Wednesday, 9 March 2016

MS Risks of the Pill

Hellwig K, Chen LH, Stancyzk FZ, Langer-Gould AM. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility. PLoS One. 2016; 11(3):e0149094.

OBJECTIVE:To determine whether the use of combined oral contraceptives (COCs) are associated with MS risk and whether this varies by progestin content.
METHODS:We conducted a study of females ages 14-48 years with incident MS or clinically isolated syndrome (CIS) 2008-2011 from the membership of Kaiser Permanente Southern California. Controls were matched on age, race/ethnicity and membership characteristics. COC use up to ten years prior to symptom onset was obtained from the complete electronic health record.
RESULTS: We identified 400 women with incident MS/CIS and 3904 matched controls. Forty- percent of cases and 32% of controls had used COCs prior to symptom onset. The use of COCs was associated with a slightly increased risk of MS/CIS (adjusted OR = 1.52, 95%CI = 1.21-1.91; p<0.001). This risk did not vary by duration of COC use. The association varied by progestin content being more pronounced for levenorgestrol (adjusted OR = 1.75, 95%CI = 1.29-2.37; p<0.001) than norethindrone (adjusted OR = 1.57, 95%CI = 1.16-2.12; p = 0.003) and absent for the newest progestin, drospirenone (p = 0.95).
CONCLUSIONS: Our findings should be interpreted cautiously. While the use of some combination oral contraceptives may contribute to the rising incidence of MS in women, an unmeasured confounder associated with the modern woman's lifestyle is a more likely explanation for this weak association.
It is not my position to provide medical advice and certainly not contraceptive advice, but this study may suggest there are small increased risks of MS associated with some contraceptive pills, but it is clear that sex hormones have an influence on the susceptibility to autoimmunity

9 comments:

  1. I was on the pill before I got MS. Firstly mircogynon combined bill. Unfortunately I became depressed on this pill. Some time later I began another combined pill cilest which has a slightly higher quantity of oestrogen and I was ok on it. Other people have said some contraceptive pills can bring on a psychological change.

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  2. Progestin has been known to lower levels of serotonin making depression worse in women. I do wonder what else it is doing to the body. I will be interested to know the results of fluoxetine in the MS SMART trial.

    Does the mini pill (progestin only pill) make MS symptoms worse compared to the combined pill?

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  3. Who is meant to provide women with MS with contraceptive advice? Our GPs know very little about MS, our neurologists do not consider contraception to be their business. I read a very scary paper suggesting the IUS increases the chance of getting MS and may worsen outcomes for women with MS. I wish I had known this when I started to use the IUS (more than 10 years ago). Here's a link to the paper http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358313/

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    1. Re Who is meant to provide women with MS with contraceptive advice?

      Good question, start off with asking an experienced MS specialist nurse maybe? If not much joy then MS specialist neurologist?
      Team G any ideas? thanks

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    2. Do we really expect MS specialist nurses to be up with the latest research on hormone effects on MS? I there's more chance of neurologists knowing about this ... but only a small chance with them.

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  4. Taking the pill = need for control, career ambitions = slightly higher long term stress levels overall in pill taking population = impacts on immune system = possible higher MS risk? Yes, I think the authors are right to advise caution in interpretting this weak association. Then again, it probably makes me think twice about the pill.

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  5. This issue still remains through the "dark" to me. MD there is some research looking progestins as gestodene and etonogestrel?


    I used for 4 years, a gestodene contraceptive with ethinylestradiol when the outbreak that made me discover MS ...

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  6. I took Diane 35 for about a month when I was 22 and right after I started getting what I now know to be my first MS symptom. It's been going downhill every since helped in its progression by stress, hep B vaccination and infections.

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