A 32-year-old woman (gravida 0) who is hypothyroid and takes phenytoin (Dilantin) for a seizure disorder wants contraception. A second method is recommended when an oral contraceptive (OC) is used. My patient doesn’t want to use condoms. I think an intrauterine device may be the best choice, but I’m not familiar with the sponge. What would you recommend?
—Ivanka Vassileva, MD, Lawton, Okla.
Phenytoin increases the metabolism of contraceptive steroids, so it is recommended that women using OCs take a formulation containing 50 µg of ethinyl estradiol. An intrauterine contraceptive is an excellent method of contraception for women taking phenytoin. Medroxyprogesterone acetate (Depo-Provera) injections in the usual dosage are also effective contraceptives for phenytoin users.
—Daniel R. Mishell Jr, MD (108-3)