Multiple Sclerosis Experts Offer Guidelines on Contraceptive Use Among Women with MS

Two studies that recently appeared in the Multiple Sclerosis Journal shed light on how contraceptive use may affect women with MS, as well as how the disease might affect the safety and effectiveness of birth-control medications.

Relapsing MS patients treated with older drugs such as interferons and Copaxone (glatiramer acetate) have a lower risk of relapse if they previously used oral contraceptives, found one study, “Oral contraceptives and MS disease activity in a contemporary real-world cohort,” which used data from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Boston’s Brigham and Women’s Hospital.

Researchers recruited 162 women with relapsing disease, of which half were treated with interferons and half with Copaxone. They divided women into previous, current and never-users of oral contraceptives.

Data showed no increased risk of relapse in women using oral contraceptives. Those who had used contraceptives in the past had significantly lower relapse rates compared to women who never used birth-control pills; however, the team found that the lower annualized relapse rate in current users relative to never users was insignificant.

The National MS Society — which co-funded the study together with the National Institutes of Health — underscored that although researchers did not detect an increased risk, the study didn’t take factors such as age and certain health behaviors into account. These factors can potentially influence both contraceptive use and relapse rates.

According to a National MS Society press release, other studies are underway, which explore the effects of specific doses and types of contraceptives in combination with both injectable and oral disease-modifying drugs.

Meanwhile, guidelines for healthcare staff on how to handle contraception in MS, caution about the use of combined hormonal contraceptives — containing both estrogen and progestin — in women who have limited mobility, since these drugs increase the risk of blood clots.

The publication — “Contraception for women with multiple sclerosis: Guidance for healthcare providers,” made it clear that MS is now among the conditions for which specific contraception recommendations exist. Researchers at the Atlanta-based Centers for Disease Control and Prevention, which developed the guidelines, also said that despite the scarcity of studies on drug interactions, nothing indicates that disease-modifying treatments lower the effectiveness of hormonal contraception.

Besides describing the guidelines, the article outlined the evidence that led to the recommendations. Other than warning women with limited mobility about combination contraceptives, researchers underscored that long-acting contraceptive methods are the best choice for women taking drugs that may cause birth defects.

“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,” the National MS Society said. “Women are encouraged to discuss and concerns about pregnancy or contraception with their healthcare providers.”