Influence of Menstrual Cycle and Hormonal Contraceptive Use on MS Symptom fluctuations: a pilot study

BackgroundIn clinical practice, women with MS often report menstrually-related symptom fluctuations. Hypothetically, use of oral contraceptives (OCs) could reduce these fluctuations, particularly continuous OCs (11+ weeks consistent exogenous hormones followed by 1 week placebo).ObjectivesTo prospectively capture (1) whether neurologic and generalized symptoms vary menstrual cycle phase (2) type contraception impacts fluctuations.MethodsIn this two-center pilot study, females a regular tracked their cycles completed surveys for up to 6 months. Participants were categorized as 1) users contraceptives, either a) cyclic or b) continuous, 2) endogenously cycling, c) hormonal intrauterine device (IUD) d) “none users” (e.g. no contraception; included condoms, copper IUD, tubal ligation, “fertility awareness methods”). There was correction multiple analyses.ResultsAltogether, 47/69 participants (64%) provided >4 data in the analyses. Mean (SD) age 35.0 (0.9) years, median (IQR) EDSS 1.5 (1-2) mean SymptoMScreen score 10.4 (9.6). For cycling patients (IUD none users), fatigue (MFIS) lower perimenstrual period than luteal (p<0.05). OC users, variability (MFIS: p<0.01; Daily Hassles, from Uplift & Hassles Survey: p<0.05) p<0.001).ConclusionsIn severity did not definitively fluctuate relationship participants. However, daily hassles less variable using no-OC users. Future confirmatory studies are warranted further examine contraceptive choice can be leveraged manage fluctuation MS. Such enroll larger cohorts over fewer employ incentivization measurements enhance participant retention statistical power.