Multiple sclerosis has no direct effect on fertility, which means that anyone with MS has as good a chance of conceiving with their partner as they would have had if they did not have MS. Choice of contraception may however be influenced by an individuals MS symptoms and treatments.
Good manual dexterity is needed for the use of barrier contraceptives. There is some evidence that antibiotic or immunosuppressive drugs may reduce the effectiveness of intrauterine devices (IUDs).
Some drugs used in the treatment of MS symptoms, including antibiotics, modafinil, phenytoin and carbamazepine, may reduce the effect of oral contraceptives. People with limited mobility may need extra monitoring as the risk of blood clots occurring in the veins in the legs may be increased.
Oral contraceptives, the risk of development MS and impact on progression
Multiple sclerosis is more frequent in women than men. Research from 2005 compared the medical records of 106 women with MS with those of 1,001 women who had not developed MS. They found that women who had used oral contraceptives in the previous three years were 40% less likely to develop MS than those who had not. They also found that the risk of developing MS increased in the six months following pregnancy, but was not otherwise related to bearing children.
The researchers concluded that the hormonal changes that occur whilst using oral contraceptives, and in pregnancy, may reduce the risk of MS in the short-term, and that the period immediately following childbirth may be associated with a short-term increase in the risk of developing MS.
The authors drew attention to other factors that may have influenced the results, such as a pregnancy during the follow-up period, or whether those using the pill were 'healthy' individuals (eg not smokers or overweight), but feel that the study demonstrates the need for more research into the link between hormones and MS.
In a subsequent review comparing results from several studies, the same researchers concluded that oral contraceptives did not affect the risk of developing MS but could delay the onset of multiple sclerosis.
Research presented at the ACTRIMS/ECTRIMS conference in 2014 found the reverse effect. Records from 2008 to 2011 for 4,300 women in California showed that those who had used oral contraceptives containing norethindrone or levonorgestrel had a 57% higher risk of being diagnosed with multiple sclerosis or clinically isolated syndrome (CIS).
There remains scant information on the impact of oral contraceptive use on the prognosis of MS. Recent studies suggest that oral contraceptive use in women with relapsing remitting MS (RRMS) is possibly associated with a milder disabling disease course, whilst in progressive onset MS a more rapid progression occurred when women reported the use of oral contraceptives.
- Archives of Neurology 2005;62(9):1362-1365. Summary Recent use of oral contraceptives and the risk of multiple sclerosis.
- Journal of Neurological Sciences 2009;286(1-2):73-75. Summary Oral contraceptives and the risk of multiple sclerosis: a review of the epidemiologic evidence.
- Journal of Neurological Sciences 2012;317(1-2):47-51. Summary Oral contraceptive use and clinical outcomes in patients with multiple sclerosis.
- Journal of Neurology 2012;259(5):855-861. Summary Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis.
Last reviewed: September 2014
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