Age at onset of multiple sclerosis is correlated to use of combined oral contraceptives and childbirth before diagnosis

Holmqvist, Per; Hammar, Mats; Landtblom, Anne‐Marie; Brynhildsen, Jan

doi:10.1016/j.fertnstert.2010.06.045

Cited by 73 publications

(74 citation statements)

References 31 publications

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“…Therefore, our results suggest that women who use OC after the first symptoms of the disease have a milder disease course in comparison to those who never used OC or stopped its intake before DO. As previously suggested, we found that OC use and having children before DO [6,7] as well as OC intake duration [7] might be associated with a delayed age at DO. Nevertheless, the protective effect on disability accumulation observed when OC use was maintained after the appearance of the first symptoms of the disease was independent of age, age at DO, OC intake duration and other studied potential confounders, including smoking habits and parity.…”

Section: Discussionsupporting

confidence: 81%

“…The effect of OC use on age at DO was assessed using multiple linear regression, adjusting for potential confounders, and the effect of OC duration on age at DO was evaluated using the non-parametric test for trend, after OC duration was categorized into 1 to 3 years, 4 to 5, 6 to 10, and more than 10 years of OC duration [7]. Vitamin D levels were compared between groups by analysis of variance (ANOVA).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, OC use may provide an opportunity to assess the influence of these hormones on the risk and clinical course of MS. Some studies have suggested a delay in the age of disease onset (DO) associated with OC use [6,7]. Nevertheless, despite its practical interest for MS women who decide to take this preventive method of conception, only few inconclusive studies have addressed the impact of its use on the prognosis of the disease [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Oral contraceptive use and clinical outcomes in patients with multiple sclerosis

Sena¹,

Couderc²,

Vasconcelos³

et al. 2012

Journal of the Neurological Sciences

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Experimental and clinical data suggest a role of sex steroids in the pathogenesis of multiple sclerosis (MS). Scant information is available about the potential effect of oral contraceptive (OC) use on the prognosis of the disease. We aimed to evaluate this. The study population consisted of 132 women with relapsing-remitting MS before receiving disease modifying treatment and a mean disease duration 6.2 (SD 5.1) years. Three groups of patients were distinguished according to their OC behavior: [1] never-users, patients who never used OC [2] past-users, patients who stopped OC use before disease onset, and [3] after-users, those who used these drugs after disease onset. Multiple linear and logistic regression models were used to analyze the association between oral contraceptive use and annualized relapse rates, disability accumulation and severity of the disease. After-user patients had lower Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Severity Score (MSSS) values than never users (p b 0.001 and p = 0.002, respectively) and past users (p = 0.010 and p = 0.002, respectively). These patients were also more likely to have a benign disease course (MSSS b 2.5) than never and past users together (OR: 4.52, 95%CI: 2.13-9.56, p b 0.001). This effect remained significant after adjustment for confounders, including smoking and childbirths (OR: 2.97, 95%CI: 1.24, 6.54, p = 0.011 and for MSSS β: − 1.04; 95% C.I. − 1.78, − 0.30, p = 0.006). These results suggest that OC use in women with relapsing-remitting MS is possible associated with a milder disabling disease course.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oral contraceptive use and clinical outcomes in patients with multiple sclerosis

Sena¹,

Couderc²,

Vasconcelos³

et al. 2012

Journal of the Neurological Sciences

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“…Overall, estrogens have been implicated in both shifts in immunomodulation in MS as well as purported neuroprotective effects. 19 Oral contraceptives, in observational studies, have been reported to have protective, [20][21][22] neutral, 23,24 and negative effects on MS risk and course [25][26][27] ; of note, the composition (estrogen and/or progestogen) and dosing may have varied according to the relevant study epochs, with potentially differing effects on risk. In addition, treatment with estriol (an estrogen markedly elevated during pregnancy, and that at lower doses has been used as HT in Europe and Asia 28 ) for 24 months was recently reported to have beneficial effects on relapses and patientreported fatigue.…”

mentioning

confidence: 99%

Hormone therapy use and physical quality of life in postmenopausal women with multiple sclerosis

et al. 2016

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Objective: To determine the association between hormone therapy (HT) and physical quality of life (QOL) in postmenopausal women with multiple sclerosis (MS). Methods:We included female participants from the prospective Nurses' Health Study, with a diagnosis of definite or probable MS, who had completed a physical functioning assessment (PF10; subscale of the 36-Item Short-Form Health Survey QOL survey) at a time point between 3 and 10 years after their final menstrual period (early postmenopause). We assessed the association between HT use at this time point (never vs at least 12 months of systemic estrogen with/without progestin) and both PF10 and the 36-Item Short-Form Health Survey Physical Component Scale. We used a linear regression model adjusting for age, MS duration, menopause type and duration, and further for additional covariates (only ancestry was significant).Results: Among 95 participants meeting all inclusion criteria at their first postmenopausal assessment, 61 reported HT use and 34 reported none. HT users differed from non-HT users in MS duration (p 5 0.02) and menopause type (p 5 0.01) but no other clinical or demographic characteristics. HT users had average PF10 scores that were 23 points higher than non-HT users (adjusted p 5 0.004) and average Physical Component Scale scores that were 9.1 points higher in the 59 women with these available (adjusted p 5 0.02). Longer duration of HT use was also associated with higher PF10 scores (p 5 0.02, adjusted p 5 0.06). Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease in which onset and course may be modified by hormonal exposures. Conclusions:1 In MS, there is an age-related increase in disability and conversion to progressive course observed at approximately age 45 years, while the incidence of new inflammatory symptoms or lesions diminishes.2 Little is known about the effect of hormonal changes occurring at menopause on MS course and whether hormone therapy (HT) modulates these changes. 3,4 In healthy women, a decline in cognition has been observed after menopause, especially with the abrupt decline in hormones occurring when menopause is induced surgically, 5,6 and HT, when initiated within a 5-year perimenopausal "window of opportunity," has been reported to protect against cognitive decline.5-7 Investigating possible protective effects of HT on MS-related functional decline would have important clinical implications for women who develop MS before menopause, comprising the majority of MS cases.

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“…In MS, contradictory findings have been reported regarding hormonal treatment and pregnancies and their relation to MS risk and disease modulation. Several epidemiological studies concluded that oral contraceptive (OC) use and parity were not associated with the risk of MS [342][343][344][345] , with some studies suggesting an associated delay in the age of disease onset [345][346][347] . In a recent RCT, female MS patients receiving high dose estrogens as add-on therapy to interferon-beta had significantly less new lesions (total), and less new active lesions, compared to patients who received only interferon-beta [348] .…”

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confidence: 99%

Mapping the effects of vitamin D in multiple sclerosis

Rolf¹

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Columbus (1451Columbus ( -1506 on one of his four voyages Er zijn verrassend veel parallellen te trekken tussen onderzoek doen en een van mijn favoriete vrijetijdsbestedingen, namelijk koken. Alles begint met een inspiratie, nieuwsgierigheid en een idee. Dan volgt de planning en de uitvoering en na (lang…) wachten kun je het resultaat proeven. Het blijft altijd spannend of het gelukt is en of het wel lekker is. Als het lekker is, dan smaakt het vaak ook naar meer! Zo niet, dan moet je het recept aanpassen, of crucialer, iets heel anders verzinnen...De weg naar een goed gelukt gerecht is, althans voor mij, minstens zo belangrijk: watertandend recepten zoeken en menu's samenstellen, op zoek gaan naar de juiste producten, lekker creatief combineren en (al of niet met succes) uitproberen. Dat kon ook in de voor mij nieuwe keuken van de wetenschap, en wel in een restaurant met een excellente ambiance. Verder is de diversiteit aan smaken, waar ik bij eten zo van houd, zeker ook terug te vinden in de verschillende hoofdstukken.Of kookkunsten gewaardeerd worden is vervolgens een kwestie van smaak, maar ook van kennis. De fijnproevers zullen zich op de details storten en boeren die het niet kennen zullen het niet eten, maar voor iedereen die aan tafel schuift: hopelijk is datgene wat in dit boekje geserveerd wordt smakelijk en levert het gespreksstof op voor het natafelen! Abbreviations and glossary & G L O S S A R Y AB BR EVI ATI ONS 23General IntroductionHistorical explorers discovered new land around the world, and with every journey more details have been added to global maps. For multiple sclerosis research, explorers of the 20 th century put vitamin D on the map, and from 2008 onwards, our research team in Maastricht has tried to add more details to this area. Today, vitamin D in multiple sclerosis is still an active area of research. Many reviews concentrate on the role of vitamin D in multiple sclerosis, illustrated by clinical and immunological studies. Also in this thesis two reviews elaborate on this topic. Therefore, the introduction to this thesis is restricted to the essential players, i.e. multiple sclerosis, its immune pathogenesis, and vitamin D, followed by the outline of the thesis.Multiple sclerosis (MS) is the most common disabling neurological disease among young people. Initial symptoms generally occur in the age of 20-40 years and MS affects women 2-3 times more often compared to men [1][2] . Currently, almost 1 in 1000 people suffers from MS in the Netherlands [3] . MS is characterized by inflammation and neurodegeneration of the central nervous system (CNS; brain and spinal cord). Though, it is still a matter of debate whether it is neurodegenerative or inflammatory from onset [1,4] . Most accepted, however, is the thought that inflammatory processes lead to damage of the fatty myelin sheaths covering the neuronal axons, which normally support fast transduction of signals, and this process is called demyelination. The inflammation can be accompanied by axonal injury and over time this result...

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Age at onset of multiple sclerosis is correlated to use of combined oral contraceptives and childbirth before diagnosis

Cited by 73 publications

References 31 publications

Oral contraceptive use and clinical outcomes in patients with multiple sclerosis

Oral contraceptive use and clinical outcomes in patients with multiple sclerosis

Hormone therapy use and physical quality of life in postmenopausal women with multiple sclerosis

Mapping the effects of vitamin D in multiple sclerosis

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