From the Research
Contraception is generally safe and recommended for patients with multiple sclerosis (MS), with most contraceptive methods, including hormonal options, being suitable for use without worsening the condition. The choice of contraception should be individualized based on the patient's MS symptoms, disability level, medication regimen, and personal preferences 1.
Key Considerations
- Most contraceptive methods, including hormonal options like combined oral contraceptives, progestin-only pills, patches, vaginal rings, injections, implants, and intrauterine devices (IUDs), can be used by MS patients without worsening their condition.
- For those with mobility limitations or increased risk of blood clots, progestin-only methods or IUDs may be preferable to estrogen-containing options.
- Barrier methods like condoms are also safe alternatives.
- MS medications generally don't reduce contraceptive effectiveness, though some disease-modifying therapies (such as teriflunomide) are teratogenic and require reliable contraception during treatment.
- Women with MS who are planning pregnancy should consult with both their neurologist and obstetrician to coordinate care, potentially adjust medications, and develop a comprehensive reproductive health plan.
Recent Evidence
A recent review of clinical data on hormonal therapies in MS found that exogenous hormones, used in varied doses and for diverse indications, have variable effects on MS risk, inflammatory activity, and neuroprotection 2. However, the most recent and highest quality study suggests that hormonal contraceptives containing estrogen may have a mild protective effect against MS relapses in some patients.
Guidance for Healthcare Providers
Healthcare providers should consider the following when counseling women with MS on contraception:
- The patient's level of disability and immobility
- The patient's medication regimen, including disease-modifying therapies
- The patient's personal preferences and values
- The potential risks and benefits of each contraceptive method By taking a comprehensive and individualized approach to contraception counseling, healthcare providers can help women with MS make informed decisions about their reproductive health and reduce the risk of unintended pregnancy and related complications 1.