Multiple sclerosis has no direct effect on fertility, which means that a person with MS has as good a chance of conceiving with their partner as a person without MS. However, the contraception you choose may be influenced by your MS symptoms and any other treatments you are taking.
Many people diagnosed with MS are in the process of planning or building their families. Some of the Disease Modifying Drugs used for treating MS are toxic to the growing baby in the womb and must not be taken during pregnancy. The contraceptive methods that involve withdrawal or attempting to time ovulation are not considered to be as effective as those listed below. Given the risks associated with unplanned pregnancy, it is worth finding the right contraceptive solution for you and your partner.
Good manual dexterity is needed for the use of barrier contraceptives like the male and female condom. You might also find them difficult to use if you have stiffness or spasticity in the legs or hands. Otherwise, barrier methods are suitable for use if you have MS.
Hormonal contraceptives use versions of natural hormones to prevent pregnancy. They can be taken orally as tablets ('the Pill'), given as injections or provided through objects implanted in or worn on the body.
Oral contraceptives (tablets) usually need to be taken every day throughout the whole or most of the month. Some oral contraceptives can increase the risk of blood clots occurring in the veins of the legs. If you have limited mobility, then this risk would be increased further, and your doctor may advise extra monitoring.
Some drugs used in the treatment of MS symptoms, including antibiotics, modafinil, phenytoin and carbamazepine, may interact with hormonal contraceptives and reduce their effectiveness at preventing pregnancy.
Hormonal contraception can also be provided through long acting reversible contraception methods (LARCS). These include intrauterine devices (IUDs) and implants. LARCS provide pregnancy protection for 3 - 10 years, but can be removed at any time if you choose to become pregnant. They are inserted by a medical professional, and so you don't have to remember to take them yourself.
There is some evidence that antibiotics, anti-inflammatories or immnosuppresive drugs may reduce the effectiveness of IUDs.
Progestin-only contraceptive injections are associated with a slight increase in bone loss and osteoporosis risk. If you have limited mobility or your bone health is compromised by other drugs you are taking, you may wish to consider this carefully.
A number of studies have looked at whether using oral contraceptives makes existing MS more severe or progress more quickly. The studies looked at whether relapses were more likely, whether the experience of disability got worse, and also at the rates at which new brain lesions appeared.
The research so far suggests that women using oral contraceptives experience milder MS symptoms and have a slower progression of the disease. This seems consistent for those with relapsing remitting MS (RRMS). For primary progressive MS (PPMS), the picture is not so clear. Some research suggests that oral contraceptives may make PPMS symptoms more severe.
