To examine the risk of multiple sclerosis in users of combined oral contraceptives.
Design
Cohort study conducted between 1968 and 1996 using diagnostic data supplied by general practitioners
Setting
General practices throughout the United Kingdom.
Population
Royal College of General Practitioners' Oral Contraception Study cohort of initially 46,000 women recruited during the late 1960s.
Methods
Directly standardised incidence rates of multiple sclerosis were calculated for current, former and never-users of oral contraceptives using first ever cases of multiple sclerosis reported by the general practitioners. The standardisation variables were age, parity, social class and smoking history. Five-year survival rates in the different contraceptive groups were calculated using standard life table techniques.
Results
One hundred and fourteen first ever cases of multiple sclerosis had been reported by November 1996 during 564,000 woman-years of observation. The incidence rate in both current and former users was not materially different to that in never-users. Although based on limited evidence there was no suggestion that the five-year survival was affected by a woman's use of combined oral contraceptives.
Conclusions
These findings do not suggest a greatly elevated risk of multiple sclerosis during, or after, use of combined oral contraceptives.
oral contraceptives multiple sclerosis risk cohort study, combined oral contraceptive autoimmune disease multiple sclerosis, Thorogood Hannaford RCGP oral contraception study MS, Royal College General Practitioners contraception cohort study, oral contraceptive use neurological disease incidence women, multiple sclerosis incidence current former never users OC, hormonal contraception autoimmune risk long-term follow-up, five-year survival multiple sclerosis oral contraceptive users, standardised incidence rate MS contraceptive exposure UK cohort
PMID 9883921 9883921 DOI 10.1111/j.1471-0528.1998.tb10008.x 10.1111/j.1471-0528.1998.tb10008.x Thorogood et al. 1999, Thorogood 1999
Cite this article
Thorogood, M., & Hannaford, P. C. (1998). The influence of oral contraceptives on the risk of multiple sclerosis. British journal of obstetrics and gynaecology, 105(12), 1296-1299. https://doi.org/10.1111/j.1471-0528.1998.tb10008.x
Thorogood M, Hannaford PC. The influence of oral contraceptives on the risk of multiple sclerosis. Br J Obstet Gynaecol. 1998;105(12):1296-1299. doi:10.1111/j.1471-0528.1998.tb10008.x
Thorogood, M., and P. C. Hannaford. "The influence of oral contraceptives on the risk of multiple sclerosis." British journal of obstetrics and gynaecology, vol. 105, no. 12, 1998, pp. 1296-1299.
Keywords
Contraceptives, Oral, Combined
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Real-world, nationwide, prospective cohort study.
Denmark, by use of national registries. All women aged 15-49 years residing in Denmark between 1996 and 2021, with no history of arterial or venous thrombosis, antipsychotics use, cancer, thrombophilia, liver disease, kidney disease, polycystic ovary syndrome, endometriosis, infertility treatment, hormone therapy use, oophorectomy, and hysterectomy. First time diagnosis of ischaemic stroke or myocardial infarction at discharge. Among 2 025 691 women followed up for 22 209 697 person years, 4730 ischaemic strokes and 2072 myocardial infarctions occurred. Standardised ischaemic stroke rate per 100 000 person years were 18 (95% confidence interval 18 to 19) for no use, 39 (36 to 42) for combined oral contraception, 33 (25 to 44) for progestin-only pills, and 23 (17 to 29) for intrauterine device. Standardised myocardial infarction rate per 100 000 person years were 8 (8 to 9) for no use, 18 (16 to 20) for combined oral contraception, 13 (8 to 19) for progestin-only pills, and 11 (7 to 16) for intrauterine device. Compared with no use, current use of combined oral contraception was associated with an adjusted rate ratio of 2.0 (1.9 to 2.2) for ischaemic stroke and 2.0 (1.7 to 2.2) for myocardial infarction. These corresponded to standardised rate differences of 21 (18 to 24) extra ischaemic strokes and 10 (7 to 12) extra myocardial infarctions per 100 000 person years. Compared with no use, current use of progestin-only pills was associated with an adjusted rate ratio of 1.6 (95% CI 1.3 to 2.0) for ischaemic stroke and 1.5 (1.1 to 2.1) for myocardial infarction, equating to 15 (6 to 24) extra ischaemic strokes and four (-1 to 9) extra myocardial infarctions per 100 000 person years. Increased arterial thrombotic risk was also observed with use of the combined vaginal ring (adjusted incidence rate ratio of 2.4 (1.5 to 3.7) for ischaemic stroke and 3.8 (2.0 to 7.3) for myocardial infarction), patch (3.4 (1.3 to 9.1) and no myocardial infarctions), and progestin-only implant (2.1 (1.2 to 3.8) and ≤3 myocardial infarctions), whereas no increased risk was observed with progestin-only intrauterine device (1.1 (1.0 to 1.3) for ischaemic stroke and 1.1 (0.9 to 1.3) for myocardial infarction). Use of contemporary oestrogen-progestin and progestin-only contraceptives was associated with an increased risk of ischaemic stroke and, in some cases, myocardial infarction except for the levonorgestrel-releasing intrauterine device, which was not associated with either. Although absolute risks were low, clinicians should include the potential risk of arterial thrombosis in their assessment of the benefits and risks when prescribing a hormonal contraceptive method.
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