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The right multiple sclerosis (MS) treatment can slow your disease and reduce the number of attacks you get. But if you're a woman -- as 3 out of 4 people with MS are -- choosing a treatment becomes more challenging.

Some MS medications are risky during pregnancy. Others weaken your bones or reduce your desire for sex. While you want to manage MS symptoms, you also don't want to cause new problems.

Your neurologist, gynecologist, and other specialists can help you find workarounds to MS medication issues while making sure your disease stays under good control.

MS Medicines and Birth Control Pills

MS often first appears in your 20s to 40s. That's smack dab in the middle of your reproductive years when you may be thinking about pregnancy or preventing it.

Birth control is an important consideration. Getting pregnant while taking certain MS medicines can be risky for an unborn baby. It might be a good idea to avoid pregnancy while on those medications.

But finding the right birth control method can be tricky. Most birth control methods are generally considered safe for women with MS. But the following  medications used to treat MS and other common illnesses can make some types of birth control less effective:

  • Antibiotics
  • Modafinil (Provigil)
  • Anti-seizure medications such as carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), and primidone (Mysoline)

Taking these drugs while you're on hormonal birth control might lead to an unplanned pregnancy. Ask your MS doctor and gynecologist whether you should use a backup method like condoms or a diaphragm if you're taking one of these medicines.

Some types of birth control interact with drugs used to treat MS or manage its symptoms . Birth control can make these drugs less effective:

  • Lamotrigine (Lamictal)
  • Salicylates
  • Benzodiazepines such as lorazepam (Ativan), oxazepam (Serax), and temazepam (Restoril)

They can also  increase the effects of these MS medicines:

  • Benzodiazepines such as diazepam (Valium)
  • Beta-blockers like propranolol (Inderal)
  • Corticosteroids
  • Tricyclic antidepressants like amitriptyline (Elavil)

Discuss your birth control method with your doctor. They can help you adjust the dose of your MS medicine if needed.

Pregnancy

MS shouldn't stop you from having a healthy pregnancy and delivery. Yet it can make family planning a little more complicated. You have to balance the risks to your baby of staying on your MS medicine against the risks to yourself if you stop your treatment.

None of the disease-modifying medications for MS is FDA-approved for use during pregnancy. While many of the MS medications are considered safe during pregnancy and breastfeeding, your gynecologist or neurologist might recommend that you do a "washout period." This means you stop taking your medicine and give it time to get out of your system before trying to get pregnant.

Going off a medication that's been controlling your symptoms can be stressful. But being pregnant can give you a break from MS. The same changes in your body that protect your growing baby also reduce inflammation, which can mean fewer relapses. And if you do relapse during pregnancy, you may be able to take corticosteroids safely during your second and third trimesters.

Some women relapse in the first few months after delivery. Breastfeeding your baby exclusively can help lower that risk. If your symptoms do return while you're breastfeeding, your doctor can help you find a treatment that's safe while you nurse.

MS Treatments and Your Bones

Women are already more likely to have weak bones than men. In women who have MS, the risk of osteoporosis is even higher. Steroids and antidepressant medicines, both possible treatments for MS, each increase the risk of bone loss if you take them for a long time.

Ask your doctor whether you should have a bone density scan. If you're at risk for osteoporosis, a medication switch might help. The MS drug fingolimod (Gilenya) may be safer for your bones than other disease-modifying drugs.

You can also protect your bones with:

  • Extra vitamin D and calcium
  • Regular exercise
  • A well-balanced diet that includes lots of fruits and vegetables

Your Sex Life

More than half of women with MS say they've lost interest in sex or they have problems with sexual function. Symptoms like fatigue, pain, and tight muscles can get in the way of a healthy sex life. So can medications like antidepressants that you take to manage MS symptoms.

Depression, anxiety, and other mood changes are common with MS. Antidepressants are good at boosting your mood, but they can also make it harder to get excited or reach orgasm. Ask your doctor about switching to a type of antidepressant that isn't as likely to cause sexual side effects.

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SOURCES:

BMC Neurology: "Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross-sectional study."

Cleveland Clinic: "Sexual Dysfunction in Multiple Sclerosis."

Expert Opinion on Pharmacotherapy: "Pharmacotherapeutic considerations in women with multiple sclerosis."

Mayo Clinic: "Emerging treatments for multiple sclerosis."

MS Focus: "MS Medications and Oral Contraceptives: What You Need to Know." "Prevent Osteoporosis with 6 Bone Health Boosters."

MS Trust: "Osteoporosis."

Multiple Sclerosis: "Contraception for women with multiple sclerosis: Guidance for health care providers."

National MS Society: "Pregnancy and Reproductive Issues." "Who Gets MS? (Epidemiology)."

Neurology Clinical Practice: "Multiple sclerosis is associated with low bone mineral density and osteoporosis."

Office on Women's Health: "Osteoporosis."

Therapeutic Advances in Neurological Disorders: "Sex and gender issues in multiple sclerosis."