First, we discussed differences between men and women who develop multiple sclerosis.  Next we explored how hormones, specifically testosterone, play a significant role in men who develop MS.  Then, we saw how testosterone and estradiol affect brain damage seen in women with MS.  Today, we’re going to explore how the pregnancy hormone estriol could be used to treat women with MS.

Pregnancy and MS

For years, it has been observed that women with auto-immune diseases are affected by pregnancy.  Women with MS (as well as RA or other inflammatory diseases) may experience an improvement of symptoms during pregnancy, but can also experience a temporary “rebound” exacerbation postpartum (3-6 months after the baby is born).  It is believed that the change in hormones occurring during pregnancy causes this temporary clinical improvement or temporary relapse. 

Research is inconclusive as to if clinical improvement and reduced relapse rates during pregnancy improve long-term outcomes.  One short-term study (over 2 years) indicated that a single pregnancy has no real ‘net’ effect on disability.  However, a long-term study showed that patients who had at least one pregnancy after the onset of MS were wheelchair dependent after 18.6 years, versus 12.5 years for women who did not have children after MS onset.

Contrary to accepted belief that pregnancy improves MS symptoms during pregnancy, several mothers I know have said the opposite was their experience.  So perhaps, we really should say that - statistically - pregnancy seems to positively, and temporarily, effect women with auto-immune diseases.

Estriol and Pregnancy

Pregnancy is characterized by the presence of potentially immuno-modulatory and neuroprotective hormones including estrogens, cortisol, progesterone, and prolactin. It is believed that the secretion of these factors are important for the CNS neuronal and oligodendroglial cell lineages during development of the baby.  The mother’s body goes through many other changes as well.

Estriol is the estrogen hormone which is most significant for multiple sclerosis.  It is produced by the placenta during pregnancy and seems to have a protective quality on the immune system, as well as the central nervous system, for the mother.  Used therapeutically, estriol has been shown to have anti-inflammatory as well as neuroprotective effects in women with MS.

Estriol as Therapy

In a pilot study with a crossover design (meaning each participant acted as her own control), estriol was administered to 10 women with MS (six with RRMS and four with SPMS) in an attempt to recreate the protective effect of pregnancy on the disease.  After a 6-month pretreatment period to establish baseline, the patients were treated with oral estriol (8 mg/day) for 6 months, observed for another 6 months during the post-treatment period, followed by another 4-month re-treatment period with daily estriol.