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Epilepsy – Contraceptive Interactions — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersEpilepsy – Contraceptive InteractionsSCE Neurology

A 27-year-old taking carbamazepine for focal epilepsy wants highly effective reversible contraception and does not plan pregnancy for five years. She prefers a method whose efficacy is not reduced by hepatic enzyme induction. Which option is best?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Use a copper intrauterine device after contraceptive counselling

Carbamazepine induces hepatic enzymes and can reduce systemic hormonal contraceptive exposure. A copper intrauterine device is highly effective and unaffected by enzyme induction. Standard combined pills, progestogen-only pills, implants and patches may have reduced efficacy; selection should follow specialist contraceptive advice rather than dose improvisation.

Reference: NICE NG217 principles of epilepsy treatment, safety, monitoring and withdrawal (Updated January 2025): https://www.nice.org.uk/guidance/ng217/chapter/principles-of-treatment-safety-monitoring-and-withdrawal