November 9, 2017 | News | Living with MSMS Research

Hormonal changes affect MS activity – ECTRIMS 2017

Highlights from the 7th Joint ECTRIMS-ACTRIMS MEETING, OCTOBER 25-28, Paris, France

It’s been well established that women with multiple sclerosis have fewer relapses during pregnancy, but at risk of relapses in the 3-6 months after childbirth (Vukusic and colleagues. Brain 2004;127[Pt 6]:1353-1360). A developing fetus is “foreign” tissue, from an immune point-of-view, so the immune response shifts to a less reactive profile during pregnancy, enabling the fetus to grow and develop. This less reactive profile translates to fewer MS relapses during pregnancy, but there can be a rebound effect as the woman’s immune system returns to normal after the baby is born.

An Italian study has looked at what happens if there is a miscarriage (Landi and colleagues. ECTRIMS 2017; abstract P326). The researchers used data from 88 miscarriages in 69 women over a 33-year period. The rate of relapses was unchanged before and after a miscarriage. However, there were more flare-ups in the brain, as shown by inflammatory lesions visible on MRI, after miscarriage, indicating that there was a reactivation of MS after a miscarriage/ This would appear to be because after a miscarriage, the body was returning to its usual immune profile, and had lost the protection provided by pregnancy.

A curiosity of the ECTRIMS meeting was that the printed abstract of the above research differed from what was presented. What was shown was a report on the effects of abortion on MS. The study looked at 139 spontaneous or elective abortions in 114 women for the period 1995-2017. The relapse rate tended to go up after abortion, and there was a significant increase in inflammatory activity seen on MRI. When there was a relapse, it occurred about 63 days after the abortion. The relapse risk was higher if the duration of pregnancy was shorter, which can be interpreted in two ways:  with a shorter pregnancy, there was less time for the immune system to shift to a less inflammatory profile; and greater inflammatory disease activity at the start of pregnancy may have contributed to a spontaneous abortion (most abortions in this series were spontaneous rather than medically induced). Both of these studies suggest that after a miscarriage or abortion, it may be advisable to re-start an MS medication as soon as possible to prevent an inflammatory flare-up.

MS is generally not believed to have a significant impact on a woman’s fertility, although women with MS are less likely to undergo treatment for infertility (Houtchens and colleagues. ECTRIMS 2017; abstract P356). Infertility treatments, such as in vitro fertilization (IVF), include hormonal therapies, which can affect MS disease activity. A study five years ago found that women with MS undergoing assisted reproduction had 7-fold risk of a relapse if treatment didn’t result in a pregnancy (Correale and colleagues. Ann Neurol 2012;72:682-694). The same researchers have revisited this issue using pooled results from several centres (Bove and colleagues. ECTRIMS 2017; abstract P352). They again found that relapse rates are higher in the three months after infertility treatment, and there was a trend to a higher relapse risk for up to a year after the procedure. Some infertility drugs are more likely to be associated with relapses, so this needs to be discussed with the gynecologist before undergoing infertility treatment.

Share this article
pin it!

Related Posts