Use of Systemic Hormonal Contraceptives is Associated with Faster Timed 25-foot Walk Speeds in Females with Multiple Sclerosis
Katherine Havard1, Marisa McGinley2, Kunio Nakamura2, Daniel Ontaneda2, Lindsay Ross1
1Cleveland Clinic Foundation, 2Cleveland Clinic
Objective:
To evaluate the association between use of hormone-containing contraceptives and disability and MRI measures in multiple sclerosis (MS).
Background:
The role sex hormones, including estrogen and progesterone, play in the pathophysiology of MS activity is uncertain, with possible contributions to immuno-protection and remyelination. Thalamic volume predicts long term disability, while the timed 25-foot walk (T25-FW) is a functional gait measurement representing lower extremity disability.
Design/Methods:
This retrospective study included female MS patients ages 18-45 that received both MS care and primary care or OBGYN care at our institution. Contraceptive use was defined as 6 months stable use of 1) systemic hormonal contraception, 2) hormone-containing intrauterine devices (IUDs), or 3) non-users of hormonal contraception. Inclusion required a brain MRI completed as part of routine care within 18 months of contraception periods. T25-FW (included if within 90 days of MRI) was obtained as part of routine MS care.
Multivariable linear regression models were used to assess the association of contraceptive group with thalamic volume and T25-FW, adjusting for age at MRI, age of MS symptom onset, MS disease course, and disease modifying therapy (DMT) efficacy (high, moderate or low).
Results:
1,504 patients were included (age 38 ±6.6 years, 75% White, 73% with RRMS, and 59% on high efficacy DMT). 261 females (17.4%) were using systemic hormonal contraceptives, 56 (3.7%) using IUDs, and 1,187 (78.9%) non-users. Compared to non-users, systemic hormonal contraceptive users performed better in T25-FW [ -0.76s (SE=0.30), p=0.01], while IUD users showed no significant difference [-0.32s (SE=0.62), p=0.6]. There was no significant difference in thalamic volume fraction for systemic hormone or IUD users compared to non-users [–0.01 (SE=0.01), p=0.1 and 0.01 (SE=0.01), p=0.33 respectively].
Conclusions:
Systemic hormonal contraception use was associated with better gait speed, but did not affect thalamic volume, suggesting contraception may improve functional performance without a clear protective CNS effect.
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