Contraception in Neurologic and Psychiatric Disorders

All women of reproductive age with psychiatric and neurologic disease should be screened for contraceptive need, and offered counseling on options compatible with their medications and medical conditions. While non-hormonal methods are appropriate for all patients, hormonal contraception may interact with some medications used by women in treatment of epilepsy, multiple sclerosis and mood disorders. Women at risk for or with a history of stroke should avoid estrogen-containing options; similarly, women who report migraine with aura are also discouraged from use of any estrogen-based contraception due to the potential increase in risk of stroke. Fortunately, the highly effective reversible contraceptive options that include intrauterine devices (IUDs) and the progestin-only implant are appropriate for almost all these women. This chapter provides evidence and guidance for selection of appropriate, safe contraceptive options in women with migraine disease, epilepsy, stroke, multiple sclerosis and psychiatric disease.