Hormonal fluctuations of the menstrual cycle can influence the incidence of some types of seizures. Not all seizures are sensitive to estrogen and progesterone ratios; however, this possibility may influence the choice of hormonal contraceptives. Importantly, women with TSC are at risk of developing the lung manifestation lymphangioleiomyomatosis (LAM). Use of estrogen is not advised for women with LAM, so it is critical for a woman with TSC who has epilepsy to discuss these medication issues with her health care providers.
Additionally, some anticonvulsant medications can interact with estrogen-based contraceptives and the result can be a lowered rate of efficacy, leading to unintended pregnancy. A higher dosage estrogen pill might be appropriate for women using epilepsy drugs that affect the rate at which the liver metabolizes estrogen. The dosage for emergency contraception (morning after pill) will also depend on the type of anticonvulsant medication a woman takes. The use of barrier methods such as a diaphragm, sponges, or condoms is appropriate for women with epilepsy.
Furthermore, women with epilepsy have special concerns when they decide to get pregnant. Some anti-seizure drugs are not advised for women who are pregnant, so it is important to discuss this with both your neurologist and gynecologist/obstetrician as soon as you decide to—or find out you are—pregnant. Women with TSC are also encouraged to meet with a geneticist or genetic counselor so that they fully understand the risk of passing TSC on to their children. Each child of a woman with TSC has a 50% chance of inheriting TSC, so pregnancy is something that needs to be carefully considered and discussed between the prospective parents.