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ClinicSpeak: contraceptive guidance


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How seriously have you considered your choice of contraceptive? #MSBlog #ClinicSpeak

Fertility, family planning, how to manage DMTs and relapses in pregnancy and breast feeding are all important issues for women with MS. 

The following review discusses the issue of contraception. The specific evidence-base on contraception in MS is quite thin on the ground. In summary, most contraceptive methods are safe for women with MS. However, use of combined hormonal contraceptives in women with prolonged immobility should be discouraged as it increases the risk of venous thrombosus; DVT and pulmonary embolism. DMTs do not decrease the effectiveness of hormonal contraception. For women with MS taking potentially teratogenic medications, i.e. drugs that cause foetal malformations, highly effective longer-acting methods are the best option. 

Not covered in this review is abortion, which is not a method of contraception but an option for women with an unplanned and unwanted pregnancy. To the best of my knowledge methods used for both medical and surgical abortion are safe in women with MS.


If you are a woman with MS the following is a list of questions you may want your HCP to answer: 
  1. Does MS affect my fertility? 
  2. Will pregnancy affect the course of my MS?
  3. Will I be able to breast feed after delivery?
  4. How long before I fall pregnant must I stop my DMT?
  5. If I fall pregnant on a DMT will this affect the baby?
  6. Can I breast feed on my DMT? 
  7. Will I be able to be a good parent if I become disabled from my MS?
  8. If I become disabled or unemployed as a result of MS will I be able to support my children?
  9. What is the risk of my children getting MS?
  10. Can I do anything to prevent them from getting MS?
  11. Am I more likely  to need an assisted delivery because I have MS?
  12. Will I be able to have a normal vaginal delivery?
  13. Will I be able to have an epidural during labour?
  14. What is the safest contraceptive for me? 
  15. Do contraceptives affect the way DMTs work?
Houtchens et al.  Contraception for women with multiple sclerosis: Guidance for healthcare providers. Mult Scler. 2017 Mar 1:1352458517701314. 

Family planning is essential for any comprehensive treatment plan for women of reproductive age with multiple sclerosis (MS), including counseling on using effective contraception to optimally time desired and prevent unintended pregnancies. This topical review summarizes the first evidence-based recommendations on contraception safety for women with MS. In 2016, evidence-based recommendations for contraceptive use by women with MS were included in US Medical Eligibility Criteria for Contraceptive Use. They were developed after review of published scientific evidence on contraception safety and consultation with experts. We summarize and expand on the main conclusions of the Centers for Disease Control and Prevention guidance. Most contraceptive methods appear based on current evidence to be safe for women with MS. The only restriction is use of combined hormonal contraceptives among women with MS with prolonged immobility because of concerns about possible venous thromboembolism. Disease-modifying therapies (DMTs) do not appear to decrease the effectiveness of hormonal contraception although formal drug-drug interaction studies are limited. Neurologists can help women with MS make contraceptive choices that factor their level of disability, immobility, and medication use. For women with MS taking potentially teratogenic medications, highly effective methods that are long-acting (e.g. intrauterine devices, implants) might be the best option.

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