The combined oral contraceptive pill improves MS outcome

Use of the oral contraceptive pill associated with a better outcomes. Why? #MSBlog #MSResearch

"The following small study suggest that use of the combined oral contraceptive pill (COC) affects the natural history of MS. This study is small and retrospective and therefore needs to be confirmed by others. It is important as it adds to the body of evidence that sex hormones play a role in MS, which is well established. Woman have a higher incidence of MS with a sex ratio to men of between 2:1 and 3:1; in some parts of the world this ratio is above 5:1. In most parts of the world this ratio is increasing. Why? If we could answer this question we may be able to explain the cause of MS. Interestingly, women reach disability milestones in MS at an older age than men. In contrast, males progress more rapidly and have a much worse outcome than women. Levels of sex steroid hormones are related to the frequency of relapses. During pregnancy the rel[ae rate goes down, particularly in the second and third trimesters. However, after the delivery there is a rebound in relapse rate. Just having children is associated with a favorable long-term effect on the course of MS; women with at least two pregnancies have reduced disability progression compared with women who do not have children. More recently a trial of estriol, a hormone produced by the placenta in pregnancy, was shown to reduce the relapse rate in women MSers. COCs are a source of sex hormones; could they be mimicking the pregnancy state and having a favourable effect on MS? Should we be recommending COCs to all women with MS? No, this evidence is weak and we need better trials; i.e. randomised controlled trials. What I can say is that if you are a woman with MS and you are still fertile and are on a DMT, you need to be on some form of contraception. If you have no contraindications to the COCs it would seem that this would be a good choice of contraception."

"Please don't forget about reverse causation; instead of COCs having a favourable effect on MS could more benign MSers be more likely to be taking COCs? For example, they may be less disabled, less depressed and have better quality of life and hence more likely to be sexually active and more likely to be not wanting to fall pregnant."

Epub: Gava et al. Long-term influence of combined oral contraceptive use on the clinical course of relapsing-remittingmultiple sclerosis. Fertil Steril. 2014 Apr 29.

OBJECTIVE: To assess the long-term effects of combined oral contraceptives (COCs) on the clinical course of relapsing-remitting multiple sclerosis (RRMS), focusing on disability progression and evolution to secondary-progressive multiple sclerosis (SPMS).

PATIENT(S): A total of 174 women with clinically confirmed MS; of these, 33 had evolved to SPMS at the time of enrollment in the study, whereas 141 still had a relapsing-remitting form of disease.

MAIN OUTCOME MEASURE(S): Expanded Disability Status Scale (EDSS); Multiple Sclerosis Severity Score (MSSS); annualized relapse rate; evolution to SPMS.

RESULT(S): Mean ± SD duration of disease was 14.3 ± 9.8 years. Compared with non-users of COCs, COC users had lower EDSS scores and MSSS only in the subset of the population with prior or current immunomodulatory treatment. Non-use of COCs was a predictor of disease evolution in SPMS, whether treated or not with immunomodulatory drugs. The annualized relapse rate was not influenced by COC use. No differences in EDSS scores and evolution to SPMS depending on COC formulation were detected.

CONCLUSION(S): Our results suggest that COC use is associated with a less severe disease and less severe evolution. Whether different doses or types of progestin may have different effects remains to be defined.