title: Oral contraceptives and the incidence of multiple sclerosis.
abstract: BACKGROUND
  Experimental and clinical data suggest a protective effect of estrogens on the development and progression of MS.
  
  
  METHODS
  We assessed whether MS incidence was associated with oral contraceptive use or parity in two cohort studies of U.S. women, the Nurses' Health Study (NHS; 121,700 women aged 30 to 55 years at baseline in 1976) and the Nurses' Health Study II (NHS II; 116,671 women aged 25 to 42 years at baseline in 1989). Participants with a diagnosis of MS before baseline were excluded. Oral contraceptive history and parity were assessed at baseline and updated biennially. During follow-ups of 18 years (NHS) and 8 years (NHS II) we documented a total of 315 definite or probable cases of MS.
  
  
  RESULTS
  Neither use of oral contraceptives nor parity were significantly associated with the risk of MS. As compared with women who never used oral contraceptives, the age-adjusted relative risk (95% CI) was 1.2 (0.9, 1.5) for past users, and 1.0 (0.6, 1.7) for current users. Similar results were obtained after adjustment for latitude, ancestry, and other potential confounding factors. There was no clear trend of MS risk with either increasing duration of use or time elapsed since last use. Age at first birth was also not associated with the risk of MS.
  
  
  CONCLUSIONS
  These prospective results do not support a lasting protective effect of oral contraceptive use or pregnancy on the risk of MS. The decision to use hormonal contraception should not be affected by its effects on the risk of MS.
authors.affiliation: Departments of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. miguel_hernan@post.harvard.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Hernán
authors.forename: M J
authors.initials: MJ
authors.lastname: Hohol
authors.forename: M J
authors.initials: MJ
authors.lastname: Olek
authors.forename: D
authors.initials: D
authors.lastname: Spiegelman
authors.forename: A
authors.initials: A
authors.lastname: Ascherio
mesh_terms: D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D003278:Contraceptives, Oral, Hormonal