Should I Worry About Blood Clots With Ms And Hormonal Contraceptives
Some hormonal contraceptives can increase the risk of clots. And if your MS means that you cant move around much, you might have a greater risk of blood clots.
Speak to your doctor about it. There could be other methods that are more suitable. Your doctor might monitor you for any early signs of problems.
What Have Studies Into Ms And Pregnancy Found
A number of reviews, including a meta-analysis of 23 papers reporting on 13,144 women with MS, have found that:
MS has little or no effect on pregnancy
- People with MS can expect normal fertility and normal pregnancy outcomes
- MS produces no increase in adverse outcomes for mother or baby
This confirms findings from a study in British Columbia that reviewed the records of 432 births to women with MS. Compared to control groups, there were no differences in gestational age, birth weight, or rates of assisted vaginal delivery or caesarean section. However, an estimated 50% to 90% of people with MS experience symptoms of sexual dysfunction, which affect conception rates.
Do I Have To Use Contraception If I Take A Dmt For My Ms
If you take certain DMTs for your MS, its important to use reliable contraceptives. Thats because some DMTs could harm a developing baby.
If you want to get pregnant, you might need to stop taking your DMT or switch to a safer one. With some DMTs you need to stop some weeks or months in advance to be sure theyre out of your system.
Your neurologist or MS nurse can discuss any precautions youd need to take with your DMT. Speak to them before you make any changes.
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Is My Baby At Risk Of Getting Ms Themselves
Most people who develop MS have no previous family history of the condition. However, having a relative with MS does increase your chance of being diagnosed with MS, although the risk remains low.
In the UK, the risk for a member of the general population being diagnosed with MS in their lifetime is about 1 in 330. First degree relatives, such as the child of someone with MS are estimated to have a 1 in 48 risk of developing MS . For second degree relatives it is around 1 in 100.
Although the chances of your children getting MS are low, it makes sense to avoid the known risk factors. To give your children the best chance of avoiding MS themselves, ensure that you are not deficient in vitamin D while you are pregnant, and give them vitamin D supplements as recommended by your doctor. You should also avoid exposing children to cigarette smoke either before birth or during childhood.
How Will Ms Treatment Affect My Baby
All pregnant women are advised to think carefully about any substances they put into their body. This is because some substances can move from the mothers bloodstream directly to the babys bloodstream . It is important to discuss all medicines that you are taking with your healthcare provider when you are pregnant, including herbal medicines. Your healthcare provider will weigh the risks and benefits of any medicines that you are currently taking to help you decide what to receive during your pregnancy.
In many cases, when a mother receives a medicine, the effect of that medicine on the health of babies is unknown. This is because pregnant women are not usually included in clinical research studies where potential new medicines are being tested. Pregnancy registries are designed to help healthcare providers learn more about medicines and their effects on babies. The aim is to provide women and their healthcare providers with information to help them make informed decisions in the future about their treatment during pregnancy. It is not known if OCREVUS® will harm your unborn baby.
Learn about the OCREVUS Pregnancy Registry here
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Will Having A Baby Make My Ms Worse
Before 1950, women with MS were routinely advised by their doctors not to have children. All of the published research since has pointed to a very different conclusion. A womans MS is likely to be stable, or even improved, during the nine months of pregnancy. In the few months following the pregnancy , the risk of exacerbation has been found to range from 20% to 75%.
Research suggests that a possible indicator might be related to the frequency of exacerbations experienced by the woman prior to the pregnancy. Given the increased chance of an exacerbation, it may be beneficial to arrange for some additional short-term assistance in the home. This support may include help from family and friends. Community Support Staff from the MS Society in your region can also provide information on services available in the community. Researchers have also concluded that pregnancy does not affect the womans long-term disease course or level of disability. This means that a woman can make her decision knowing that becoming pregnant is unlikely to have any long-lasting impact on the course of her MS.
My Ms Makes It Hard To Use A Tampon Or Sanitary Towel
If MS symptoms make it harder for you to use sanitary towels, tampons or menstrual cups, you might find an alternative works well.
For example, if your period flow isnt too heavy, period pants, designed to soak up the blood, might work for you. And some designs of menstrual cup might be easier to use than others, so it could be worth shopping around. You can find menstrual cups and period pants in chemists and online.
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Ms Relapses During Pregnancy
Pregnancy is associated with a reduced relapse rate, particularly during the third trimester. The Pregnancy and Multiple Sclerosis trial, which looked at 269 pregnancies, found that pregnancy resulted in:
- A 70% reduction in relapse rate in the third trimester
- A corresponding increase in the relapse rate in the three months after childbirth
Despite the relative increase in relapses in the postnatal period, 72% of women experienced no relapses during this period. Predictors for postpartum relapses included:
- Increased relapse rate in the year before pregnancy or during pregnancy
- Higher EDSS score at the onset of pregnancy
In the longer term, there is evidence that pregnancy may be beneficial for women with MS:
- A 10-year follow-up study found a lower relapse rate in women with pregnancies after MS onset compared to those without pregnancies after MS onset
- A prospective 5-year study compared the rate of progression in disability between childless women, women who had onset of MS after childbirth, and women who had onset before or during pregnancy. Disability rates increased most rapidly in women with no children
Pregnancy after onset of MS is associated with a longer duration until wheelchair dependence develops, as compared to never-pregnant women or those who had children only before onset of the disease, and less risk of conversion to secondary progressive MS.
How Is Multiple Sclerosis Treated
There is no cure for multiple sclerosis, however there are disease-modifying therapies available that can slow the progression of the disease and improve symptoms. These include:
There are also treatments to help manage symptoms, treat flare-ups or relapses, improve your function and safety, and provide much needed emotional support.Rehabilitation therapies, including physical therapy, occupational therapy, speech and swallowing assistance, cognitive therapy, or the use of assistive devices like splints may also be helpful.
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What Medications Are Safe For Use During Pregnancy And Breast
As a general rule, the use of any medications during pregnancy and breast-feeding should be done cautiously and under the supervision of your GP. If at all possible, a woman who wishes to become pregnant should consult her GP prior to conception about any medications she may be taking. The GP will eliminate any unnecessary medications and substitute safer ones where required. Both men and women taking Disease Modifying Treatments who wishes to start a family should review treatment options with their neurologist or GP. A woman who becomes pregnant while taking any medications should review them with her doctor as soon as possible. Similarly, men may also need to cease use of these treatments to assist spermatogenesis and should seek the advice of their treating doctor.
What Are The Symptoms Of Multiple Sclerosis
Symptoms of MS are erratic. They may be mild or severe, and of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. Throughout the course of the illness, you may have any or all of these symptoms:
Muscle weakness in the arms and legs
Trouble with coordination
Changes in reflexes
MS may also cause cognitive effects. The effects may be mild, often found only after thorough testing. They may include problems with:
The symptoms of multiple sclerosis may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
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How To Plan For Pregnancy With Multiple Sclerosis
Being pregnant can put your multiple sclerosis into remission, but you’ll need to speak to your doctor about taking MS medications before you conceive.
Generally speaking, getting pregnant and carrying a baby to term is no more difficult, or less safe, for women who have multiple sclerosis than it is for women of childbearing age who dont have MS. In addition, experts say a mothers MS poses no known risks to the developing fetus. And the state of pregnancy may have some benefits for women with MS.
Were learning that pregnancy is a good thing for women with multiple sclerosis, says Anthony T. Reder, MD, a professor of neurology at the University of Chicago Medicine and the director of its neurology and inflammatory disease infusion center.
Up until the 1960s, women with multiple sclerosis were discouraged from becoming pregnant because of the concern that it could make the condition worse. But scientists have since observed that pregnancy reduces the likelihood of an MS relapse, particularly in the second and third trimesters.
How Is Ms Treated
Theres no cure for MS, but medicines can help control the symptoms. Many women dont need medicines during pregnancy because their symptoms get better. If you have MS and are pregnant or thinking about getting pregnant, talk with your health care provider about the medicines you take for MS. Some may not be safe to use during pregnancy or breastfeeding.
For example, many people with MS take a medicine called beta interferon . This medicine can help lessen flares and slow down the spread of nerve damage and the course of MS, but its not safe to take during pregnancy. Beta interferon may increase the risk of miscarriage and stillbirth . Cancer-fighting medicines called immunosuppressives are sometimes used to treat MS, but theyre also not safe to use during pregnancy. Your provider can switch you to a safer medicine.
Other therapies for MS are important, especially during pregnancy. For example, finding a support group for people with MS or talking to a counselor can be helpful. A support group is a group of people who have the same kind of concerns. They meet together to try to help each other. Exercise or physical therapy also can help. Physical therapy is an exercise program created just for you to help improve your strength and movement.
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Pregnancy And Giving Birth
Several studies have shown that mothers with MS are just as likely to have healthy pregnancies and healthy babies as those without.
Research so far shows that having MS does not increase the risk of miscarriage, premature birth, still-birth, birth abnormalities, or ectopic pregnancy .
Having MS doesnt mean that you’ll need to have an epidural any more than anyone else with similar mobility problems or disabilities. Epidurals and anaesthetics for caesarean births are as safe for people with MS as those without.
Can Women With Ms Take The Pill And Other Hormone
Women with MS can usually take the pill and other hormone-based contraceptives, just like other women. But some medications and herbal supplements can raise the chances of them not working.
The evidence suggests that hormonal contraceptives dont increase relapses or make MS progress more quickly.
Some studies have also looked at whether these contraceptives might delay the development of MS, or affect the chances of getting MS. But theyve had mixed results on this and theres not enough evidence to show an effect. We hope more studies will shed light on this.
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What Impact Will Pregnancy Have On The Course Of My Ms
There has been limited research into the long-term effects of childbirth on the course of MS. However, the research that exists suggests that pregnancy and childbirth are associated with less long term disability. A Belgian study looked at 330 women over 18 years, and showed that women who have given birth at any time were 34% less likely to reach EDSS 6. This is the point of being unable to walk without a walking aid.
No impact on the long-term course of MS or likelihood of transitioning to secondary progressive MS has been found. As yet no studies have explored pregnancy in primary progressive MS.
Can Ms Medication Affect My Periods
Some MS disease modifying therapies and symptom treatments can affect periods. These include beta interferons and SSRIs .
For example, these can cause irregular periods or spotting between periods. Side-effects often improve on their own after several months of taking the treatment.
Even so, always mention any side-effects you have to your MS team so they can help you monitor them.
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Pregnancys Impact On Ms Disease Activity
The pregnancy in multiple sclerosis study was the first prospective study including 254 patients with MS . Women were followed-up during pregnancies and one year postpartum. Research results concluded that the rate of MS relapses decreased through pregnancy, mostly during the last trimester, while relapse rates increased 3 months after delivery and were equal to pre-pregnancy relapse rates . Estrogens and other sex hormones activate immunological transformation during pregnancy by shifting T helper cells to mostly Th2 , instead of Th 1 , while after the delivery immunomodulation is reversed . Animal studies on experimental allergic encephalomyelitis demonstrated the significance of sex hormones on EAE manifestation, prognosis and disease activeness these results are important for the progression of treatment for MS, as the study revealed the anti-inflammatory and neuroprotective impact of estrogens and estriol ), progesterone and testosterone . The concentration of these hormones rises continuously during pregnancy and maximizes in the last trimester, providing the highest relapse protection, although a very recent study analyzed pregnancy related relapses in 375 women with MS . Annualized relapse rates decreased to 0.140.07 compared to 0.39 ARR prior to conception and remained reduced for 3 months after delivery , turning back to prior pregnancy rates in 46 months postpartum. The authors did not report any increased disease activity during the postpartum period .
Neuromyelitis Optica Spectrum Disorder
NMOSD is an inflammatory disease that, like multiple sclerosis, attacks the myelin sheaths the protective covering of the nerve fibers of the optic nerves and spinal cord, says Conway. But unlike MS, it usually spares the brain in its early stages.
Symptoms of NMOSD can be similar to MS but can also include sudden vision loss or pain in one or both eyes, numbness or loss of sensation in the arms and legs, difficulty controlling the bladder and bowels, and uncontrollable vomiting and hiccups, according to Oregon Health and Sciences University.
Treatments for MS are ineffective for and can even worsen NMOSD, so getting an accurate diagnosis is extremely important. A blood test known as the NMO IgG antibody test can help to differentiate between MS and NMOSD.
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Perinatal And Postpartum Depression
Perinatal depression is defined as depression that occurs during pregnancy or during the first year after childbirth.
People with MS are already at risk for depression, due to the psychological impact of dealing with a chronic illness. Women with MS have a higher likelihood of developing perinatal depression.
Women who are diagnosed with MS during the postpartum period report the highest levels of depression, while women who are diagnosed before pregnancy have similar rates of depression as women without MS.
Will Multiple Sclerosis Make It Hard To Get Pregnant
Multiple sclerosis is a type of immune disease that affects the nervous system. It does not affect the ability to get pregnant. However, MS may cause symptoms that make sex challenging. Some women who have MS notice dryness in the vagina that may make sex painful. Some men who have MS experience erectile dysfunction . Fatigue can also make having sex less appealing. Talk to your partner about how you can make sex more inviting. For example, use vaginal lubricants if dryness is a problem, talk to your doctors about options to treat ED, and choose times when you both feel rested and ready to engage in sex.
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Can Pregnancy Cause Multiple Sclerosis
Pregnancy does not cause multiple sclerosis, but if you have undiagnosed MS you may experience symptoms for the first time during pregnancy.
- Having multiple sclerosis can make delivery more difficult.
- Pain sensations may be altered in people with MS, which means a woman may not feel pain with contractions. This can make it difficult to tell when labor begins.
- The pelvic muscles and nerves used for pushing during delivery may also be weakened. Some women with MS may require the help of forceps or vacuum to assist with delivery, or may need a Cesarean birth .