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Most women are diagnosed with MS during the peak of their reproductive years. Some drugs used to treat MS carry higher risks to women who are pregnant or breastfeeding than others because of the potential harm of the drug to the developing fetus or baby. In addition, some drugs used for symptom management may lessen the effectiveness of certain types of contraception. Product monographs are available for all drugs approved by Health Canada and will discuss safety precautions and warnings of the drug related to pregnancy and breastfeeding. It is important to understand the potential interactions between any medications, or supplements being taken concurrently. Women are advised to speak with their healthcare provider or pharmacist to understand any potential drug interactions.

Intrauterine devices (IUD)

An IUD is a tiny T-shaped device placed in to the uterus to prevent pregnancy. IUDs are long-term and reversible contraceptive options. There are two types of IUDs: copper and progestin hormone (levonorgestrel). Copper IUDs can remain in the uterus for approximately 12 years, while the hormone-based IUD will need to be replaced every 3-5 years, depending on the product being used. Both types of IUDs must be inserted by a healthcare provider.

Contraceptive implant

A contraceptive implant is a flexible plastic rod (about the size of a matchstick) placed under the skin of the upper arm. The implant releases a low, steady dose of a progestational hormone for up to three years. The implant thickens cervical mucus and thins the lining of the uterus preventing sperm from entering.

Combined hormonal contraceptives (CHCs)

CHCs include low-dose combined oral contraceptives, hormone patch, and vaginal ring. CHCs carry an increased risk of venous thromboembolism (blood clot) therefore women with prolonged mobility issues may benefit from a different type of contraception.

Hormonal contraception patch

The hormonal contraceptive patch is applied to the skin on one of the following areas: buttocks, lower abdomen, upper arm, or upper torso. A new patch is place on the skin each week for three weeks and releases the hormones estrogen and progestin into your bloodstream to prevent pregnancy.

Hormonal contraceptive ring (vaginal ring)

The vaginal ring is a small, flexible plastic ring that is self-inserted into the vagina close to the cervix. It contains the hormones estrogen and/ or progesterone, depending on the product prescribed. The ring remains in place for three consecutive weeks. Women who experience upper limb spasticity or difficulty with dexterity may not find this type of contraception an optimal choice.

Injectable contraception (birth control shot)

The injected birth control is a highly effective and reversible contraception, containing progestin, but not estrogen. It is administered by intramuscular injection four times a year by a healthcare provider. The hormone injection prevents the ovaries from releasing an egg, thickens cervical mucus to prevent sperm from reaching an egg, and changes the lining of the uterus making implantation difficult.[i]

Most types of contraception are safe for women living with MS other than combined hormone contraceptives (vaginal ring, hormone patch or low-dose hormone oral contraceptives) as previously mentioned, for women with limited mobility due to the risk of blood clots.

[i] North American Menopause Society

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