The oral contraceptive and MS

We have the swinging 60s to thank for lots of things: Mary Quant, Twiggy, The Beatles…oh, and the oral contraceptive Pill, which revolutionized the sex lives of women (and men) everywhere. Today, the Pill continues to be a popular method of birth control and is taken by more than 100 million women worldwide1.

If you’re one of them, you may have noticed news reports2  that have linked taking the Pill to an increased risk of developing Multiple Sclerosis (MS). However, there is also evidence that the Pill (and pregnancy for that matter) actually decrease the risk of MS and may delay its onset3, 4, 5  for those with the condition. So, let’s take a look at the information behind these headlines.

MS and Hormones

No one knows the exact cause of MS, but it is likely that a mixture of genetic and environmental factors play a role6. Hormones may be one of these7, as the incidence of MS is twice as high in women as it is men8. It could be, for example, that sex hormones could affect the immune system in some way. This is one of the reasons that researchers have investigated the link between MS and taking the Pill in a number of studies9.

Theory One: Birth Control Pills Could Increase MS Risk

In one study10, 11, researchers compared the health records of more than 3,000 women who had attended the Kaiser Permanente medical center in Southern California, USA. The records showed that 29% of women with MS had taken the Pill for at least 3 months in the 3 years preceding onset of symptoms, compared with 23% of women without MS.

After analyzing this data, the researchers concluded that women who had taken the Pill for at least 3 months in the 3 years preceding onset of symptoms had a slightly increased risk of developing MS. According to Dr. Kirstin Hellwig, who led the study, “These findings suggest that using hormonal contraceptives may be contributing at least in part to the rise in the rate of MS among women12 .” However, it is important to remember that the study took into consideration only some variables like smoking and birth rates; it did not look at other factors associated with the lifestyle of modern women, such as diet, activity levels, or how long they spent outside.

Theory Two: Birth Control Pills Could Decrease MS Risk

Before you race off to flush your prescription down the toilet, it’s worth noting that there have been a number of studies that either found no link between taking the Pill and risk of MS, or that showed a reduction in risk or delayed onset of the disease.

One recent study by Italian researchers13, for example, found that women with relapsing–remitting MS (RRMS) who took the Pill had lower levels of disability and were less likely to progress to secondary progressive MS than those who had never taken the Pill. Another study published in the Archives of Neurology found women who took the Pill had a small decrease in risk of developing MS than those who didn’t. A review of evidence published last year in the journal Multiple Sclerosis concluded that even after pregnancy there is a potential benefit to taking the Pill for women when it comes to risk of MS, and states, “There is no evidence that oral contraceptive Pill use predisposes to MS, nor influences the clinical course of MS.” And another suggested that the use of the Pill in women with relapsing–remitting MS is potentially associated with a milder disabling disease course of MS14.

So What Does This All Mean For You?

Given the lack of a clear picture on this subject, you certainly shouldn’t make any rash decisions without consulting your healthcare professional. As Dr. Hellwig herself points out, “The use of birth control might explain a little bit of the increasing incidence [of MS] among women, but only [by] a small amount… [We] don’t intend to mean that young women should avoid birth control to avoid MS15.”

MS is a complex disease, and while the role of sex hormones in MS is an interesting field, the only thing that’s clear right now is that we still need further research before we can draw any firm conclusions about a possible link between MS and taking the Pill. That’s why it’s really important to consult your doctor for advice on the need or use of contraceptives if you have MS. You may even be required to take effective contraceptive measures dependent on your treatment. Regardless of the headlines, it’s a case of finding the right method of birth control to suit you.

References:

  1. Website “University of Illinois McKinley Health Center”: Health Information Handouts – The Pill. Available at: http://www.mckinley.illinois.edu/handouts/pill_the.html
  2. Daily Mail article, “Multiple Sclerosis linked to contraceptive pill”. Available at: http://www.dailymail.co.uk/health/article-2569855/Multiple-sclerosis-linked-contraceptive-pill-Risk-50-higher-women-taken-it.html
  3. Age at onset of multiple sclerosis is correlated to use of combined oral contraceptives and childbirth before diagnosis. Holmqvist P, Hammar M, Landtblom AM, et al. Dec;94(7):2835-7. doi: 10.1016/j.fertnstert.2010.06.045. Available at: http://www.ncbi.nlm.nih.gov/pubmed/?term=20807659
  4. Oral contraceptives and the risk of multiple sclerosis: a review of the epidemiologic evidence. Alonso A, Clark CJ. J Neurol Sci. 2009 Nov 15;286(1-2):73-5. doi: 10.1016/j.jns.2009.04.038. Available at: http://www.ncbi.nlm.nih.gov/pubmed/?term=19427649
  5. Recent use of oral contraceptives and the risk of multiple sclerosis. Alonso A, Jick SS, Olek MJ, Ascherio A, Jick H, Hernán MA. Arch Neurol. 2005 Sep;62(9):1362-5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16157743
  6. Website “Multiple Sclerosis Society”: Causes of MS. Available at: http://www.mssociety.org.uk/what-is-ms/information-about-ms/causes
  7. Hormonal influences in multiple sclerosis. Shuster EA. Curr Top Microbiol Immunol. 2008;318:267-311. Available at:  http://www.ncbi.nlm.nih.gov/pubmed/?term=18219822
  8. Website “National Multiple Sclerosis Society”: Who gets MS? (Epidemiology). Last accessed: 12.01.15. Available at:  http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS
  9. Female reproductive issues in multiple sclerosis. McCombe PA, Greer JM. Mult Scler. 2013 Apr;19(4):392-402. doi: 10.1177/1352458512452331.
  10. American Academy of Neurology (AAN) 66th Annual Meeting, Philadelphia, April 26 to May 3, 2014. Abstract 1644. Study not yet publicly released.
  11. Website “Medscape Medical News”: Conference News - MS Linked With Use of Hormonal Contraceptives. Published: 06.03.14. Available at: http://www.medscape.com/viewarticle/821579
  12. Website “Medical News Today”: Obesity and birth control pills may increase risk of multiple sclerosis. Published 28.02.14. Available at: http://www.medicalnewstoday.com/articles/273248.php
  13. Long-term influence of combined oral contraceptive use on the clinical course of relapsing-remitting multiple sclerosis. Gava G, Bartolomei I, Costantino A, Berra M, Venturoli S, et al. 2014 Jul;102(1):116-22. doi: 10.1016/j.fertnstert.2014.03.054. Available at: http://www.ncbi.nlm.nih.gov/pubmed/?term=24794311
  14. Oral contraceptive use and clinical outcomes in patients with multiple sclerosis. Sena A, Couderc R, Vasconcelos JC, Ferret-Sena V, et al. J Neurol Sci. 2012 Jun 15;317(1-2):47-51. doi: 10.1016/j.jns.2012.02.033. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22459356
  15. Website “Fox News”: Oral contraceptives linked to increased risk of multiple sclerosis. Published: 28.02.14. Available at: http://www.foxnews.com/health/2014/02/28/oral-contraceptives-linked-to-increased-risk-multiple-sclerosis/
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