Multiple sclerosis (MS) typically affects 3 times more women than men during the reproductive years. The author describes what is known about the effects of various reproductive exposures on MS course, including menarche, childbearing, and menopause. Then, the management of childbearing is reviewed. Topics include preconception counseling, prenatal care, discontinuation of MS therapies, and management of postpartum relapses. Overall, most women with MS can be encouraged to become pregnant and breastfeed their children, should they choose to do so.