Many women develop multiple sclerosis (MS) during their reproductive years. Since MS treatment can affect pregnancy, understanding your birth control options can make family planning easier.
Research suggests that MS doesn’t affect fertility. So, if you live with MS and are in your reproductive years, you may need to think about your contraceptive options.
Many MS medications are not safe for an unborn baby. But if your MS is well managed, you may be able to go off your medication long enough to achieve pregnancy and childbirth.
If pausing treatment isn’t an option, or pregnancy isn’t part of your plan, effective birth control is important. Here’s what to consider when choosing a contraceptive method that works for you.
Pregnancy and breastfeeding don’t usually affect the course of a person’s MS.
MS is highly individual, though, so the factors surrounding your situation and treatment plan can affect whether you want to achieve or avoid pregnancy.
Contraception hormones and their effect on MS symptoms and disease progression have been the subject of some debate. But a 2017 study involving 162 women found that oral hormonal contraceptives did not appear to be associated with an increased chance of MS relapses.
Some research indicates the possibility of an increase in MS annualized relapse rates following the use of assisted reproductive technologies (ART). More recent research, however, found no increase in relapses after fertility treatments in women managing MS with disease-modifying therapies (DMTs).
Most types of birth control are considered safe and effective for people living with MS.
The best birth control methods are the ones that you can use consistently, as instructed.
Your MS symptoms can affect your choice of contraception. For example, certain types of contraception require manual dexterity to use or the ability to swallow pills without difficulty. If these are issues for you, long-acting, reversible contraception (LARC) may be an option. Once they’re in place, you don’t have to take any action for them to be effective. IUDs and implants are types of LARC.
People with MS mobility issues may have an increased chance of venous thromboembolism (VTE), which is an important factor when selecting a contraceptive. Some types of oral contraceptives may
Intrauterine device (IUD)
An IUD is a small, T-shaped device that a doctor implants into the wall of your uterus to prevent pregnancy from occurring.
There are two types:
- copper, which can remain implanted for up to 12 years
- progestin hormone-based, which need to be replaced every 3 to 5 years
IUDs are highly effective in addition to being long lasting.
IUDs are safe for teens too, according to the American College of Obstetricians and Gynecologists (ACOG). Although MS usually develops between
Contraceptive implant
This is a matchstick-sized, flexible plastic rod that a doctor implants under the skin of your upper arm. It releases a progestational hormone that thickens the cervical mucus to prevent sperm from entering and thins your uterine lining.
Contraceptive patch
This method uses a patch that releases estrogen along with progestin into your bloodstream to prevent pregnancy. The patch is changed weekly for 3 weeks.
Patch locations can be:
- upper arm
- upper torso
- lower abdomen
- buttocks
Hormonal contraceptive ring
This is a small and flexible plastic ring that you insert into the vagina, close to your cervix. Depending on the type of ring you choose, it releases either estrogen or estrogen with progesterone.
The ring stays in place for 3 weeks.
If your MS symptoms include spasticity or reduced dexterity, which can make placing the ring more difficult, you might prefer a different type of contraception.
Oral hormonal contraceptives
This type of birth control is a daily pill that you take for the entire month or most of the month, depending on the type you choose.
Some forms of oral contraceptives may increase a person’s chance of blood clots in their legs. Limited mobility can increase this risk.
Barrier methods
Barrier methods such as condoms may be difficult to use if you experience the MS symptoms of stiffness and spasticity. Otherwise, they’re an effective type of contraception and are suitable for people living with MS.
Birth control injection
The injectable form of birth control contains the hormone progestin.
It works by:
- preventing your ovaries from releasing eggs
- thickening your cervical mucus to block sperm from reaching an egg
- changing the uterine lining to make implantation difficult
A healthcare professional administers this injection for you, four times a year.
Combined hormonal contraceptives (CHC)
CHC combines three hormone sources to prevent pregnancy:
- a hormone patch
- low dose oral contraceptives
- vaginal ring
CHC can increase a person’s chance of blood clots. It’s recommended that people living with reduced mobility due to MS choose a different type of contraception.
There are several things to take into account when choosing a birth control method that works best for you.
Lifestyle
Contraception products vary to suit a range of lifestyles.
Some people like the freedom of implantable devices that they don’t have to remember. Others prefer methods over which they have more control, such as barrier contraceptives or a daily pill.
If you live with MS and would need a medication
You may be able to try different birth control methods until you find one you prefer.
Mobility
If MS symptoms interfere with your mobility, it can affect your choice of contraception.
Reduced mobility increases a person’s chance of blood clots and may adversely affect bone health.
CHC is associated with an increased risk of blood clots and is not recommended for people living with reduced mobility.
Progestin-only contraception may cause changes in bone mineral density, which may add to the bone-weakening effect of reduced mobility.
Medications
MS medications can affect pregnancy and birth control.
Some MS medications have the potential to harm an unborn baby. DMTs are of particular concern, and there aren’t any that are approved for use during pregnancy.
If you use a DMT to treat your MS and want to achieve pregnancy, you may be able to try a medication washout period before conception. Depending on the type of medication you use, this washout time could be several months.
Medications can also affect your choice of birth control.
Certain MS medications can affect bone health, making them incompatible with progestin-only contraceptive method. This type of birth control may contribute to bone loss and increase your chance of osteoporosis.
Some medications for specific symptoms of MS may interact with oral contraceptives,
When choosing a contraceptive, talk with a doctor about all the medications you take to ensure there won’t be any interactions.
MS doesn’t reduce the chance you could become pregnant. However, your MS medication might not be safe for an unborn baby.
Unless you want to pause your MS treatment to achieve pregnancy and childbirth, using safe and reliable birth control is important.
Most forms of birth control are safe for people with MS. When deciding which is right for you, things to consider include how much mobility you have and whether you experience dexterity issues.