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Two Reports on Impacts of Contraceptives in Women with MS

May 11, 2017

Summary:
 
  • In a newly published study co-funded by the National MS Society, researchers report that oral contraceptives were not associated with an increased risk of MS relapses in 162 women with MS. The team report their findings in the MS Journal (Published online February 3, 2017).
  • A separate publication reports that guidance on contraception from the Centers for Disease Control and Prevention for healthcare professionals has been updated to include MS. Most contraceptive methods appear safe for women with MS based on current evidence. This team reports on the guidelines in an open-access paper in the MS Journal (2017 May;23(6):757-764). 
 
Background: MS is more prevalent in women of childbearing age than in any other group. When young women receive a diagnosis of MS, they frequently have questions about the effects of the disease on reproductive issues such as pregnancy, nursing, and contraception—and vice versa. Studies undertaken over the past several decades allow health professionals to provide answers to some of these questions. 
 
The Oral Contraceptives Study: The team examined whether the use of oral contraceptives affected the relapse rate (number of relapses over one year) in 162 women with MS while being treated with interferon therapy or glatiramer acetate for MS. These women are being followed as part of the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital.
 
In this group of 162 women, 81 were treated with interferon therapy and 81 with glatiramer acetate. Among all women, there was no increase in relapse rate based on contraception use. In fact, those who had used oral contraceptives in the past had significantly lower relapse rates than those who had never used them. There was no difference in relapse rate based on the type of medication used.
 
It’s important to note that the study did not take into account participants’ age or certain health behaviors that might affect both contraceptive use and relapse rate. Studies are ongoing to assess the effects of specific doses and formulations of contraceptives, combined with injectable and oral disease-modifying medications.
 
The team (Riley Bove, MD, now at the University of San Francisco and Tanuja Chitnis, MD, Brigham & Women’s Hospital, Boston) report their findings in the MS Journal (Published online February 3, 2017). This research was supported by the National MS Society and the National Institutes of Health.
 
Contraception Guidelines for Healthcare Professionals: Another publication reports that guidance on contraception from the Centers for Disease Control and Prevention has been updated to include MS. Most contraceptive methods appear safe for women with MS based on current evidence.
 
Importantly, the guidelines note that combined hormonal contraceptives (containing both estrogen and progestin) should be restricted in women with MS who have prolonged immobility, because of concerns about the possible occurrence of blood clots. Formal studies of drug interactions are limited, but disease-modifying therapies do not appear to decrease the effectiveness of hormonal contraception. The guidelines also note that if women with MS are taking medications that are potentially “teratogenic,” meaning they may cause harm to the fetus during pregnancy, long-acting methods of contraception (such as intrauterine devices or implants) might be the best option.
 
This team (Maria Houtchens, MD, from Harvard Medical School, and colleagues from the Centers for Disease Control and Prevention) reports on the guidelines in an open-access paper in the MS Journal (2017 May;23(6):757-764). 
 
Comment: This study and the guidelines provide further information to women with MS and healthcare professionals about the general safety of contraceptives, along with important considerations. Women are encouraged to discuss and concerns about pregnancy or contraception with their healthcare providers.
 
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About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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