Contraceptive use among women with multiple sclerosis: A systematic review.

BACKGROUND: Contraception is an important consideration for women with multiple sclerosis (MS), however little is known about the possible effects of hormonal contraception on disease progression or other adverse outcomes (e.g., thrombosis, low bone mineral density). OBJECTIVE: To evaluate the evidence on the safety of contraceptive use among women with MS. SEARCH STRATEGY: We searched the PubMed database for peer-reviewed articles published in any language from database inception through July 2015. SELECTION CRITERIA: We included studies that examined health outcomes among women diagnosed with MS initiating or continuing a contraceptive method. We excluded case reports and case series but included all other study designs. RESULTS: From 111 articles, we identified four studies (from 5 articles) that met our inclusion criteria. Evidence from one randomized controlled trial, two retrospective cohort studies, and one cross-sectional study suggests that use of combined oral contraceptives or oral contraceptives (type not specified) among women with MS does not worsen the clinical course of disease, defined as disability level, disease severity or progression, relapse, or number of new brain lesions on magnetic resonance imaging (body of evidence grading Level I, fair to Level II-3, poor). No studies were identified that examined the safety of other contraceptive methods or examined other outcomes of interest (venous thromboembolism, changes in bone mineral density) related to contraceptive use among women with MS. CONCLUSIONS: Limited evidence suggests that COC or OC use after MS onset does not worsen the clinical course of disease.