Hormonal contraception is not associated with increased risk for seizures in the general population: results from a cohort study using The Health Improvement Network

Christoph Patrick Beier*, Luis A. García Rodríguez, María E. Sáez, David Gaist, Antonio González-Pérez

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Purpose: Endogenous human gonadal steroids and especially female sex hormones modulate the risk of developing epileptic seizures. In most circumstances, estrogens increase excitability, while progesterone bears substantial anticonvulsive properties. We questioned whether exogenous gonadal steroids used as hormonal contraception are associated with risk of seizures. Methods: In a dynamic cohort ascertained within The Health Improvement Network database, we identified 2201 female patients aged 20–44 years with seizures during follow-up. In a nested case-control analysis, we matched these cases to 10,143 controls. Using logistic regression, we calculated the risk of seizure associated with use of contraceptives and adjusted for potential confounders. We performed same analyses among women with no prior hormonal contraception use (“new user” analyses) and in patients with a history of epilepsy. Results: Unadjusted data suggested a lower risk for seizures in patients taking exogenous gonadal steroids irrespective of type of contraception used. After adjustment for potential confounders, neither use of combined oral contraceptives nor progestin-only oral contraceptives was associated with the risk for seizures overall. Analyses of “new users” of oral contraceptives produced similar risk estimates. Conclusions: We found no evidence supporting an effect of oral exogenous gonadal steroids used for hormonal contraception on the risk of seizures in the general female population.

Original languageEnglish
JournalEuropean Journal of Clinical Pharmacology
Volume74
Issue number9
Pages (from-to)1175–1180
ISSN0031-6970
DOIs
Publication statusPublished - Sep 2018

Fingerprint

Cohort Studies
Health
Population
Oral Contraceptives
Contraceptives, Oral, Combined
Progestins
Contraceptive Agents
Estrogens
Logistic Models
Databases

Keywords

  • Allopregnanolone
  • Epilepsy
  • Ethinylestradiol
  • Hormonal contraception
  • Progesterone
  • Seizure
  • Contraceptives, Oral/administration & dosage
  • Risk Assessment
  • Seizures/chemically induced
  • Administration, Oral
  • Humans
  • Risk Factors
  • Contraceptive Agents, Female/administration & dosage
  • United Kingdom/epidemiology
  • Young Adult
  • Injections
  • Adult
  • Female
  • Retrospective Studies
  • Databases, Factual

Cite this

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title = "Hormonal contraception is not associated with increased risk for seizures in the general population: results from a cohort study using The Health Improvement Network",
abstract = "Purpose: Endogenous human gonadal steroids and especially female sex hormones modulate the risk of developing epileptic seizures. In most circumstances, estrogens increase excitability, while progesterone bears substantial anticonvulsive properties. We questioned whether exogenous gonadal steroids used as hormonal contraception are associated with risk of seizures. Methods: In a dynamic cohort ascertained within The Health Improvement Network database, we identified 2201 female patients aged 20–44 years with seizures during follow-up. In a nested case-control analysis, we matched these cases to 10,143 controls. Using logistic regression, we calculated the risk of seizure associated with use of contraceptives and adjusted for potential confounders. We performed same analyses among women with no prior hormonal contraception use (“new user” analyses) and in patients with a history of epilepsy. Results: Unadjusted data suggested a lower risk for seizures in patients taking exogenous gonadal steroids irrespective of type of contraception used. After adjustment for potential confounders, neither use of combined oral contraceptives nor progestin-only oral contraceptives was associated with the risk for seizures overall. Analyses of “new users” of oral contraceptives produced similar risk estimates. Conclusions: We found no evidence supporting an effect of oral exogenous gonadal steroids used for hormonal contraception on the risk of seizures in the general female population.",
keywords = "Allopregnanolone, Epilepsy, Ethinylestradiol, Hormonal contraception, Progesterone, Seizure, Contraceptives, Oral/administration & dosage, Risk Assessment, Seizures/chemically induced, Administration, Oral, Humans, Risk Factors, Contraceptive Agents, Female/administration & dosage, United Kingdom/epidemiology, Young Adult, Injections, Adult, Female, Retrospective Studies, Databases, Factual",
author = "Beier, {Christoph Patrick} and {Garc{\'i}a Rodr{\'i}guez}, {Luis A.} and S{\'a}ez, {Mar{\'i}a E.} and David Gaist and Antonio Gonz{\'a}lez-P{\'e}rez",
year = "2018",
month = "9",
doi = "10.1007/s00228-018-2494-5",
language = "English",
volume = "74",
pages = "1175–1180",
journal = "European Journal of Clinical Pharmacology",
issn = "0031-6970",
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Hormonal contraception is not associated with increased risk for seizures in the general population : results from a cohort study using The Health Improvement Network. / Beier, Christoph Patrick; García Rodríguez, Luis A.; Sáez, María E.; Gaist, David; González-Pérez, Antonio.

In: European Journal of Clinical Pharmacology, Vol. 74, No. 9, 09.2018, p. 1175–1180.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Hormonal contraception is not associated with increased risk for seizures in the general population

T2 - results from a cohort study using The Health Improvement Network

AU - Beier, Christoph Patrick

AU - García Rodríguez, Luis A.

AU - Sáez, María E.

AU - Gaist, David

AU - González-Pérez, Antonio

PY - 2018/9

Y1 - 2018/9

N2 - Purpose: Endogenous human gonadal steroids and especially female sex hormones modulate the risk of developing epileptic seizures. In most circumstances, estrogens increase excitability, while progesterone bears substantial anticonvulsive properties. We questioned whether exogenous gonadal steroids used as hormonal contraception are associated with risk of seizures. Methods: In a dynamic cohort ascertained within The Health Improvement Network database, we identified 2201 female patients aged 20–44 years with seizures during follow-up. In a nested case-control analysis, we matched these cases to 10,143 controls. Using logistic regression, we calculated the risk of seizure associated with use of contraceptives and adjusted for potential confounders. We performed same analyses among women with no prior hormonal contraception use (“new user” analyses) and in patients with a history of epilepsy. Results: Unadjusted data suggested a lower risk for seizures in patients taking exogenous gonadal steroids irrespective of type of contraception used. After adjustment for potential confounders, neither use of combined oral contraceptives nor progestin-only oral contraceptives was associated with the risk for seizures overall. Analyses of “new users” of oral contraceptives produced similar risk estimates. Conclusions: We found no evidence supporting an effect of oral exogenous gonadal steroids used for hormonal contraception on the risk of seizures in the general female population.

AB - Purpose: Endogenous human gonadal steroids and especially female sex hormones modulate the risk of developing epileptic seizures. In most circumstances, estrogens increase excitability, while progesterone bears substantial anticonvulsive properties. We questioned whether exogenous gonadal steroids used as hormonal contraception are associated with risk of seizures. Methods: In a dynamic cohort ascertained within The Health Improvement Network database, we identified 2201 female patients aged 20–44 years with seizures during follow-up. In a nested case-control analysis, we matched these cases to 10,143 controls. Using logistic regression, we calculated the risk of seizure associated with use of contraceptives and adjusted for potential confounders. We performed same analyses among women with no prior hormonal contraception use (“new user” analyses) and in patients with a history of epilepsy. Results: Unadjusted data suggested a lower risk for seizures in patients taking exogenous gonadal steroids irrespective of type of contraception used. After adjustment for potential confounders, neither use of combined oral contraceptives nor progestin-only oral contraceptives was associated with the risk for seizures overall. Analyses of “new users” of oral contraceptives produced similar risk estimates. Conclusions: We found no evidence supporting an effect of oral exogenous gonadal steroids used for hormonal contraception on the risk of seizures in the general female population.

KW - Allopregnanolone

KW - Epilepsy

KW - Ethinylestradiol

KW - Hormonal contraception

KW - Progesterone

KW - Seizure

KW - Contraceptives, Oral/administration & dosage

KW - Risk Assessment

KW - Seizures/chemically induced

KW - Administration, Oral

KW - Humans

KW - Risk Factors

KW - Contraceptive Agents, Female/administration & dosage

KW - United Kingdom/epidemiology

KW - Young Adult

KW - Injections

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Databases, Factual

U2 - 10.1007/s00228-018-2494-5

DO - 10.1007/s00228-018-2494-5

M3 - Journal article

C2 - 29855657

AN - SCOPUS:85047923404

VL - 74

SP - 1175

EP - 1180

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

SN - 0031-6970

IS - 9

ER -