Neurologic diseases are prevalent among women of reproductive age. For instance, the peak age of onset of multiple sclerosis is during childbearing years. Additionally, epilepsy and migraine (with and without aura) affect many women and are sometimes even triggered by steroid hormones. Contrastingly, ischemic strokes are rare events during the reproductive years and are facilitated by preexisting risk factors such as hypercholesterinemia, hypertension, smoking, and diabetes. Women with preexisting neurologic diseases require individual differentiated contraceptive counseling. Preexisting risk factors have to be considered, as do interactions between hormonal contraceptives and disease-modifying drugs. Efficacy is another important issue for safe contraception, especially if women are on disease-modifying therapies with teratogenic risks.