Contraception of choice in epileptics

• Several anti-epileptic drugs including phenobarbitone, carbemazipine and phenytoin are enzyme inducers which will increase the metabolism of COCP making it less effective

Mechanism

The contraceptive injection works by releasing progestogen, which interferes with ovulation, thickens the cervical mucus and thins the lining of the uterus.

Features of the contraceptive injection

• It is given every 13 weeks, can be used when breast feeding, and the patient does not have to remember to adhere to a treatment regimen.
• The patient's periods can stop, become irregular or last longer. It is associated with weight gain also, and is the only contraceptive option whereby a patient may take time to return to fertility (6-12 months).
• progestogen-only injectable is not recommended in women after the age of 50 due to its effect on reducing bone mineral density.
• Available as an intramuscular injection (Depo Provera), which must be administered by a healthcare professional, and as a subcutaneous injection (Sayana® Press) which may be administered by the patient.