Oral contraceptive use and clinical outcomes in patients with multiple sclerosis

Abstract

Experimental and clinical data suggest a role of sex steroids in the pathogenesis of multiple sclerosis (MS). Scant information is available about the potential effect of oral contraceptive (OC) use on the prognosis of the disease. We aimed to evaluate this. The study population consisted of 132 women with relapsing-remitting MS before receiving disease modifying treatment and a mean disease duration 6.2 (SD 5.1) years. Three groups of patients were distinguished according to their OC behavior: [1] never-users, patients who never used OC [2] past-users, patients who stopped OC use before disease onset, and [3] after-users, those who used these drugs after disease onset. Multiple linear and logistic regression models were used to analyze the association between oral contraceptive use and annualized relapse rates, disability accumulation and severity of the disease. After-user patients had lower Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Severity Score (MSSS) values than never users (p b 0.001 and p = 0.002, respectively) and past users (p = 0.010 and p = 0.002, respectively). These patients were also more likely to have a benign disease course (MSSS b 2.5) than never and past users together (OR: 4.52, 95%CI: 2.13-9.56, p b 0.001). This effect remained significant after adjustment for confounders, including smoking and childbirths (OR: 2.97, 95%CI: 1.24, 6.54, p = 0.011 and for MSSS β: − 1.04; 95% C.I. − 1.78, − 0.30, p = 0.006). These results suggest that OC use in women with relapsing-remitting MS is possible associated with a milder disabling disease course.

Female Gender and Reproductive Factors Affecting Risk, Relapses and Progression in Multiple Sclerosis

“…The strength of evidence was based upon criteria used in a systematic review of prognostic factors of whiplash-associated disorders (table 2B) [45]. An overview of the most important findings is given in table 3[46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. …”

Multiple Sclerosis in relation to sex steroid exposure

“…The odds ratio for MS was 0.6 (95% confidence interval 0.4-1.0) in oral contraceptive users compared with non-users during the previous 3 years Sena 2012 (62) Cross-sectional 132 More benign disease course among women who had used oral contraceptives after onset of MS in comparison to women who had not.…”

Hormone therapy use and physical quality of life in postmenopausal women with multiple sclerosis

“…Overall, estrogens have been implicated in both shifts in immunomodulation in MS as well as purported neuroprotective effects. 19 Oral contraceptives, in observational studies, have been reported to have protective, [20][21][22] neutral, 23,24 and negative effects on MS risk and course [25][26][27] ; of note, the composition (estrogen and/or progestogen) and dosing may have varied according to the relevant study epochs, with potentially differing effects on risk. In addition, treatment with estriol (an estrogen markedly elevated during pregnancy, and that at lower doses has been used as HT in Europe and Asia 28 ) for 24 months was recently reported to have beneficial effects on relapses and patientreported fatigue.…”