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Kontrazeption bei Frauen mit Epilepsie

Contraception for women with epilepsy

Der Gynäkologe Aims and scope

Zusammenfassung

Epilepsien gehören zu den häufigsten neurologischen Erkrankungen. Die interdisziplinäre Zusammenarbeit zwischen den betreuenden Neurologen und Gynäkologen ist bei der Betreuung von Frauen, die unter einer Epilepsie leiden, unerlässlich. Mögliche bidirektionale Interaktionen zwischen der antiepileptischen Therapie und hormonalen Kontrazeptiva müssen berücksichtigt werden, um ungeplante Schwangerschaften und eine Verschlechterung der Anfallskontrolle zu verhindern. Enzyminduzierende Antiepileptika (EI-AED) können die kontrazeptive Wirksamkeit reduzieren. Um die kontrazeptive Sicherheit zu erhöhen, empfiehlt sich die kontinuierliche Anwendung eines monophasischen kombinierten Kontrazeptivums; hierbei soll der Gestagenanteil deutlich oberhalb der Ovulationshemmdosis gelegen sein. Die niedrig-dosierten „Gestagenmonoverfahren“, wie die Minipille, aber auch das subdermale Verhütungsstäbchen (Implanon®/Nexplanon®, Implanon NXT®) sollten nicht in Kombination mit EI-AED eingesetzt werden. Die hoch-dosierten injizierbaren Depotverfahren sind zwar vermutlich auch in Kombination mit EI-AED wirksam, sollen aber wegen des Nebenwirkungsprofils nur nach gründlicher Abwägung von Nutzen und Risiken zum Einsatz kommen. Die klassischen Intrauterinpessare aus Kupfer oder das neuere Levonorgestrel freisetzende Intrauterinsystem (LNG-IUS, Mirena®) sind nach Angaben der World Health Organization (WHO) eine Alternative für Frauen, die unter einer Epilepsie leiden, selbst wenn diese EI-AED einnehmen müssen.

Abstract

Epilepsy is one of the most common neurological disorders. For women with epilepsy collaboration between neurologists and gynecologists is crucial. To prevent unintended pregnancies and impaired seizure control the bidirectional interactive potential of antiepileptic drugs (AEDs) and hormonal contraceptives needs to be taken into account. Enzyme-inducing AEDs (EI-AED) may reduce the efficacy of hormonal contraceptives. To improve contraceptive safety monophasic combined oral contraceptives (COCs) should be used continuously without a hormone-free interval if used in combination with EI-AEDs. The progestin component should be well above the ovulation inhibiting dose. Progestin-only pills (POPs) are likely to be ineffective if used in combination with EI-AEDs. Subdermal progestogen implants (Implanon/Nexplanon/Implanon NXT) are not recommended for patients on EI-AEDs because of published high failure rates. High-dose injectable contraceptives appear to be effective; however they are not the first choice due to potential serious side effects. According to the World Health Organization (WHO) the use of copper intrauterine devices or the new levonorgestrel-releasing intrauterine system (IUS) may be an alternative for many women with epilepsy in need of contraception even if used in combination with EI-AEDs.

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Correspondence to A. Schwenkhagen.

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Dieser Beitrag bezieht sich v. a. auf das Buch Seminarbuch Gynäkologische Endokrinologie (2012); Herausgeber und Autor ist Prof. Dr. Dr. Rabe.

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Schwenkhagen, A., Schaudig, K., Rabe, T. et al. Kontrazeption bei Frauen mit Epilepsie. Gynäkologe 45, 723–731 (2012). https://doi.org/10.1007/s00129-012-3047-0

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  • DOI: https://doi.org/10.1007/s00129-012-3047-0

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