Progestogen contraceptive use increases MS incidence in women
Why does Professors Wingerchuk and Weinshenker’s “State of the Art” clinical review ignore the evidence that use of progestogen dominant contraceptives have increased the incidence of multiple sclerosis (MS) in women?1
Hellwig and colleagues found the increased risk of MS in women using oral contraceptives varied with progestin potency. The odds ratio increased significantly to 1.75 with use of levonorgestrel and to 1.5 with use of norethindrone.2
Large population studies in Canada and Denmark have found that the sex ratio of MS patients born before 1930s was lower than two but increased to more than three females for each male patient by the 1976 to 1880 birth cohort. 3,4 In Buenos Aires during the 22 years from 1992-2013, the incidence rate in women increased significantly from 1/100,000 (95 % CI 0.8-1.6) to 4.9/100,000 (95 % CI 4.1-5.4, p < 0.001), while in men there was no significant increase in men (1.4/100,000 to 1.8, p = 0.16).5
An Australian study5 found that a higher number of offspring was inversely associated with the risk of a first clinical demyelinating event among women—but not men, which could fit with longer use of progestogen dominant contraceptives from young ages.
In my experience, young women who have used hormonal contraceptives for years and then develop MS can be deficient in zinc, copper, B vitamins and polyunsaturated fatty acids and can also have toxic DNA adducts to nickel from jewellery or cadmium from smoking. Drinking alcoholic spirits can also cause a relapse and exacerbate visual symptoms. Progesterone is immunosuppressive whereas oestrogens can stimulate immunity. In pregnancy levels of both hormones are high whereas all hormonal contraceptives are predominantly progestogenic in action. My lectures and publication list are at www.harmfromhormones.co.uk.
1 Wingerchuk DM, Weinshenker BG. Disease modifying therapies for relapsing multiple sclerosis Clinical Review.BMJ 2016;354:i3518.
2 Hellwig K. Chen LH, Stancyzk FZ, Langer-Gould AM. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility. PLoS One. 2016 Mar 7;11(3):e0149094. doi: 10.1371/journal.pone.0149094. eCollection 2016.
3 Sarah-Michelle Orton, Blanca M Herrera, Irene M Yee, William Valdar, Sreeram V Ramagopalan, A Dessa Sadovnick, George C Ebers, for the Canadian Collaborative Study Group Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006; 5: 932–36
4 Bentzen J1, Flachs EM, Stenager E, Brønnum-Hansen H, Koch-Henriksen N. Prevalence of multiple sclerosis in Denmark 1950--2005. Mult Scler. 2010 May;16(5):520-5. doi: 10.1177/1352458510364197. Epub 2010 Mar 9.
5 Cristiano E, Patrucco L, Miguez J, Giunta D, Peroni J, Rojas JI. Increasing incidence of multiple sclerosis among women in Buenos Aires: a 22 year health maintenance organization based study. Neurol Sci 2016 June 23.
Rapid Response:
Progestogen contraceptive use increases MS incidence in women
Why does Professors Wingerchuk and Weinshenker’s “State of the Art” clinical review ignore the evidence that use of progestogen dominant contraceptives have increased the incidence of multiple sclerosis (MS) in women?1
Hellwig and colleagues found the increased risk of MS in women using oral contraceptives varied with progestin potency. The odds ratio increased significantly to 1.75 with use of levonorgestrel and to 1.5 with use of norethindrone.2
Large population studies in Canada and Denmark have found that the sex ratio of MS patients born before 1930s was lower than two but increased to more than three females for each male patient by the 1976 to 1880 birth cohort. 3,4 In Buenos Aires during the 22 years from 1992-2013, the incidence rate in women increased significantly from 1/100,000 (95 % CI 0.8-1.6) to 4.9/100,000 (95 % CI 4.1-5.4, p < 0.001), while in men there was no significant increase in men (1.4/100,000 to 1.8, p = 0.16).5
An Australian study5 found that a higher number of offspring was inversely associated with the risk of a first clinical demyelinating event among women—but not men, which could fit with longer use of progestogen dominant contraceptives from young ages.
In my experience, young women who have used hormonal contraceptives for years and then develop MS can be deficient in zinc, copper, B vitamins and polyunsaturated fatty acids and can also have toxic DNA adducts to nickel from jewellery or cadmium from smoking. Drinking alcoholic spirits can also cause a relapse and exacerbate visual symptoms. Progesterone is immunosuppressive whereas oestrogens can stimulate immunity. In pregnancy levels of both hormones are high whereas all hormonal contraceptives are predominantly progestogenic in action. My lectures and publication list are at www.harmfromhormones.co.uk.
1 Wingerchuk DM, Weinshenker BG. Disease modifying therapies for relapsing multiple sclerosis Clinical Review.BMJ 2016;354:i3518.
2 Hellwig K. Chen LH, Stancyzk FZ, Langer-Gould AM. Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility. PLoS One. 2016 Mar 7;11(3):e0149094. doi: 10.1371/journal.pone.0149094. eCollection 2016.
3 Sarah-Michelle Orton, Blanca M Herrera, Irene M Yee, William Valdar, Sreeram V Ramagopalan, A Dessa Sadovnick, George C Ebers, for the Canadian Collaborative Study Group Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol 2006; 5: 932–36
4 Bentzen J1, Flachs EM, Stenager E, Brønnum-Hansen H, Koch-Henriksen N. Prevalence of multiple sclerosis in Denmark 1950--2005. Mult Scler. 2010 May;16(5):520-5. doi: 10.1177/1352458510364197. Epub 2010 Mar 9.
5 Cristiano E, Patrucco L, Miguez J, Giunta D, Peroni J, Rojas JI. Increasing incidence of multiple sclerosis among women in Buenos Aires: a 22 year health maintenance organization based study. Neurol Sci 2016 June 23.
Competing interests: No competing interests