The effect of combined oral contraceptives on the course of multiple sclerosis
ESC Congress Library. Kochetkova A. May 4, 2016; 127015; A-189
Dr. Anastasiia Kochetkova
Dr. Anastasiia Kochetkova
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Abstract
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Background: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system characterized by inflammation, demyelination, gliosis, pathology of oligodendrocytes and axons and progressive increase of neurological symptoms. Studies indicate that sex hormones may influence the pathogenesis and course of MS, so the assignment of combined oral contraceptives (COCs) for contraception in women with this disease seems logically justified.
Objectives: To assess the effects of COCs on the clinical course of relapsing-remitting MS.
Material and methods: The study included 55 women with relapsing-remitting course of MS. Mean age of patients was 27.9 ± 7.3 (19 to 45 years). There were 35 (63.6%) women of the early reproductive age (19-35 years) and 20 (36.4%) women of the late reproductive age (36-45 years). The average age of the onset of the disease was 26.4 ± 7.9 (11 to 44 years). The average duration of the disease was 6.4 ± 4.8 (1 to 18).
Depending on the COC using patients were divided in 3 groups: I - patients, who never used COCs, II - patients, who used COCs before the onset of MS, III - patients who used COCs after the onset of the disease. Patients of II and III groups used COCs for contraception.
The first phase of the study included the collection of detailed data concerning the course of MS, obstetric and gynecological history; then patients had a comprehensive examination, including bimanual examination, cervical cytology, vaginal smear and neurological examination. The assessment of functional disorders was made with the Kurtzke Expanded Disability Status Scale.
Results: The average duration of using COCs in groups II and III was 3.5 ± 2.0 and 3.0 ± 2.4, respectively. The average EDSS score in patients who used COCs before the onset of MS (II group) and after the diagnosis of MS (III group) was 2,4 ± 1,68 points, indicating a mild disability (II degree) in two functional systems (FS). In the group of patients who never used COCs (I group) the average EDSS score was 3,5 ± 1,4, indicating a moderate degree of disability (III degree) in one FS and II degree in one or two FS; or III degree in two FS.
Conclusion: Patients who used COCs before and after the diagnosis of MS had lower EDSS scores compared with patients who never used COCs. Thus, the assignment of COCs to patients with MS revealed a positive side neuroprotective effect.

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