Journal Article

Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility

Chen, Lie H., Stancyzk, Frank Z., Hellwig, Kerstin, Langer-Gould, Annette M.

2016

Overview

The incidence of multiple sclerosis (MS) is rising in women. To determine whether the use of combined oral contraceptives (COCs) are associated with MS risk and whether this varies by progestin content. We conducted a nested case-control study of females ages 14-48 years with incident MS or clinically isolated syndrome (CIS) 2008-2011 from the membership of Kaiser Permanente Southern California. Controls were matched on age, race/ethnicity and membership characteristics. COC use up to ten years prior to symptom onset was obtained from the complete electronic health record. We identified 400 women with incident MS/CIS and 3904 matched controls. Forty- percent of cases and 32% of controls had used COCs prior to symptom onset. The use of COCs was associated with a slightly increased risk of MS/CIS (adjusted OR = 1.52, 95%CI = 1.21-1.91; p<0.001). This risk did not vary by duration of COC use. The association varied by progestin content being more pronounced for levenorgestrol (adjusted OR = 1.75, 95%CI = 1.29-2.37; p<0.001) than norethindrone (adjusted OR = 1.57, 95%CI = 1.16-2.12; p = 0.003) and absent for the newest progestin, drospirenone (p = 0.95). Our findings should be interpreted cautiously. While the use of some combination oral contraceptives may contribute to the rising incidence of MS in women, an unmeasured confounder associated with the modern woman's lifestyle is a more likely explanation for this weak association.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Biology and Life Sciences / Birth control / Cloning / Complications and side effects / Contraceptives / Contraceptives, Oral, Combined - adverse effects / Cytokines / Disease Susceptibility / Dosage and administration / Electronic health records / Electronic medical records / Ethnicity / Female / Females / Humans / Incidence / Inflammatory bowel disease / Medical records / Medicine and Health Sciences / Middle Aged / Minority & ethnic groups / Multiple sclerosis / Multiple Sclerosis - chemically induced / Multiple Sclerosis - metabolism / Neurology / Obesity / Oral contraceptives / Pharmacy / Population / Pregnancy / Prescriptions / Progestin / Progestins - metabolism / Research and Analysis Methods / Retrospective Studies / Risk / Risk factors / Socioeconomic factors / Studies / Systematic review / Womens health / Young Adult