For many women with multiple sclerosis (MS), symptoms of the disease begin during childbearing years. But thankfully, having MS doesn’t affect your ability to get pregnant or have a successful, uncomplicated delivery.
Of course, not every woman is interested in having—or ready to have—a baby. As a result, finding the right contraceptive is important. If you have MS, here’s what you need to know about making birth control decisions.
Consider Oral Contraceptives
Oral contraceptives, also known as birth control pills, are one of the safest and most effective birth control options available. What’s more, some experts believe that the use of oral contraceptives may have a positive effect on MS, potentially delaying symptoms in the short term.
However, birth control pills may not be the right choice for you, because they can interact with other medications. For example, the pills can decrease the effectiveness of commonly prescribed MS medications, such as benzodiazepines, including lorazepam (Ativan), oxazepa(Serax), and temazepam (Restoril). Conversely, some drugs, such as antibiotics and certain anti-seizure medications, including carbamazepine (Tegretol) and phenytoin (Dilantin), can decrease the effectiveness of birth control pills.
Look to Other Options
Your choices don’t end with oral contraception. In general, you have the same birth control options as women without MS.
Intrauterine devices (IUDs), small devices that your doctor implants in your uterus, are generally safe and effective. Some IUDs release hormones, while others release a small amount of copper, which prevents the sperm from fertilizing your egg. There is some evidence that immunosuppressive drugs may reduce the effectiveness of the IUD.
Another option is a progesterone implant, which also requires no maintenance and is effective for up to five years. Progesterone also can be injected. This injected contraception is often called by its brand name, Depo-Provera. It’s important to know that Depo-Provera has been linked to a greater risk for osteoporosis. If you have MS, you may be at higher risk for this bone condition because of your limited mobility or use of steroids.
Other options include the patch, which is sometimes called by its brand name, Ortho Evra. This skin patch, usually worn on your lower abdomen or buttocks, releases hormones into your bloodstream to stop your ovaries from releasing eggs. You can also consider a thin, flexible vaginal ring, commonly called NuvaRing. This releases the hormones progestin and estrogen, but may require good manual dexterity to insert correctly.
What to Know About Hormones
Hormonal birth control options aren’t right for everyone. If you smoke and are older than age 35, talk to your doctor before taking hormonal birth control. It can increase your risk for blood clots. If you have MS and have mobility issues, you also may be more susceptible to blood clots in your legs and should be closely monitored by your doctor if you use these options.
If hormonal birth control is a concern, barrier devices such as diaphragms, condoms, and spermicides may be good choices. Keep in mind that hand tremors or weakness may cause problems using barrier devices. Your doctor can help you sort through your options.
Planning for Pregnancy
If you’re considering trying to conceive, talk with your doctor first. Some MS medications haven’t been thoroughly studied during pregnancy and may not be safe. Preventing pregnancy is especially important when taking medication such as Copaxone, Rebif, and Avonex. Ask your doctor about other medication options and how long you must be off certain medications before getting pregnant.
