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Gynecological health: A missing link in comprehensive treatment monitoring for multiple sclerosis
Melika Arab Bafrani1, Viviana Rios1, Min Ji Kim1
1UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
Abstract:
Safety monitoring of disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) has largely overlooked the domain of gynecological health. This topical review aims to provide MS clinicians with an overview of the three categories of complications described to date, as well as risk mitigation strategies. These are increased risk of human papilloma virus (HPV) positivity and related cervical dysplasia/cancers; inflammatory and infectious vaginitis and susceptibility to bacterial vaginosis (BV); and herpesvirus infections, including genital Herpes Simplex Virus (HSV). Current knowledge may be biased due to limited studies and lack of gynecological focus in neurological encounters. Risk mitigation strategies include promoting HPV vaccination, following guidance for immune compromised individuals relating to cervical cancer screening and antiviral suppression, and proactive communication with patients about gynecological health when starting DMTs. Together, these might improve gynecological health and thereby quality of life in females with neuroinflammatory diseases.
Insights
Disease-modifying therapies for multiple sclerosis (MS) require attention to gynecological health. This review highlights risks like HPV, vaginitis, and herpesvirus infections, offering mitigation strategies for improved quality of life.
Area of Science:
- Gynecologic Oncology
- Infectious Diseases
- Neuroimmunology
Background:
- Safety monitoring of multiple sclerosis (MS) disease-modifying therapies (DMTs) has historically neglected gynecological health.
- Neurological consultations often lack a dedicated focus on gynecological well-being in patients with MS.
Purpose of the Study:
- To review gynecological complications associated with MS DMTs.
- To outline risk mitigation strategies for clinicians treating women with MS.
Main Methods:
- Topical review of existing literature on gynecological health in MS patients undergoing DMTs.
- Categorization of identified complications and associated risk factors.
Main Results:
- Increased risk of human papilloma virus (HPV) positivity, cervical dysplasia, and cancer.
- Higher susceptibility to inflammatory vaginitis, infectious vaginitis, and bacterial vaginosis (BV).
- Increased incidence of herpesvirus infections, including genital Herpes Simplex Virus (HSV).
Conclusions:
- Proactive gynecological health management is crucial for women with MS on DMTs.
- Strategies include HPV vaccination, tailored cervical cancer screening, and antiviral suppression.
- Open communication regarding gynecological health can enhance patient quality of life.
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