Navigating family planning and pregnancy while living with multiple sclerosis (MS) requires careful consideration and collaboration with healthcare providers due to the unique nature of each person’s condition. While MS typically does not affect fertility, various factors related to the disease and its management should be taken into account when planning for pregnancy or contraception. Here’s an overview of key considerations:
Menstrual Cycle and MS Symptoms:
For individuals experiencing menstruation, MS symptoms may worsen during the premenstrual cycle. Continuous use of oral contraceptives, where only hormone pills are taken continuously to skip the inactive pills and menstruation, may help stabilize these symptoms. Discuss any menstrual cycle-related impacts on MS symptoms with your healthcare provider to explore management strategies.
Contraception Options:
All contraception methods are generally considered safe for individuals with MS. However, certain oral contraceptives may potentially interact with MS symptom management drugs, and vice versa. Barrier methods like cervical caps or condoms may be challenging to use due to MS symptoms. Long-acting reversible contraceptives (LARCs) are effective and have no permanent effects on fertility, allowing for quick resumption of ovulation and menstruation upon removal. Consult with your healthcare provider to determine the most suitable contraception method based on your individual needs.
Fertility Treatments and MS:
While some studies suggest a possible increased risk of relapses with fertility treatments such as in vitro fertilization (IVF), more recent research indicates no significant association, particularly when individuals are actively managing their symptoms with disease-modifying therapies (DMTs). Ongoing research aims to provide clearer recommendations in this area.
DMTs and Family Planning:
Although no disease-modifying therapies are FDA-approved for use during pregnancy or breastfeeding, evolving guidance exists regarding their use in these periods. Many individuals with MS may not require DMTs during pregnancy. However, decisions about DMT continuation depend on factors such as medication safety, disease progression risk, and personal preferences. Injectable DMTs like glatiramer acetate and interferon-beta are considered relatively safe for use during pregnancy, with some clinicians allowing their use up until conception. Conversely, B-cell depleting therapies like ocrelizumab should be avoided during pregnancy and for six months post-therapy cessation due to potential fetal risks. Discuss the risks and benefits of DMT continuation or discontinuation with your healthcare provider and obstetrician or midwife.
Pregnancy and MS Symptoms:
During pregnancy, some MS symptoms like fatigue, bladder, and bowel problems may exacerbate, especially toward the end of pregnancy due to the baby’s additional weight. Certain medications used to manage MS symptoms may pose risks to the fetus, necessitating consideration of alternative management strategies. Cognitive behavioral therapy or rehabilitation therapy may be viable options. Collaborate with your healthcare provider to develop a tailored treatment plan suitable for pregnancy.
Overall, proactive communication with healthcare providers is essential throughout the family planning and pregnancy journey for individuals with MS to ensure optimal management of both the condition and maternal health.
