Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

Abstract

Over two thirds of all individuals who develop multiple sclerosis (MS) will be women prior to the age of menopause. Further, an estimated 30% of the current MS population consists of peri- or postmenopausal women. The presence of MS does not appear to influence age of menopausal onset. In clinical practice, symptoms of MS and menopause can frequently overlap, including disturbances in cognition, mood, sleep, and bladder function, which can create challenges in ascertaining the likely cause of symptoms to be treated. A holistic and comprehensive approach to address these common physical and psychological changes is often suggested to patients during menopause. Although some studies have suggested that women with MS experience reduced relapse rates and increased disability progression post menopause, the data are not consistent enough for firm conclusions to be drawn. Mechanisms through which postmenopausal women with MS may experience disability progression include neuroinflammation and neurodegeneration from age-associated phenomena such as immunosenescence and inflammaging. Additional effects are likely to result from reduced levels of estrogen, which affects MS disease course. Following early retrospective studies of women with MS receiving steroid hormones, more recent interventional trials of exogenous hormone use, albeit as oral contraceptive, have provided some indications of potential benefit on MS outcomes. This review summarizes current research on the effects of menopause in women with MS, including the psychological impact and symptoms of menopause on disease worsening, and the treatment options. Finally, we highlight the need for more inclusion of MS patients from underrepresented racial and geographic groups in clinical trials, including among menopausal women.

What Can We Learn from Sex Differences in MS?

“…Osteoporosis prophylaxis may be offered. Other treatments involve herbal supplements (soy and black cohosh) and off-label use of SSRIs and anticonvulsants [64]. The hormonal therapy involves low estrogen (in an oral, patch, topical, or vaginal formulation).…”

Quantitative effect of sex on disease activity and disability accumulation in multiple sclerosis

“…The sex hormones may play a role in this difference, but genes on the X chromosome may also exert effect on the immune system independent of the sex hormones 8. The hormonal component of a sex effect on MS in women is expected to fade away with increasing age, particularly after menopause 9…”

“… 8 The hormonal component of a sex effect on MS in women is expected to fade away with increasing age, particularly after menopause. 9 …”

Let's talk about sex(ual) wellbeing! Staff perceptions of implementing a novel service for people with Multiple Sclerosis

“…Additionally, hormonal effects during the menstrual cycle and menopause may exacerbate symptoms of MS or viceversa. 2 …”

“…Additionally, hormonal effects during the menstrual cycle and menopause may exacerbate symptoms of MS or viceversa. 2 As a result of a complex interplay between neurological dysfunction, polypharmacy and psychological issues, patients with MS (PwMS) experience problems with their sexual and reproductive wellbeing. [3][4][5] Whilst urinary and bowel dysfunction are often discussed and managed, problems with sexual dysfunction, although common, are often overlooked during clinical reviews.…”