Pregnancy is known to alleviate the symptoms of Multiple Sclerosis due to increased levels of estrogen and progesterone in the body. This suggests that oral contraceptives, or birth control pills, which contain estrogen and progestin, should produce a similar effect on the development of MS and severity of its symptoms (Hellwig, Chen, Stancyzk & Langer-Gould, 2016). This hypothesis been studied many times in the past; however, results are conflicting.
Studies from 1993 and 1998 report that there is little to no evidence of oral contraceptives having any effect on prevalence or survivability of the disease (Villard-Mackintosh & Vessey, 1993; Thorogood & Hannaford, 1998). Another study from 2005 concludes that the use of oral contraceptive pills mirrors the symptom-reducing effect of pregnancy on multiple sclerosis (Alonso, Jick, Olek, Ascherio, Jick & Hernán, 2005). The most comprehensive study that I could find, published in 2016, suggests that oral contraceptives most likely either slightly enhance the risk of developing MS in women due to progestin activity or have no effect at all. This is most likely due to the fact that most modern oral contraceptives contain little estrogen and high levels of progestin, and the hormones shown to alleviate MS symptoms are high levels of estrogen and progesterone.
Without further research it is difficult to ascertain whether there is any relationship between oral contraceptive use and the development or symptoms of MS, and there are many factors that can obscure the data, such as the varying levels of estrogen and progestin in different types of pills (Hellwig, Chen, Stancyzk & Langer-Gould, 2016). Although there is a long way to go, I believe that researching the link between MS and estrogen/progesterone levels could be a stepping-stone to a cure for Multiple Sclerosis, and the possible beneficence for patients suffering from this disease makes it worth continuing. In terms of nonmalfeasance, the negative side effects are limited, so continuing to study this type of treatment is unlikely to backfire on the patients.
References:
Alonso, Á., Jick, S. S., Olek, M. J., Ascherio, A., Jick, H., & Hernán, M. A. (2005). Recent use of oral contraceptives and the risk of multiple sclerosis. Archives of neurology, 62(9), 1362-1365.
Hellwig, K., Chen, L. H., Stancyzk, F. Z., & Langer-Gould, A. M. (2016). Oral contraceptives and multiple sclerosis/clinically isolated syndrome susceptibility. PLoS One, 11(3), e0149094.
Villard-Mackintosh, L., & Vessey, M. P. (1993). Oral contraceptives and reproductive factors in multiple sclerosis incidence. Contraception, 47(2), 161-168.
Thorogood, M., & Hannaford, P. C. (1998). The influence of oral contraceptives on the risk of multiple sclerosis. BJOG: An International Journal of Obstetrics & Gynaecology, 105(12), 1296-1299.
As a biology student that has learned a good deal about pregnancy, I find the correlation between pregnancy and reduced MS symptoms extremely interesting.
ReplyDeleteA study I examined looked at administering estriol to simulate pregnancy hormones and found that there was a large reduction in gadolinium-enhancing lesions on MRIs, a biomarker of MS.
Estriol is often used in hormone replacement therapy (HRT) for women experiencing menopausal symptoms. Moving forward, examining the impacts of HRT compared to birth control for alleviating MS symptoms could be very interesting and could provide more progress on how to control MS symptoms.
Voskuhl, R., & Momtazee, C. (2017). Pregnancy: Effect on Multiple Sclerosis, Treatment Considerations, and Breastfeeding. Neurotherapeutics, 14(4), 974-984. https://doi.org/10.1007/s13311-017-0562-7.
I wonder if there has been any study on the effects of estrogen/progesterone in men? I was able to find a study on how sex hormones impact immune function and the development of MS. Men who have reduced testosterone may be at higher risk of developing MS. Additionally, the older age of onset in men may be due to dropping testosterone levels (Ysrraelit, M.C., & Correale, J. 2019). This article concluded that there may be a correlation between gender-specific environmental and gene-environment interaction that could play a role in risk of MS. Further studies on how exactly sex hormones could improve treatment and provide more insight for MS's causes. Maybe treatments need to be gender specific?
ReplyDeleteYsrraelit, M. C., & Correale, J. (2019). Impact of sex hormones on immune function and multiple sclerosis development. Immunology, 156(1), 9–22. https://doi.org/10.1111/imm.13004
I was wondering about the inheritance factor of MS to offspring and I found an article that stated that there isn't significant evidence that this is a inherited disease. This leads into my next point about possibly using contraceptives as a treatment for men as well, but more gender specific as Amy stated above.
ReplyDeleteE Lu, F Zhu, Y Zhao, M van der Kop, AD Sadovnick, A Synnes, L Dahlgren, A Traboulsee, H Tremlett (2014). Birth outcomes of pregnancies fathered by men with multiple sclerosis, Volume: 20 issue: 9, page(s): 1260-1264. https://doi.org/10.1177/1352458514521308