title: Symptoms of multiple sclerosis during use of combined hormonal contraception.
abstract: OBJECTIVE
  The incidence and disease course of multiple sclerosis (MS) is influenced by sex steroids, and several studies have shown less disease activity during high estrogen states. We have previously shown variation in symptom experience related to the estrogen/progestogen phase in women using combined hormonal contraceptives (CHC) in a small sample. The aim of this study was to confirm these results in a larger sample.
  
  
  METHODS
  Self-assessment of symptoms of MS in relation to CHC cycle by 22 female MS patients. A symptom diary based on a validated instrument for cyclical symptoms was used. Mean symptom scores for high and low estrogen/progestogen phases were compared.
  
  
  RESULTS
  The women scored four out of ten symptoms significantly higher during the pill-free week than during the CHC phase (p<.05).
  
  
  CONCLUSIONS
  Women with MS report more pronounced symptoms during the pill-free, low-estrogen/progestogen phase of CHC use. Future studies should investigate, with a prospective, controlled design, the effects that continuous-use regimens of CHC have in women with MS.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden; Department of Obstetrics & Gynecology, County Hospital Sundsvall, Sweden. Electronic address: per.kempe@liu.se.
authors.forename: Per
authors.initials: P
authors.lastname: Kempe
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Hammar
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Brynhildsen
mesh_terms: D000328:Adult; D003277:Contraceptives, Oral, Combined / Q000494:pharmacology*; D003278:Contraceptives, Oral, Hormonal / Q000494:pharmacology*; D059026:Diagnostic Self Evaluation; D018450:Disease Progression; D004967:Estrogens / Q000008:administration & dosage*; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications*; D011372:Progestins / Q000008:administration & dosage; D011446:Prospective Studies; D063189:Symptom Assessment; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D011372:Progestins; D004997:Ethinyl Estradiol
keywords: Combined hormonal contraceptives; Multiple sclerosis; Symptom experience