Multiple sclerosis; a disease of reproductive-aged women and the dilemma involving contraceptive methods

Abstract

Multiple sclerosis (MS) is an autoimmune disorder characterized by chronic inflammation in the central nerves system and subsequent demyelination of nerves (1).The disease predominantly affects women of reproductive ages in the 3 rd and 4 th decades; 62% of these women use contraceptive methods (2, 3). There are recent conflicting studies about the effect of oral contraceptive (OC) use on MS and MS-like symptoms in the literature (4, 5). Therefore, it is important to understand the effects of hormonal contraceptives in MS patients. In addition, the medical treatments of MS such as through the use of interferons (IFNs), fingolimod, dimethyl fumarate, and, natalizumab may compromise the pregnancy in patients with this disease (6). The ongoing use of IFNs in women planning pregnancy may also be relatively contraindicated because of possible abortifacient properties (6). Therefore, the use of contraceptive methods to avoid unintended pregnancies will be extremely important in MS patients, particularly during the relapse phase of the disease or the time when the disease is not completely under control. Therefore, clinicians usually try to provide contraceptive counseling to these young MS patients for addressing the question regarding the most appropriate contraceptive method. Providing an appropriate contraception options to MS patients is one of the most challenging issues for clinicians to deal with. However, most contraceptives methods are hormonal methods, and recent studies have raised questions about their potential adverse effects on the disease. We start this review by discussing the use of hormonal contraceptives in MS patients. To understand the effect of hormonal contraceptives on MS, the effects of sex steroids on this disease are discussed initially. MS, sex steroids, hormonal contraceptive methodsAlthough the strong interaction between the pathogenesis of MS and the immune system and sex steroids is well known for a long time, the exact mechanism through which the disease develops is yet to be identified completely. Hormonal contraceptives are effectively used by many young women to prevent unintended pregnancies. Most women use this method, particularly in their middle reproductive years, in which MS is mostly detected. The well-recognized problem in the pathogenesis of MS is inflamMultiple sclerosis (MS) is an autoimmune disorder characterized by chronic inflammation in the central nerves system. Because the disease predominantly affects women of reproductive ages, having knowledge about contraception options for MS patients can make clinicians provide better counseling. Although most contraceptive methods are generally accepted as safe and effective in MS patients, recent studies have raised questions about their potential adverse effects on the disease. The use of contraceptive methods to avoid unintended pregnancies is crucial in MS patients, particularly during the relapse phase of the disease or the time when the disease is not completely under control. This review investigates the contraception...