Women With Multiple Sclerosis Require Better Reproductive Health Care

Women with multiple sclerosis (MS) should be provided more reproductive health information to help guide treatments and to raise awareness for cervical cancer, according to study findings published in the journal Multiple Sclerosis and Related Disorders.

Hormonal changes influence the disease course of MS, and many relapses occur in young women, particularly during pregnancy. While there are several disease modifying treatments (DMTs) available for MS, some are contraindicated in pregnant individuals. In addition, there is a lack of data regarding appropriate contraception and gynecologic monitoring for patients with MS. Researchers conducted a cross-sectional study to assess the gynecologic care of patients with MS of childbearing age. 

Patients were recruited from May 2022 to May 2023 from the Resources and Skills Center-Multiple Sclerosis (CRC SEP) cohort of the neurology department of Bordeaux University Hospital in France. Study participants were women aged 18 to 40 with a confirmed MS diagnosis based on 2017 McDonald criteria. Exclusion criteria were patients who were pregnant, breastfeeding, and under legal protection. 

The researchers collected through a self-reported questionnaire designed for this study. The survey included 2 parts: general information and gynecologic follow-up information regarding contraception, cervical cancer screening, and reproductive information. The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19) was also distributed to gather information regarding participant sexuality. 

After data collection, patients were divided into 3 groups for analysis: 

• Treatment-free patients
• Treatment with immunomodulatory (IMD) agents (beta interferon, peginterferon, and glatiramer acetate) 
• Treatment with immunosuppressive (IS) agents (teriflunomide, dimethyl fumarate, diroximel fumarate, fingolimod, ponesimod, natalizumab, ocrelizumab, ofatumumab, rituximab, cladribine, azathioprine, and methotrexate).

The US Centers for Disease Control and Prevention (CDC) parameters were used to determine the real-world effectiveness of contraception and the researchers categorized them into a tiered list.

Among the 328 patients in the database, 218 were initially included in the analysis. Of these patients, 192 completed the survey, with 190 having relapsing-remitting multiple sclerosis (RRMS), 1 with primary progressive multiple sclerosis (PPMS), and 1 with secondary progressive multiple sclerosis (SPMS).

The average age of study participants was 33.9 and the average age at symptom onset was 25.8. A total of 182 (95.8%) were on DMTs, specifically natalizumab (n=54 [28.4%]), ocrelizumab (n=56 [29.5%]), and IMDs (n=23 [12.2%]). Over half of study participants (n= 109 [56.8%]) received 1 DMT before their current treatment.

Out of the 192 participants, 157 (82.2%) had a gynecologic follow-up and 62 (32.3%) patients reported that health care professionals informed them of the importance of gynecologic consultation. 

Regarding patients treated with IMDs, 31 (20%) underwent annual cervical screening. Of the 40 patients (72.9%) who met the French human papillomavirus (HPV) vaccination criteria, 50 were vaccinated but the specific vaccinations used were unknown.

Among all participants, 128 (66.7%) patients used contraception, 117 (60.9%) used methods of which were considered effective (Tier 1 or 2). There were 16 (8.3%) patients who experienced an unplanned pregnancy since diagnosis.

“Health care professionals should be better informed on the follow-up needs of MS patients, particularly in terms of cervical screening for patients with IS treatments,” the researchers concluded. 

Study limitations included recall and recruitment bias, the inability to compare data by MS severity, and needed improvements in gynecologic monitoring.