Article

Menarche, oral contraceptives, pregnancy and progression of disability in relapsing onset and progressive onset multiple sclerosis

Department of Orthopedagogics, Faculty of Psychology and Education Sciences, University of Mons, Mons, Belgium; Department of Neurology UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
Journal of Neurology (impact factor: 3.47). 04/2012; DOI:10.1007/s00415-011-6267-7 pp.1-7

ABSTRACT Female gender and hormones have been associated with disease activity in multiple sclerosis (MS). We investigated age at menarche,
use of oral contraceptives and pregnancy in relation to progression of disability in relapsing onset and progressive onset
MS. We conducted a cross-sectional survey among individuals with MS, registered by the Flemish MS Society in Belgium. A time-to-event
analysis and Cox proportional hazard regression were performed with time to Expanded Disability Status Score (EDSS) of 6 (requires
a cane) as outcome measure. Hazard ratios for the time from onset and the time from birth were adjusted for age at onset and
immunomodulatory treatment. Data on 973 women with definite MS were collected. In the relapsing onset group, women with at
least two pregnancies had a reduced risk to reach EDSS 6 compared with nulliparous women. In the progressive onset group,
later age at menarche was associated with a reduced risk to reach EDSS 6, whereas oral contraceptive use was associated with
a higher risk of reaching EDSS 6. Our study corroborates the association of pregnancies with a reduced progression of disability
in relapsing onset MS. In progressive onset MS, a slower progression was found in women with a later onset of menarche and
a more rapid progression occurred when women reported the use of oral contraceptives.

KeywordsMultiple sclerosis–Female–Pregnancy–Menarche–Oral contraceptives

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Keywords

Cox proportional hazard regression
 
cross-sectional survey
 
definite MS
 
disease activity
 
Expanded Disability Status Score
 
Female gender
 
Flemish MS Society
 
higher risk
 
immunomodulatory treatment
 
KeywordsMultiple sclerosis–Female–Pregnancy–Menarche–Oral contraceptives
 
multiple sclerosis
 
oral contraceptives
 
progressive onset MS
 
rapid progression
 
reduced progression
 
reduced risk
 
relapsing onset
 
relapsing onset MS
 
slower progression
 
study corroborates