Birth Control and Epilepsy

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My wife has epilepsy, and she generally has a few seizures on one day in a month. Before we got married we took a class on the Creighton model of NFP, and because of that I noticed that her epilepsy seemed to occur around a particular part of her menstrual cycle. Once we noticed this and talked to her neurologist, he was able to prescribe us additional medication to take around the times when she might have her seizure. Now she is more likely to go a month without having a seizure, or only have a single seizure in a month. Because she still has seizures on occasion and her menstrual cycle is fairly irregular and unpredictable, her neurologist suggested she go on birth control to regulate her cycle and hopefully control her seizures. I was opposed to this because that necessarily removes one of the primary goods of sex, but from a medical perspective it doesn’t resolve the underlying issue. I told him I wanted to try to identify the underlying problem if at all possible. At that point he kind of threw his hands up in the air and kind of gave up on trying to figure out the problem.

My wife hasn’t been to an Ob/Gyn since we moved here to NY, mainly because we cannot find a pro-life or NaPro technology trained physician. The primary care doctor just wanted to put her on birth control as well. Just today we finally went to see a Ob/Gyn and she gave my wife a prescription for an injectable birth control, and my wife said that we could use it in a way that wouldn’t let it act like birth control. I wasn’t in the room with the Ob/Gyn with my wife, so I am not 100% sure what conversation my wife had with the physician since my wife has some memory problems (which are likely associated with her epilepsy).

To give a little background on myself, I am currently a PhD candidate in neural engineering and I attend a university in the diocese of Albany. I only mention this because I have a reasonable grasp on anatomy and physiology and I can speak about medicine at a reasonably high level. I’m not a med student, but I can speak somewhat technically with physicians, and the neurologist I can speak fairly fluently with because I do neuroscience research. My wife didn’t want me to go in to see the doctor with her because she was going to have an exam. I really wanted to go in to ask if there was a way that we could use a very low dose of birth control to help with hormonal regulation without making her infertile. I tried explaining to my wife that I was skeptical about using an injectable form of birth control since there are a reasonable number of safety issues associated with injectable vs pill form of birth control, and I don’t see how it could be used at a low dose to still allow her to be fertile. She immediately started crying and yelling, and it kind of scared me a bit. She then went on to explain how miserable she is with her seizures and she is willing to try anything to be over it, and that she understands that it’s wrong to intentionally make herself infertile but she is living a pretty terrible life right now.

Now that you have the reasonably long backstory, I guess I am looking for advice about:
  1. Whether birth control can be used at a low dose to regulate the menstrual cycle. If not, are their other things such as hormone replacement therapy that might allow us to help regulate her cycle without making her infertile? Being an engineer, I have run some analysis on different things and read some scientific papers on epilepsy in women and really think that hormones play a factor in her seizures.
  2. If she decides to do the birth control, what do I do? I’ve considered myself maybe having her go on birth control for a short period of time and remaining abstinent while she is on it just to see if the birth control does help to resolve the issue. My main reason for not sharing this with her is that I have suspected that she is getting desperate enough to consider staying on it permanently if she finds she has no seizures while taking it.
  3. I have kind of been worried about her position on the subject of fertility and sex since before we got married she said she wanted to not get pregnant during the first year of marriage so we could settle in with each other. I really found that mentality unacceptable, even if we didn’t conceive in the first year, since intentionally avoiding without grave reason seems to go against Evangelium Vitae. I think it is kind of coming back to haunt me now where she might be willing to go on it to prevent seizures, possibly indefinitely. I think even considering this situation in the context of the principle of double effect, taking birth control would be unacceptable since the primary action (no seizures) produces a good, but not in equal proportion to the bad side effect (infertility).
  4. Am I being overly scrupulous about this? I was a catholic theology student for a little while, and I have been a very avid reader of Saint JPII and my line of thinking seems to be appropriate according to catholic teaching. However, I have a difficult time finding someone to discuss these things with because of the area I live in. I feel my priest would tell us that it is morally acceptable to use birth control, mainly because he has told me that my opposition to gay marriage and the female priesthood is wrong. Unfortunately, the friends we have at this church have an identical position as the priest. I think part of the reason my wife is really considering using the birth control is only partially because of her exhaustion of dealing with epilepsy, but also because it is so prevalent around us even amongst our fellow church goers.
Long story short, I am looking for some faithful perspective on this difficult situation. I’m in a difficult area to really do some thoughtful dialogue with local catholics to try to figure this out. I am starting to wonder if I am just being difficult. If you could lend your advice, perspective, and prayer, I would greatly appreciate it.
 
The Catholic church allows birth control to be used for noncontraceptive medical purposes. It sounds like your wife’s situation certainly qualifies.

Honestly, it seems very selfish to me for you to want to keep her off of this against her and her doctor’s wishes. If it could help ease her epilepsy, that could enormously improve her quality of life. If she’s epileptic and suffering from memory problems as a result, is now the best time to have children anyway? Perhaps controlling it with birth control would allow you and your wife to discern whether or not she’s healthy enough to be a mother right now, and if she is, you can then work with her medical team to make that happen.
 
If the aim is to improve her epilepsy, it is legitimate to use birth control pills and it is OK for you to continue marital relations. The National Catholic Bioethics Center has a hotline for consultations:

ncbcenter.org/page.aspx?pid=1172

I could be wrong, but my understand is that the lower-dose birth control pills are in some ways more morally problematic than the higher-dose ones, as those low-dose ones are less effective at suppressing ovulation and hence rely for their mechanism more on producing an inhospitable uterine environment for the early embryo.

“I have kind of been worried about her position on the subject of fertility and sex since before we got married she said she wanted to not get pregnant during the first year of marriage so we could settle in with each other. I really found that mentality unacceptable, even if we didn’t conceive in the first year, since intentionally avoiding without grave reason seems to go against Evangelium Vitae.”

You found that mentality unacceptable, you distrusted her judgment as to the central business of marriage, and yet you got married. Hmmm.

“I think even considering this situation in the context of the principle of double effect, taking birth control would be unacceptable since the primary action (no seizures) produces a good, but not in equal proportion to the bad side effect (infertility).”

I think that’s an issue for you to discuss with an ethicist at the NCBC. Just off-hand, it does sound pretty serious to me. If, for instance, your wife had a seizure while driving or doing some other delicate and responsible task, it could cause her death or the deaths of other innocent people. Even just at home, imagine what could happen if your wife were alone with a baby and/or a toddler and she started going into a seizure, perhaps while giving a baby or toddler a bath. Use your imagination.

Perhaps you and your wife should go in for a joint pre-conception appointment with her new OB/GYN to talk about how, if ever, you and your wife will ever be able to safely have children together. That seems like an important piece of the puzzle. It’s also theoretically possible that amenorrhea (either due to pregnancy or breastfeeding) may have positive effects on your wife’s symptoms. That’s a question you and your wife should ask her doctors.

I think you should be present to hear what the OB/GYN has to say, but don’t go in sounding like an oppressive ogre. Let your wife do as much of the talking as possible, but you can be very helpful by taking notes that the two of you can discuss later.

Best wishes!
 
Mothers REALLY need their memory to keep kids safe (when did I give the baby Tylenol? where is the baby?), so I agree with the Blue Eyed Lady that your wife’s memory issues are a matter for serious concern.

That’s another issue where you should probably work with a specialist to figure out strategies for her to use to improve her level of functioning. I believe that psychologists have a lot of techniques that they use to help people with similar issues. I would encourage the OP to think very seriously about this issue.
 
It is very commendable that you wish your marital relations to continue to remain open to life. I can’t comment on whether birth control drugs are the way to go in your wife’s case from a medical perspective, but certainly from a moral perspective, if the drugs are taken primarily to treat your wife’s epilepsy and not as a form of birth control (even if you realize that the drug will act as a contraceptive in addition to treating your wife’s epilepsy as an undesired side effect), there is no wrongdoing on her part and both of you are free to continue to engage in marital relations.

In short, as long as your intention is still to be open to life, as God wills, taking medically necessary steps to treat your wife’s illness is not sinful, even if infertility is an undesired result.

From Pope Paul VI’s Humanae Vitae:
  1. On the other hand, the Church does not consider at all illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result there from—provided such impediment is not directly intended for any motive whatsoever.
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Hi all. Thanks for the replies.

To Blue eyed lady: I guess I should have included some medical information with this as well. The vast majority of women with epilepsy do not have seizures while pregnant, especially if it is a hormonal problem as we suspect it might be. There really isn’t any way to know unless she were to become pregnant. However, she is scared (rightly so) to get pregnant in the off chance that she does have seizures while pregnant. I also think you missed the point I made about trying to resolve the underlying issue. Even if she were to go on birth control so we could decide if she was healthy enough to have children, she would have to go off of it to get pregnant (and the seizures would probably return). So, I don’t think going on birth control to figure out if she is healthy enough to have children is a viable option, since she will have to go off of it eventually. Unless of course we adopt (which we have talked about considerably).

To Xantippe: Regarding the position on avoiding pregnancy, I had explained my position to her and she was in agreement once we talked it out. I didn’t have any reason to think that we were not in the same boat on that position, or I wouldn’t have married her. Thank you for the other information about the NCB center. She does not drive because of this. Regarding her seizures, she has never had a seizure without me around. I have a hard time explaining this to people that are unfamiliar with people with epilepsy, but her seizures are fairly predictable. She only has them early in the morning, so she wouldn’t be home alone with our child. The main reason I didn’t go in to see her Ob/Gyn with her is because she was having an examination, and she said she wouldn’t feel very comfortable with me in the room since she is generally uncomfortable with the whole procedure.

Thank you for the source from Humanae Vitae. I think since we have been struggling to resolve this issue for a while, some form of birth control might have to be the solution. To be clear, I do not just disregard physicians advice because I think they are wrong. Since we have been married (3 years, we are 29) she has had doctors try to prescribe her birth control for a variety of things like complexion and being a little underweight.

Thank you all for the (name removed by moderator)ut. Please pray for us.
 
CatholicThought said:
Hi all. Thanks for the replies.

To Blue eyed lady: I guess I should have included some medical information with this as well. The vast majority of women with epilepsy do not have seizures while pregnant, especially if it is a hormonal problem as we suspect it might be. There really isn’t any way to know unless she were to become pregnant. However, she is scared (rightly so) to get pregnant in the off chance that she does have seizures while pregnant. I also think you missed the point I made about trying to resolve the underlying issue. Even if she were to go on birth control so we could decide if she was healthy enough to have children, she would have to go off of it to get pregnant (and the seizures would probably return). So, I don’t think going on birth control to figure out if she is healthy enough to have children is a viable option, since she will have to go off of it eventually. Unless of course we adopt (which we have talked about considerably).

To Xantippe: Regarding the position on avoiding pregnancy, I had explained my position to her and she was in agreement once we talked it out. I didn’t have any reason to think that we were not in the same boat on that position, or I wouldn’t have married her. Thank you for the other information about the NCB center. She does not drive because of this. Regarding her seizures, she has never had a seizure without me around. I have a hard time explaining this to people that are unfamiliar with people with epilepsy, but her seizures are fairly predictable. She only has them early in the morning, so she wouldn’t be home alone with our child. The main reason I didn’t go in to see her Ob/Gyn with her is because she was having an examination, and she said she wouldn’t feel very comfortable with me in the room since she is generally uncomfortable with the whole procedure.

Thank you for the source from Humanae Vitae. I think since we have been struggling to resolve this issue for a while, some form of birth control might have to be the solution. To be clear, I do not just disregard physicians advice because I think they are wrong. Since we have been married (3 years, we are 29) she has had doctors try to prescribe her birth control for a variety of things like complexion and being a little underweight.

Thank you all for the (name removed by moderator)ut. Please pray for us.
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It is not birth control. It is hormonal therapy. Your wife might even ask the doctor if the dosages are the same if avoiding pregnancy is not a desired side effect of the therapy. Who knows, it may not be. The medication packets intended for birth control may simply be convenient or conveniently-priced. That is a medical question. (Your wife might also ask him/her not to chart or prescribe the medication as birth control, since she’d want others reading her chart to know that avoiding pregnancy is not one of her medical goals.)
 
EasterJoy said:
It is not birth control. It is hormonal therapy. Your wife might even ask the doctor if the dosages are the same if avoiding pregnancy is not a desired side effect of the therapy. Who knows, it may not be. The medication packets intended for birth control may simply be convenient or conveniently-priced. That is a medical question. (Your wife might also ask him/her not to chart or prescribe the medication as birth control, since she’d want others reading her chart to know that avoiding pregnancy is not one of her medical goals.)
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Exactly what I was trying to ask the doctor! I don’t know if there is a level she could take where it wouldn’t have the effect of infertility. I don’t have a problem with taking “birth control” if it does not result in infertility. I have a few issues with her taking the injectable form where she goes in monthly for a shot since I design drug delivery devices that do something similar for the brain. My main worry is that if it is injected and she has a bad reaction to it then it will be a much bigger problem than if we were to start off with the pill where she could just stop taking it. I know what is in birth control pills and at what doses, I just don’t know if we can use them at low doses to still allow us to be open to life while regulating hormones for her epilepsy. I’m having a hard time getting a straight answer from doctors. Based on what I know of physiology, there is no reason why we shouldn’t be able to take a low dose of “birth control” and it would still leave her fertile while controlling her hormone levels. I would like to try to exhaust every possibility before using nuclear options, meaning methods that have severe side effects such as infertility.
 
CatholicThought said:
To Blue eyed lady: I guess I should have included some medical information with this as well. The vast majority of women with epilepsy do not have seizures while pregnant, especially if it is a hormonal problem as we suspect it might be. There really isn’t any way to know unless she were to become pregnant. However, she is scared (rightly so) to get pregnant in the off chance that she does have seizures while pregnant. I also think you missed the point I made about trying to resolve the underlying issue. Even if she were to go on birth control so we could decide if she was healthy enough to have children, she would have to go off of it to get pregnant (and the seizures would probably return). So, I don’t think going on birth control to figure out if she is healthy enough to have children is a viable option, since she will have to go off of it eventually. Unless of course we adopt (which we have talked about considerably).
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I know this wasn’t addressed to me, but I just want to say that even just knowing whether this type of approach will work for her would be valuable knowledge in the future, even if she has to stop taking it to have children. If it’s not likely that she will have seizures while pregnant, and she discovers that this works for her, she can begin it again after birth. Not taking it while trying to get pregnant is basically where she is now, so there really is no harm in finding out.

Epilepsy is serious business, as you well know. As other posters have pointed out, and provided sources for, it is not wrong to resort to hormonal therapies, even if they make her infertile in the process. I hope that you are not putting more pressure on your wife than the Church requires. If she tries it and doesn’t work, at least she will know. And if it does, wouldn’t you be glad to know that she found something that helps? And when the time comes for children, you can work out a plan with the neurologist and OB (they will work together if necessary) about how to approach trying to conceive and pregnancy itself.

I understand what it’s like to live with a condition that makes your life a lot harder (not epilepsy), and to be willing to try anything to treat it. What your wife wants to do is not morally illicit. I’d encourage you to contact the Bioethics Center, as Xantippe suggested. You might be reassured by what they have to say.
 
CatholicThought said:
Exactly what I was trying to ask the doctor! I don’t know if there is a level she could take where it wouldn’t have the effect of infertility. I don’t have a problem with taking “birth control” if it does not result in infertility. I have a few issues with her taking the injectable form where she goes in monthly for a shot since I design drug delivery devices that do something similar for the brain. My main worry is that if it is injected and she has a bad reaction to it then it will be a much bigger problem than if we were to start off with the pill where she could just stop taking it. I know what is in birth control pills and at what doses, I just don’t know if we can use them at low doses to still allow us to be open to life while regulating hormones for her epilepsy. I’m having a hard time getting a straight answer from doctors. Based on what I know of physiology, there is no reason why we shouldn’t be able to take a low dose of “birth control” and it would still leave her fertile while controlling her hormone levels. I would like to try to exhaust every possibility before using nuclear options, meaning methods that have severe side effects such as infertility.
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That’s a reasonable concern with the injectables and wanting to be able to “turn it off” faster.

I strongly suspect that the dose good enough to “control her hormones” is probably exactly the same dose that will render her infertile (as that’s essentially the same thing), but I am not a doctor and you should ask. I suspect that as Easter Joy suggested, that BC pills are the cheapest way to get the medication, which is affecting the medical judgment.

In any case, the idea of her taking some sort of moderate dose of BC (or indeed just about any kind of medication at all) while trying to get pregnant probably wigs her OB/GYN out. That’s probably a major ingredient in the situation–they’d probably like her to be either totally off medication and trying to get pregnant, or 100% on medication and not likely to get pregnant. The idea of being on medication and indefinitely fertile probably worries them (there’s something like a 2-month waiting period for trying to get pregnant after stopping the pill, but of course lots of people do have healthy babies after missing a pill here or there).

Best wishes!
 
This isn’t really your question, but if you live in the US, it’s going to be really hard for your wife to be a mom without driving, unless you have somewhat unusual circumstances (you live in Manhattan or Brooklyn or something).

I didn’t have a driver’s license until a year after we left Washington, DC with a 2-year-old and an almost 5-year-old and we did just fine, but as soon as we moved to a more normal part of the country, it was very limiting not to be able to drive. Have you researched how other families manage the combination of not driving and parenthood? I suspect that the larger your family gets, the more you will feel the limitations of her not being able to drive. (While there are always taxis in an emergency, the carseat issue makes that hard to deal with with little kids.)

Best wishes!
 
As others have said, the circumstances you describe seem like the epitome of a time when artificial hormones, even if they render her infertile, are appropriate. You mention wanting to get to the “underlying causes” and I appreciate that perspective, because I’ve had BC pills pushed for many things where the pills would merely be suppressing symptoms and NOT treating the underlying cause. I see your situation as different. While the standard hormonal shifts that accompany a normal cycle are not the primary cause of the epilepsy, you have clear data that they are a major contributing factor. If something else were impacting your wife’s seizures in this manner, you’d adjust that. Let’s say, for instance, that a gluten sensitivity was triggering her seizures, you’d eliminate gluten. If lack of sleep triggered seizures, you’d adjust sleep schedules. Flashing lights, stress, etc. etc.

You asked if your being scrupulous, and, IMO, you are. Your wife is suffering. As someone else said, you’re holding her to a very high standard. I can’t imagine how incredibly frustrated she must be. Particularly if you go into her doctor’s office and “med-speak” over her head. I suspect that she kept you out of the appointment with her GYN because she wanted to be heard and have the chance to interact with the doctor without your influence. My GYN typically does the exam and then allows me to get dressed and comes in and chats. I’ve had no problem with my husband coming with me when something was concerning, but I drive the appointment. He might ask one-two questions at the end. If that. And they are clarifying questions.

Obviously, consult the bioethics center or an NFP only doc if you want to put your mind at ease. If you can’t find an NFP only doc in your area, you could consider a teleconference. FWIW, I’ve heard of NFP only doctors prescribing BC pills for similar circumstances. (I’m not 100% sure the diagnosis was epilepsy; it was definitely a disorder clearly impacted by hormonal swings.)
 
NFPWife said:
As others have said, the circumstances you describe seem like the epitome of a time when artificial hormones, even if they render her infertile, are appropriate. You mention wanting to get to the “underlying causes” and I appreciate that perspective, because I’ve had BC pills pushed for many things where the pills would merely be suppressing symptoms and NOT treating the underlying cause. I see your situation as different. While the standard hormonal shifts that accompany a normal cycle are not the primary cause of the epilepsy, you have clear data that they are a major contributing factor. If something else were impacting your wife’s seizures in this manner, you’d adjust that. Let’s say, for instance, that a gluten sensitivity was triggering her seizures, you’d eliminate gluten. If lack of sleep triggered seizures, you’d adjust sleep schedules. Flashing lights, stress, etc. etc.

You asked if your being scrupulous, and, IMO, you are. Your wife is suffering. As someone else said, you’re holding her to a very high standard. I can’t imagine how incredibly frustrated she must be. Particularly if you go into her doctor’s office and “med-speak” over her head. I suspect that she kept you out of the appointment with her GYN because she wanted to be heard and have the chance to interact with the doctor without your influence. My GYN typically does the exam and then allows me to get dressed and comes in and chats. I’ve had no problem with my husband coming with me when something was concerning, but I drive the appointment. He might ask one-two questions at the end. If that. And they are clarifying questions.

Obviously, consult the bioethics center or an NFP only doc if you want to put your mind at ease. If you can’t find an NFP only doc in your area, you could consider a teleconference. FWIW, I’ve heard of NFP only doctors prescribing BC pills for similar circumstances. (I’m not 100% sure the diagnosis was epilepsy; it was definitely a disorder clearly impacted by hormonal swings.)
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NFPWife makes a very interesting point about the hormones being possibly the “underlying cause.”

She’s also right about the GYN appointments and how there are opportunities to have fully-clothed conversations with your doctor. My doctor sometimes starts talking mid-exam, but I point out to her that I’d like to get dressed first. It just requires a little assertiveness.
 
I don’t think you should be worrying so much about “underlying cause.” What you need to do is stop the seizures. For example, some people take statins for high cholesterol. While they are taking the statins, their cholesterol goes down. When they quit the statins, their cholesterol goes back up. The “underlying cause” might be having the wrong genes, and sometimes it is impossible to lower it by diet alone.

It is perfectly moral for your wife to take birth control pills or birth control shots to stop the seizures.

I don’t understand why you would want a low enough dose for her to still be “open to life.” Many Catholics worry about losing a baby because of “breakthrough ovulation,” and the fertilized egg failing to attach. Something like this would be much more likely to happen when someone is on a low dose pill. Wouldn’t you be better off with a pill that suppressed ovulation?

I also think that your wife should be in charge of her own medical care. This is really her decision.
 
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