Oral contraceptives for females with developmental disability

Effectiveness of oral contraception depends on adherence to therapy. Many females with developmental disability can adhere to once daily regiments independently, or with assistance or supervision. As in the general population, it can be helpful to suggest a tablet-taking prompt (eg when brushing teeth). Written patient information, including cautions and interactions, should be given to the person, or their parents or carers, and stored with the medication.

For information about oral combined hormonal contraception, see Combined hormonal contraception, including advice for patients before prescribing. Consider the usual contraindications and precautions for use (eg past cardiovascular accidents, deep vein thrombosis).

If the female is taking an antiepileptic drug, consider interactions such as:

• The reliability of combined oral contraception is reduced in females taking enzyme-inducing antiepileptic drugs, see Contraception in patients with epilepsy.
• Combined hormonal contraceptives increase the metabolism of lamotrigine. This can result in significantly lower serum lamotrigine concentrations (reduced effect) while the person is taking active pills, and may result in increased concentrations (risk of toxicity) during the hormone-free interval.

Progestogen-only contraceptive pills are effective and valuable if estrogen is contraindicated, but good adherence to therapy is essential. For information, see Progestogen-only contraceptive pills. Progestogen-only contraception is not reliable in females who are taking enzyme-inducing antiepileptic drugs; see Contraception in individuals taking drugs that induce liver enzymes.