in particular is known to carry significant risks to the baby. Crucially, you should never stop medication on finding out you are pregnant without advice, as uncontrolled seizures also carry risks. Folic acid is advised as prescribed by your doctor. With the right planning, most women with epilepsy have healthy pregnancies and healthy babies.
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In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.
Contraception and epilepsy medicines
An important issue for women is that some anti-seizure medicines and hormonal contraception can affect each other, in both directions. Certain epilepsy medicines can make some hormonal contraception less effective, and some contraception can affect the level of certain epilepsy medicines. This means contraceptive choice should not be assumed but worked out with your epilepsy team, so that both your seizure control and your contraception remain reliable. This guide describes the issue in general terms, without naming products, because the right choice is individual. If you have epilepsy and use, or are considering, hormonal contraception, it is worth raising this specifically with your team.
Plan pregnancy in advance
If you are thinking about becoming pregnant, the single most important step is to plan it in advance with your epilepsy team. Ideally, speak to your epilepsy specialist before becoming pregnant, so there is time to review and, if needed, optimise your medication ahead of conception. This is because some medicines carry more risk in pregnancy than others, and changes, if any are needed, are best made carefully and well before pregnancy rather than in a hurry afterwards. Planning ahead gives you and your team the best chance of entering pregnancy on the safest suitable treatment, which protects both you and your baby.
The valproate warning
One medicine deserves specific mention. Valproate is known to carry significant risks to the developing baby, including birth defects and developmental problems, if taken in pregnancy. For this reason it is used with particular caution in anyone who can become pregnant, under special safeguards. This warning is included here generally, without doses, precisely because it is so important, but the message is not to stop any medicine yourself – it is to make sure that pregnancy and medication are discussed and planned with your epilepsy team. If you take valproate and are considering pregnancy, this is an essential conversation to have with your specialist well in advance.
Never stop medication yourself
A crucial safety point is that you should not stop taking your medication if you find out you are pregnant, without first talking to an epilepsy specialist. It is understandable to worry about medicines in pregnancy, but uncontrolled seizures carry their own real risks to both mother and baby, so stopping medication is not a safe response. The right course is to keep taking your medication as prescribed and contact your epilepsy team straight away, so they can advise you. Any decision about medication in pregnancy must be a careful, specialist one that weighs all the risks – never something to do on your own.
Folic acid
Women with epilepsy planning a pregnancy are generally advised to take folic acid before conception and in early pregnancy, often at a higher dose than the standard recommendation, prescribed by a doctor. Because the appropriate dose is individual and specialist-directed, this guide does not state a specific amount; instead, ask your doctor what is right for you. Taking folic acid as advised is a simple, positive step that supports a healthy pregnancy. Ideally this is started before you conceive, which is another reason planning pregnancy in advance with your team is so valuable, so that everything is in place from the start.
Reassurance for the journey
Amid these cautions, the overarching message is reassuring: with the right planning and support, most women with epilepsy have healthy pregnancies and healthy babies. Epilepsy is not a reason not to have children. Seizures during pregnancy can stay the same, improve or increase – the pattern is unpredictable, which is why specialist follow-up throughout pregnancy is important. Working closely with your epilepsy team and your obstetric team, taking your medication as prescribed, and attending your appointments all give you the best chance of a smooth pregnancy. In Singapore, KK Women’s and Children’s Hospital provides obstetric services for pregnancy planning and care in women with epilepsy.
Hormones through life
Hormonal changes can affect seizures at other times too. Some women notice their seizures cluster around their menstrual cycle, a pattern known as catamenial seizures, which is worth logging in a seizure diary and discussing with the epilepsy team, as there may be ways to help. Around menopause, hormonal changes may also affect seizure patterns for some women, which is another useful thing to raise at review. Being aware of these hormonal influences, and tracking your own patterns, helps you and your team manage your epilepsy well across the different stages of life, rather than being caught out by changes.
Getting the right care
The issues around women, hormones and pregnancy in epilepsy are exactly the kind of thing your epilepsy team is there to help with, so the practical advice is to raise them proactively. In Singapore, the National Neuroscience Institute provides specialist epilepsy care, and KK Women’s and Children’s Hospital offers obstetric and maternal care for pregnancy. Above all, remember the two safety rules that run through this topic: plan pregnancy in advance with your team, and never stop your medication without advice, including in pregnancy. And the emergency rule applies as always – a convulsive seizure over five minutes, or repeated seizures without recovery, means calling 995.
Related epilepsy topics
- Living with epilepsy
- Understanding epilepsy: seizure types & diagnosis
- Medication & managing treatment
- Triggers & managing seizures
- Staying safe at home & outdoors
- Driving, work & daily life
- SUDEP & epilepsy safety
- Mental health & wellbeing
- Caring for someone with epilepsy
- Seizure first aid
- Neurologists in Singapore
Sources
- NHS – Epilepsy and pregnancy: nhs.uk
- Epilepsy Action – Pregnancy, birth and epilepsy: epilepsy.org.uk
- Epilepsy Action – Sex and contraception: epilepsy.org.uk
- Epilepsy Action – Sodium valproate and pregnancy: epilepsy.org.uk