Contraception for women with multiple sclerosis: Guidance for healthcare providers

Abstract

Family planning is essential for any comprehensive treatment plan for women of reproductive age with multiple sclerosis (MS), including counseling on using effective contraception to optimally time desired and prevent unintended pregnancies. This topical review summarizes the first evidence-based recommendations on contraception safety for women with MS. In 2016, evidence-based recommendations for contraceptive use by women with MS were included in US Medical Eligibility Criteria for Contraceptive Use. They were developed after review of published scientific evidence on contraception safety and consultation with experts. We summarize and expand on the main conclusions of the Centers for Disease Control and Prevention guidance. Most contraceptive methods appear based on current evidence to be safe for women with MS. The only restriction is use of combined hormonal contraceptives among women with MS with prolonged immobility because of concerns about possible venous thromboembolism. Disease-modifying therapies (DMTs) do not appear to decrease the effectiveness of hormonal contraception although formal drug–drug interaction studies are limited. Neurologists can help women with MS make contraceptive choices that factor their level of disability, immobility, and medication use. For women with MS taking potentially teratogenic medications, highly effective methods that are long-acting (e.g. intrauterine devices, implants) might be the best option.

Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study

“…The common use of analgesics against pain caused by MS or comorbidities was plausible too [15]. Furthermore, MS is associated with a higher osteoporosis risk [50] and female MS patients should be advised to use contraception during DMD treatment [51]. Thus, osteoporosis drugs and contraceptives are frequently used.…”

Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use

“…One strategy is to expand on previous successful activities, such as joint publications with partners in specialty journals (e.g., contraception recommendations for women with multiple sclerosis). 31 Exploring new partnerships and innovative dissemination activities, such as reaching students in clinical training programs with digital tools, assessing needs of health care providers serving underserved populations, and developing new training opportunities will allow us to expand the reach of the guidelines. 31 A significantly higher proportion of Title X clinic providers than officebased physicians reported on-site availability of all contraceptive methods except the levonorgestrel-releasing IUD.…”

Recommendations for neurological, obstetrical and gynaecological care in women with multiple sclerosis: a statement by a working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society

“…The use of intramuscular sustained-release DMPA is classified in Category 2, and the combined contraceptive pill, contraceptive vaginal rings and patches in Category 3, which means that their use is associated with a risk of complications. However, they are not absolutely contraindicated [70,71].…”