June 25, 2024 | News | Living with MS MS Treatments

Q & A on contraception and MS: what the experts say

A group of experts in the U.S. and Europe met recently to discuss contraceptive use in women and men with multiple sclerosis (Hillert and colleagues. Mult Scler 2024, epublished March 8, 2024). Their recommendations were summarized as a series of questions and answers that we have adapted below.

Why discuss contraception? MS is often diagnosed during a person’s peak childbearing years. MS does not affect a person’s fertility, so many people will need to make decisions about when to start a family. There are two issues to keep in mind. Contraception will enable you to schedule the best time to become pregnant (according to how you define ‘best time’). Secondly, contraception is a requirement if you are taking an MS medication that can cause problems during pregnancy. In this scenario, you will need to develop a plan with your MS team to stop/switch medications before trying to get pregnant.

Do oral contraceptives have an impact on MS? Hormonal contraceptives (e.g. the birth control pill) do not have an impact on relapses, lesions in the brain and spinal cord, MS severity or long-term disability (Zapata and colleagues. Contraception 2016;94:612-620).

For which MS drugs is contraception advised? The expert panel stated that some disease-modifying therapies (e.g. Mavenclad, Aubagio, Gilenya, Zeposia) have known risks in pregnancy so contraception is strongly advised to avoid exposing the developing fetus to the drug. For some drugs (e.g. Tysabri, Ocrevus, Kesimpta, Tecfidera, Lemtrada), the risks in pregnancy are not well known so contraception is advised with these drugs too. In contrast, Copaxone and the interferons (e.g. Rebif, Avonex, Plegridy) can be taken right up until conception.

What should I consider when choosing the best contraception? The best method of contraception will depend on your preferences and circumstances. But there are some issues you may want to consider.

Long-acting reversible contraceptives (e.g. IUD, hormonal implants) may be advised for women taking a drug associated with pregnancy risk (e.g. Aubagio, Mavenclad, Gilenya); these methods reassure that you will not become pregnant until the device is removed. An IUD may also be the best option for women who cannot take hormonal contraceptives.
Combined hormonal contraceptives (which combine estrogen + progestin, e.g. birth control pill or patch and the vaginal ring) may not be ideal in women with a risk of blood clots, such as women with a history of cardiovascular disease or impaired mobility.
Depot Provera (medroxyprogesterone acetate [MPA] injected into the muscle every three months) is not advised for women with a history of heart disease or clotting disorders. Women with impaired mobility, who are at risk of clotting or low bone density, should also avoid this drug.
Some MS symptoms may influence your choice. Swallowing difficulties may make it hard to take an oral contraceptive. Arm spasticity or impairments in fine-motor function may make it difficult to insert a diaphragm or vaginal ring.

Can women with MS use emergency contraception? Yes, although there is limited information on this topic. The most common emergency contraceptives are the copper IUD and the emergency contraceptive pills (e.g. ulipristal acetate, levonorgestrel, or combined ethinyl estradiol + levonorgestrel).

Are there contraception issues that men need to consider? There is some evidence to suggest that some MS medications (e.g. Aubagio, Mavenclad) may be associated with fetal toxicity resulting from the male. Men with MS who are taking these medications are advised to use a condom regardless of the woman’s method of contraception. These medications will need to be stopped (with guidance from your doctor) before you and your partner try to become pregnant.

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