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Multiple sclerosis gender issues: clinical practices of women neurologists

MS Comprehensive Care Center, SUNY at Stony Brook, New York, NY, USA, pcoyle{at}notes.cc.sunysb.edu

S Christie

MS Clinic, Ottawa General Hospital, Ottawa, Ontario, Canada

P Fodor

Colorado Springs Neurological Associates and MS Center of Southern Colorado, Colorado Springs, CO, USA

K Fuchs

James Q. Miller MS Clinic, University of Virginia, Charlottesville, VA, USA

B Giesser

Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, CA, USA

A Gutierrez

Louisiana State University Health Science, New Orleans, LA, USA

J Lynn

Department of Neurology, Ohio State University, Columbus, OH, USA

B Weinstock-Guttman

Department of Neurology, Buffalo General Hospital, Buffalo, NY, USA

L Pardo

University of Kansas Medical Center and Teva Neuroscience, Kansas City, MO, USA

Women Neurologists MS Initiative (WNMSI)

Substantially more women than men develop multiple sclerosis (MS), but information about the effects of MS and gender-specific issues such as pregnancy, breastfeeding, menstruation and hormone use is lacking. A survey study of neurologists’ practice patterns was undertaken to elicit information about gender-specific topics and the use of disease-modifying MS therapies (DMT) including the interferons and glatiramer acetate (GA). A total of 147 surveys were returned. Half of respondents require patients to discontinue DMT during pregnancy, while 35% encourage discontinuation. Among those who allow patients to continue therapy, half consider GA to be safer during pregnancy than the interferons. Nearly 86% of respondents do not use DMT in patients who are breastfeeding. Among the 11% who actually prescribe during breastfeeding, most recommend GA. Neurologists generally leave the decision to breastfeed up to patients, and most refer patients to obstetrician/gynaecologists for counselling about contraception or hormone replacement therapy. The survey results described here provide insight into how neurologists manage reproductive health issues among women with MS.

Key Words: contraception • glatiramer acetate • interferons • lactation • multiple sclerosis • pregnancy • women's health

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